Citation Nr: 1320454 Decision Date: 06/25/13 Archive Date: 07/05/13 DOCKET NO. 06-15 647 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Waco, Texas THE ISSUES 1. Entitlement to service connection for a right knee disability. 2. Entitlement to compensation under provisions of 38 U.S.C.A. § 1151 for additional disability from gastroesophageal reflux disease, coronary artery disease, and liver disease due to VA medication taken as prescribed by Department of Veterans Affairs treatment providers. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD A. Hinton, Counsel INTRODUCTION The Veteran served on active duty from April 1969 to November 1970. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a July 2005 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Waco, Texas. In that decision the RO denied service connection for a right knee disability identified at that time as right knee strain; and denied entitlement to compensation for additional disability under 38 U.S.C.A. § 1151 for side effects of medication, without specifying the nature of the additional disability. In September 2009, the Board remanded the case to the RO for further development as to the claims on appeal. In that decision the Board also granted service connection for coronary artery disease. A March 2011 rating decision put into effect the Board's grant of service connection for coronary artery disease, effective September 16, 2002. In October 2011 and January 2012, the Board obtained two medical opinions from the Veterans Health Administration (VHA) in accordance with 38 U.S.C.A. § 7109 and 38 C.F.R. § 20.901. The Veteran and his representative have been provided with copies of these VHA opinions, and copies have been associated with the claims file. In June 2012 the Board remanded the case to the RO for further development. In that decision the Board identified the additional disability associated with the claim under 38 U.S.C.A. § 1151, as being from gastroesophageal reflux disease, coronary artery disease, and liver disease. Service connection is now in effect for coronary artery disease. Although that part of the claim under 38 U.S.C.A. § 1151 is no longer before the Board, any additional disability from coronary artery disease that is due to the subject medications from VA, is still part of the claim on appeal. FINDINGS OF FACT 1. A chronic right knee disability did not manifest in service, arthritis was not manifest during the first postservice year, and a current disability of the right knee is not due to an event during active service or proximately due to a service-connected disability. 2. The Veteran does not have additional disability from gastroesophageal reflux, coronary artery disease, or liver disease, claimed as a result of VA medication taken as prescribed by VA treatment providers. CONCLUSIONS OF LAW 1. The criteria for service connection for right knee disability have not been met. 38 U.S.C.A. §§ 1110, 1112, 1131, 5107 (West 2002 & Supp. 2011); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2012). 2. The criteria for compensation under 38 U.S.C.A. § 1151, for additional disability from gastroesophageal reflux disease, coronary artery disease, or liver disease, have not been met. 38 U.S.C.A. §§ 1151, 1154(a), 1732, 5107(b) (West 2002); 38 C.F.R. §§ 3.012, 3.159, 3.361, 3.800 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. 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 a claim. 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- and post- adjudication VCAA notice by a number of letters sent between April 2005 and December 2012. As for the 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); and of Dingess v. Nicholson, 19 Vet. App. 473, 484-86 (2006) (notice of the elements of the claim). To the extent that the VCAA notice came after the initial adjudication, the timing of the notice did not comply with the requirement that the notice must precede the adjudication. The timing error was cured by content-complying VCAA notice after which the claim was readjudicated as evidenced by the supplemental statement of the case, dated in January 2013. Mayfield v. Nicholson, 499 F.3d 1317, 1323 (Fed. Cir. 2007) (Timing error cured by adequate VCAA notice and subsequent readjudication without resorting to prejudicial error analysis.). 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 a claim. The RO has obtained service treatment records, VA and private medical records. In June 2012 the Board remanded the case for the RO to obtain any Social Security Administration (SSA) records, and any relevant VA treatment records dated since November 2006. The RO subsequently determined via SSA that any records pertaining to the Veteran had been destroyed and not available. VA's Appeals Management Center (AMC) asked the Veteran if he had any SSA records and he reported that he did not. The RO requested all VA treatment records (progress notes and consults) dated from November 2006 from CAPRI (Compensation and Pension Record Interchange), and these are present on Virtual VA database for review. The Veteran was afforded pertinent VA examinations in October 2009 (knee) and September 2010 (38 U.S.C.A. § 1151 claim). Additionally the Board arranged for two medical opinions, received in October 2011 and January 2012 (addendum), from the Veterans Health Administration (VHA) in accordance with 38 U.S.C.A. § 7109 and 38 C.F.R. § 20.901. As the examination reports and the VHA opinions are based on a review of the Veteran's history and described the current findings in sufficient detail so that the Board's review is a fully informed one, the examination reports and the VHA opinions are adequate to decide the claim. See Stefl v. Nicholson, 21 Vet. App. 120, 124-25 (2007) (holding an examination is considered adequate when it is based on consideration of the appellant's prior medical history and examinations and also describes the disability in sufficient detail so that the Board's evaluation of the disability will be a fully informed one). As there is no indication of the existence of additional evidence to substantiate the claim, the Board concludes that no further assistance to the Veteran in developing the facts pertinent to the claim is required to comply with the duty to assist. II. Claim for Service Connection for Right Knee Disability The Veteran claims service connection for a right knee disability due to injuries during service including falls associated with jumping from helicopters during missions in Vietnam during that war. In the March 2005 statement claiming service connection he attributed his right knee disorder to injuries in Vietnam while jumping during 180 combat assault missions. A. Applicable Law In general, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 1131 (West 2002); 38 C.F.R. §§ 3.303, 3.304. Service connection generally requires credible and competent evidence showing: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Hickson v. West, 12 Vet .App. 247, 253 (1999); Caluza v. Brown, 7 Vet. App. 498 (1995). Service connection may be granted if a disability is proximately due to or the result of a service-connected disability or if aggravation of a nonservice-connected disorder is proximately due to or the result of a service-connected disability. 38 C.F.R. § 3.310(a) and as revised by 71 Fed. Reg. 52744-52747 (final rule revising § 3.310 to conform to the Court's holding in Allen v. Brown, 7 Vet. App. 439 (1995) (en banc)). If a Veteran served 90 days or more on active duty, service incurrence will be presumed for certain chronic diseases, including arthritis, if manifest to a compensable degree within the year after active service. 38 U.S.C.A. § 1112; 38 C.F.R. §§ 3.307(a), 3.309(a). For the showing of chronic disease in service there is required 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). Entitlement to service connection on the basis of a continuity of symptomatology after discharge under 38 C.F.R. § 3.303(b) is only available for the specific chronic diseases listed in 38 C.F.R. § 3.309(a), which includes arthritis. See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Service connection may also be granted for disability shown after service, when all of the evidence, including that pertinent to service, shows that it was incurred in service. 38 C.F.R. § 3.303(d). A significant lapse in time between service and post-service medical treatment may be considered as part of the analysis of a service connection claim. See Maxson v. Gober, 230 F.3d 1330 (Fed. Cir. 2000). In making all determinations, the Board must fully consider the lay assertions of record. A layperson is competent to report on the onset and continuity of current symptomatology. See Layno v. Brown, 6 Vet. App. 465, 470 (1994). Lay evidence can be competent and sufficient evidence of a diagnosis or used to establish etiology if (1) the layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Davidson, 581 F.3d at 1316; Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). When considering whether lay evidence is competent the Board must determine, on a case by case basis, whether the Veteran's particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau, 492 F.3d at 1376-77. The Board is charged with the duty to assess the credibility and weight given to evidence. Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997). B. Factual Background The Veteran's service personnel records including his DD Form 214, Certificate of Release or Discharge from Active Duty, shows that he served in Vietnam from September 1969 to November 1970, and that his primary specialty during service was light weapons infantryman and his principal duty in Vietnam was rifleman. He was awarded decorations including the Combat Infantryman Badge, Purple Heart award, Army Commendation Medal Third Oak Leaf cluster with "V" device and Bronze Star Medal with "V" device. Service treatment records show no indications of any right knee condition in service. The report of his November 1970 separation examination shows that the evaluation of the lower extremities was normal. In the notes section of the report the Veteran reported some conditions but gave no indication of any right knee problems and the summary of defects and diagnoses contains none referable to the right knee. Private treatment records show that the Veteran was seen in September 1994 for complaints that his right knee hurts. The assessment was chondromalacia, patella. An October 1994 private treatment record shows that the Veteran reported that his right knee injury was secondary to a fall in November 1993, and that this was causing right knee pain. The assessment at that time indicated that the right knee condition was secondary to the reported trauma. Private treatment records include an October 1994 initial medical report of evaluation of the Veteran's right knee by Robert Sparks, D.O. That report shows a history of a work related injury to the right knee about one year before in November 1993, causing the Veteran to twist his right knee at that time. The Veteran reported that the knee swelled medially and laterally and was bruised. He wore an ACE bandage. The Veteran reported the following current complaints. The knee was noisy and he had a constant grinding sensation under the kneecap, and the knee locks. The Veteran reported that the knee gives way when walking causing falls. Stairs are more painful with ascending, and the pain had gotten progressively worse. After examination the impression was internal derangement, right knee with probable torn medial and lateral menisci. Surgery was scheduled for later that month. Subsequent private and VA treatment records in the 1990s and 2000s show further treatment, including surgery, for right knee symptomatology. Notably, VA treatment records in January 2005 show that the Veteran was seen for complaints of severe right knee pain after the knee locked and gave way, causing a fall three weeks earlier. The diagnosis was acute superimposed on chronic right knee pain with impaired ambulation; probable progressive internal derangement. Subsequent VA treatment records in March 2005 show that the Veteran reported that the recent injury to the right knee in January 2005 resulted when his knee buckled and inverted posteriorly, in the opposite direction from which the knee normally flexes, causing severe pain and swelling. The provider assessed right knee strain at that time. The report of an October 2009 VA examination of the right knee shows that the examiner noted that his review of the claims file showed no treatment for the right knee in service. The Veteran reported that he twisted his knee in 1970 when he jumped out of a helicopter in the field in Vietnam, and apparently received an ACE wrap and no other treatment. The Veteran reported that he had no pain in the knee on discharge and began having pain in the knee twenty years ago. The report noted that the Veteran had had arthroscopic surgeries on the right knee in 1994 and again in 1998. The Veteran reported complaints of daily pain, locking that causes him to fall, and that he uses a cane and braces with minimal relief from pain but with some stability. After examination, the report contains an impression of marked degenerative arthritis of the right knee. The examiner opined that because there was no evidence of the Veteran being treated for knee pain in service, and that the knee pain started 20 years after service, it is less likely than not that the Veteran's current knee trouble is from his military service. The examiner opined that the right knee condition most likely represents degenerative arthritis of obesity and wear and tear. The examiner also opined that the Veteran had no associated difficulty from medication taken for his knee. In October 2011, the Board obtained a medical opinion from the Veterans Health Administration (VHA) on the likelihood that any current right knee disability is related to service, to include the accepted history of field combat treatment for right knee twisting and the overall impact of the rigors of combat military duties as reported by the Veteran. The VA orthopedic surgeon providing that opinion, opined that there is no causal relationship between the Veteran's military service and his right knee arthritis. As rationale for that opinion, the orthopedic surgeon noted the following. There was no documented knee injury sustained in service. The Veteran performed full time construction work, often working seven days a week in 1991 and continued various construction jobs until retirement in 1997 due to PTSD. The Veteran sustained right knee injury at work and had two arthroscopic surgeries on his right knee, which revealed early arthritis of the knee in 1994. The right knee arthritis that presented 24 years after service is related to his work history and work injuries, and not any injury sustained 24 years earlier. The Veteran had no history of knee problems until 1994 and would not have been able to work in construction for 24 years if he had a knee injury sustained in the Army. The arthritis of the right knee is related to his post service work injuries and worsened by his obesity and meniscal surgery for his work related injury. In a January 2012 addendum to the October 2011 VHA opinion, the VA orthopedic surgeon clarified that in making his opinion, he accepted that the Veteran completed his tour in Vietnam jumping out of helicopters on multiple combat zone jumps and only required an ACE wrap on one occasion. The surgeon opined that the Veteran would not have been able to fulfill his multiple combat jumps if he had sustained a knee injury on active duty. The surgeon noted that the Veteran had a lifelong career in construction, which he could not have had if he had a prior knee injury; and that the Veteran's job related injuries in the 1990s requiring surgery on his knee was responsible for his knee arthritis. The surgeon concluded again with the opinion that there was no connection between the Veteran's right knee arthritis and his active duty service. C. Analysis The Veteran's right knee arthritis is not affirmatively shown to have been present during service and therefore service connection is not warranted on that basis. 38 C.F.R. §§ 3.303(a). Nor is arthritis shown to have become manifest to a compensable degree within one year after active service. Thus the criteria for entitlement to service connection for right knee disability have not been met under provisions of 38 C.F.R. §§ 3.307, 3.309. There is no medical evidence indicating any right knee condition, including arthritis, prior to 1994 when the Veteran was treated for right knee complaints he related at that time to a right knee injury in November 1993. In the course of receiving treatment, on more than one visit in October 1994, the Veteran reported that the then diagnosed right knee condition was due to a right knee injury one year before in November 1993. Thus there is no medical evidence of any continuity of right knee symptomatology to link the Veteran's right knee disorder to service. The Veteran is competent to describe symptoms of knee symptomatology including pain and other symptoms of dysfunction observed. See 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). And the Veteran as a lay person is competent to identify a simple medical condition, or describe a contemporaneous medical diagnosis, or symptoms that later support a diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The Veteran as a lay person is also competent to offer an opinion on a simple medical condition. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009). As reflected in the Veteran's VA Form 9, he claims that there has been a continuity of right knee pain observed since during service. Although he competent to observe these symptoms, his contemporaneous reports during the November 1970 separation examination, in 1994 during treatment, and during the October 2009 VA examination, along with the other medical evidence on file showing no complaints prior to the reported injury in the early 1990s, all contradict his assertions of continuity made in connection with the claim on appeal. The Board therefore finds the Veteran's assertion of a continuity of symptoms since service, to lack probative value against the remainder of the evidence. In the face of the remainder of a substantial amount of internally consistent other evidence, including his own contemporaneous reports, the Veteran's report of such continuity of symptoms since service, is not credible and therefore is not probative on this matter. Moreover, the Veteran is not competent to otherwise opine as to an etiological link between his current right knee disorder and service. The Veteran as a lay person is competent to describe a contemporaneous medical diagnosis or symptoms that later support a diagnosis by a medical professional. Jandreau, at 1377. However, no medical professional has diagnosed the current right knee disorder before 1994, approximately 24 years after service separation in 1970. The VA examiner at the October 2009 VA examination, and the VA orthopedic surgeon who provided a comprehensive set of opinions in October 2011 and January 2012, both expressed opinions that the Veteran's right knee disorder was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury/conditions. These VA examiners explained essentially that review of the service treatment records revealed no documentation of any evaluation or treatment of a right knee injury or condition. Considering the merits of the analysis and the details of these opinions, the Board finds that these opinions, which were based on medical analyses applied to the facts of case, are persuasive medical evidence against the claim. As there is no favorable medical evidence to consider and weigh against these opinions, the preponderance of the evidence is against the claim under the applicable theories of service connection, applying 38 C.F.R. § 3.303 and 38 C.F.R. §§ 3.307, 3.309, and the benefit-of-the-doubt standard of proof does not apply. 38 U.S.C.A. § 5107(b). III. Compensation Under Provisions of 38 U.S.C.A. § 1151 The Veteran claims entitlement to compensation under provisions of 38 U.S.C.A. § 1151 for additional disability from gastroesophageal reflux disease, coronary artery disease, and liver disease, all due to VA medication taken as prescribed by VA treatment providers. He has specifically implicated the medications Etodolac, Naproxen, Vioxx, and Bextra, as causing or aggravating these conditions. A. Applicable Law Controlling law provides that in order to warrant the award of the benefit sought, the evidence must demonstrate that the VA hospital care, medical or surgical treatment, or examination in question resulted in an additional disability and that the proximate cause of the additional disability was carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault on VA's part in furnishing such care, treatment, or examination, or that the proximate cause of the additional disability was an event that was not reasonably foreseeable. 38 U.S.C.A. § 1151 (West 2002). In determining whether a Veteran has an additional disability, VA compares the Veteran's condition immediately before the beginning of the hospital care or medical or surgical treatment upon which the claim is based to the Veteran's condition after such care or treatment. 38 C.F.R. § 3.361(b). To establish causation, the evidence must show that the hospital care or medical or surgical treatment resulted in the Veteran's additional disability. Merely showing that a Veteran received care or treatment and that the Veteran has an additional disability does not establish cause. 38 C.F.R. § 3.361(c)(1). Hospital care or medical or surgical treatment cannot cause the continuance or natural progress of a disease or injury for which the care or treatment was furnished unless VA's failure to timely diagnose and properly treat the disease or injury proximately caused the continuance or natural progress. 38 C.F.R. § 3.361(c)(2). Under Chapter 17 of Title 38 of the United States Code, which governs VA's provision of medical services, the term "hospital care" includes medical services rendered in the course of the hospitalization. The term "medical services" includes examination and treatment. 38 U.S.C. § 1701(5) and (6). For the purpose of compensation under 38 U.S.C.A. § 1151 the disability must result from VA hospital care, that is, medical services rendered in the course of the hospitalization, which includes examination and treatment. Id. To establish that carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault on VA's part in furnishing hospital care, medical or surgical treatment, or examination proximately caused a Veteran's "additional disability" or death, it must be shown that the hospital care or medical or surgical treatment caused the Veteran's additional disability or death; and (i) VA failed to exercise the degree of care that would be expected of a reasonable health care provider; or (ii) VA furnished the hospital care or medical or surgical treatment without the Veteran's informed consent. In this regard, determinations of whether there was informed consent involve consideration of whether the health care providers substantially complied with the requirements of 38 C.F.R. § 17.32. Minor deviations from the requirements of 38 C.F.R. § 17.32 that are immaterial under the circumstances of a case will not defeat a finding of informed consent. 38 C.F.R. § 3.361(d)(1). The determination of whether the proximate cause of a Veteran's additional disability or death was an event not reasonably foreseeable is based on what a reasonable health care provider would have foreseen. The event need not be completely unforeseeable or unimaginable but must be one that a reasonable health care provider would not have considered to be an ordinary risk of the treatment provided. In determining whether an event was reasonably foreseeable, VA will consider whether the risk of that event was the type of risk that a reasonable health care provider would have disclosed in connection with the informed consent procedures of 38 C.F.R. § 17.32. 38 C.F.R. § 3.361(d)(2). B. Factual Background and Analysis In the Veteran's March 2005 claim for benefits under provisions of 38 U.S.C.A. § 1151, he stated that he was prescribed Etodolac in early 2000 for shoulder and knee pain, and that two months later he was taken off of that medication due to stomach bleeding. He indicated that he was then put on Vioxx (rofecoxib) for over two years until he received a letter from the Dallas VA (VA Medical Center) to stop taking Vioxx and to change to Etodolac. He stated that he could not take Etodolac so he was put on Bextra (valdecoxib). He further stated that he just received his second letter from the Dallas VA telling him to stop taking Bextra. He stated that while he was taking Vioxx he had chest pains and took nitro pills daily. He further stated that after he quit taking Vioxx, he had not had chest pain, and had not taken a nitro pill since. On this basis he requested service connection for side effects of VA prescribed medicines. In a subsequent statement of June 2005 the Veteran stated that when he was drafted he had had rheumatic fever with an enlarged heart prior to service; and that during service, medications including aspirin aggravated the condition, and after service he was treated with Vioxx and Bextra, which caused more aggravation of his heart condition. In his August 2005 notice of disagreement to the July 2005 rating decision denial of his claim, the Veteran reported that VA prescribed Bextra, Naproxen, and Vioxx had damaged his liver. Etodolac, Rofecoxib, and Valdecoxib are all nonsteroidal anti-inflammatory drugs used as an analgesic and anti-inflammatory, especially in treatment of arthritis/osteoarthritis. See Dorland's Illustrated Medical Dictionary 660, 1677, 2048 (31st ed. 2007). The report of a September 2010 VA examination shows that the examiner discussed his review of the Veteran's claims files regarding the claim of additional disability due to side effects from VA prescribed medication for his shoulder and knee. The examiner noted that the Veteran had claimed that his heart disease, liver and stomach have been affected by the medications-Etodolac, Naproxen, Vioxx, and Bextra-received from VA for his shoulder and knee. The examiner noted that the Veteran had a known history of coronary artery disease. Noting that service connection was in effect for the coronary artery disease, the examiner opined that it is less likely than not that there was any worsening of the coronary artery disease due to the medications received. He also opined that even if, arguendo, there had been a relationship between the Veteran's heart disease and the medications, this case would not be one due to carelessness, negligence, lack of proper skill, error in judgment, or similar incidence of fault on the part of VA. As rationale, the examiner noted that any liability would be attributable to the manufacturer because medications were not continued upon notification that increased risk of heart disease was found in people taking the medication. The examiner noted that the Veteran had claimed liver damage due to the medication taken, but that there was no evidence in the medical records that the Veteran had ever had any liver problems; and that the Veteran's liver function tests had been normal and no abnormalities had been noted. On that basis the examiner opined that it is less likely than not that the Veteran has a liver condition that is due to side effects from the medications noted above. The examiner noted that the Veteran had been treated in the Dallas VA Medical Center for gastroesophageal reflux, and that he had upper endoscopies demonstrating reflux, but did not show any evidence of ulcers. The examiner noted that the complaint of reflux continued after the Veteran was no longer on the medications noted above, and to some degree increased afterward. The examiner noted that the medications noted above are not associated with a permanent increase in reflux. Based on the foregoing, the examiner opined that it is less likely than not that the Veteran's gastroesophageal reflux is due to the medications noted above. The report of the September 2010 VA examination provides a thorough review of the material aspects of the Veteran's medical history with respect to the claim, and is fundamentally consistent with the remainder of the competent evidence on file. The VA medical records of treatment reflect that the Veteran was taking at different times Etodolac, Naproxen, Vioxx, or Bextra. With respect to the claimed additional disabilities, claimed as due to medication from VA, the VA and private treatment records reflect treatment for, and assessments of esophageal reflux. VA treatment records also include past medical histories, listing conditions including rectal bleeding and upper gastrointestinal bleeding. None of the medical records on file have associated these conditions to the subject medications prescribed by VA. Further, the September 2010 VA examiner opined that the medications noted above are not associated with a permanent increase in reflux. Nor have any of the medical records diagnosed a chronic liver disease linked to those medications, which was also the conclusion of the VA examiner in September 2010. The medical records on file do show that the Veteran has been diagnosed with atherosclerotic heart disease/coronary artery disease. Notably, in a March 2011 rating decision the RO granted service connection for coronary artery disease, and assigned a 30 percent disability rating based on the condition as reflected in the clinical record evidence on file. Thus entitlement to compensation under 38 U.S.C.A. § 1151 for additional disability represented by the now service-connected coronary artery disease, is no longer subject to appeal. Moreover, there is no evidence on file of any additional disability resulting from the service-connected coronary artery disease that is shown to be due to the medications prescribed by VA. On review overall, the preponderance of the competent evidence on file does not show that the Veteran has additional disability from gastroesophageal reflux disease, coronary artery disease, and liver disease due to VA medication taken as prescribed by Department of Veterans Affairs treatment providers. This is the essential opinion of the most recent VA examiner on the matter and there are no medical opinions to the contrary. The Veteran is competent to report the onset and continuity of current symptoms for which he has personal knowledge. See Layno v. Brown, 6 Vet. App. 465, 470. However, his lay statements are not competent to identify a diagnosis constituting additional disability in a case that requires a diagnosis by a medical professional; and as discussed, his description of his symptoms is not supported by a diagnosis by a medical professional. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Therefore, the Veteran's lay statements on this matter, while credible as to the symptoms reported, are not probative as to whether there is additional disability resulting from the cited medications prescribed by VA. The preponderance of the evidence is against the claim, and the benefit-of-the-doubt standard of proof does not apply. 38 U.S.C.A. § 5107(b). ORDER Service connection for a right knee disability is denied. Entitlement to compensation under provisions of 38 U.S.C.A. § 1151 for additional disability from gastroesophageal reflux disease, coronary artery disease, and liver disease due to VA medication taken as prescribed by VA is denied. ____________________________________________ T. MAINELLI Acting Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs