Citation Nr: 1320615 Decision Date: 06/26/13 Archive Date: 07/05/13 DOCKET NO. 02-18 368 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Muskogee, Oklahoma THE ISSUE Entitlement to service connection for a lumbar, thoracic and cervical spine disability. REPRESENTATION Veteran represented by: Timothy M. White, Attorney WITNESSES AT HEARING ON APPEAL The Veteran and his spouse ATTORNEY FOR THE BOARD A. Nigam, Counsel INTRODUCTION The Veteran served on active duty from December 1956 to February 1957. This matter initially came before the Board of Veterans' Appeals (hereinafter "Board") on appeal from a June 2001 rating decision of the Department of Veterans Affairs (hereinafter "VA") Regional Office (hereinafter "RO") in Muskogee, Oklahoma, which denied the Veteran's claim for service connection for a lumbar, thoracic and cervical spine disability. In July 2003, the Veteran presented testimony on the issue on appeal at a videoconference hearing at the RO before one of the undersigned Veterans Law Judges (hereinafter "VLJ"). A transcript of the hearing has been associated with the record. In January 2004, the matter was remanded to the RO via the Appeals Management Center (hereinafter "AMC") in Washington, DC for additional development of the record, to include ensuring all notification and development action was completed in accordance with the Veterans Claims Assistance Act of 2000 (hereinafter "VCAA"), and obtaining outstanding treatment records. In August 2006, the Board issued a decision and denied the claim for service connection. The claim was thereafter the subject of a July 2008 Memorandum Decision of the United States Court of Appeals for Veterans Claims (hereinafter "the Court"), which vacated the August 2006 Board decision and remanded the claim for further development. The case was thereafter returned to the Board. In July 2007 the RO issued a rating decision denying the Veteran's request to reopen a claim for service connection for a lumbar, thoracic and cervical spine disability. In May 2010, the Veteran presented testimony on the issue on appeal at another videoconference hearing at the RO before another of the undersigned VLJs. A transcript of the hearing has also been associated with the record. In March 2012, the matter was again remanded to the RO via the AMC for additional development of the record, to include ensuring all notification and development action was completed in accordance with the VCAA, and to obtain VA examination and medical opinion. This remand was issued by a panel of the three undersigned VLJs. The VLJ who conducts a hearing shall participate in making the final determination of the claim. 38 U.S.C.A. § 7107 (West 2002); 38 C.F.R. § 20.707 (2012). Where testimony has been given before two different Veterans Law Judges, a panel decision of not less than three members of the Board must be issued. See 38 U.S.C.A. § 7102 (West 2002). In this case, two of the three undersigned VLJs held hearings on the issue on appeal. After the May 2010 hearing was conducted, the Court held, in Arneson v. Shinseki, 24 Vet. App. 379, 386 (2011), that under § 20.707, a claimant must be afforded an opportunity for a hearing before all the Board members who will ultimately decide his appeal. Thus, if the claimant's appeal is assigned to a Board panel, that claimant must be afforded the opportunity for a hearing before every member of the panel that will ultimately decide his case. Id. As noted, however, only two of the undersigned Veterans Law Judges on the panel of three who will decide this case have taken testimony on the issue on appeal. Pursuant to 38 C.F.R. § 20.707 and the Court's holding in Arneson, a letter was sent to the Veteran in December 2011 offering him the opportunity to testify at a hearing before the third undersigned VLJ who has participated in the panel remand and will participate in the panel decision. The Veteran declined a hearing before the third undersigned VLJ in a correspondence dated on December 13, 2011. The case was then returned to the Board for further appellate review. In April 2012, a VA examination (also known in the record as a Disability Benefits Questionnaire or "DBQ") was performed in accordance with the March 2012 Board remand directives. In December 2012, in accordance with 38 U.S.C.A. § 7109 and 38 C.F.R. § 20.901, the Board also obtained a medical opinion from the Veterans Health Administration (hereinafter "VHA"). The Veteran and his attorney have been provided with a copy of the VHA opinion, and a copy has been associated with the claims file. In evaluating this case, the Board has not only reviewed the physical claims file, but has also reviewed the file on the "Virtual VA" system to ensure a complete assessment of the evidence. Additional, pertinent medical evidence was added to the file in Virtual VA in June 2012. A supplemental statement of the case (hereinafter "SSOC") was issued in June 2012. Also, in a written statement received in July 2012, the Veteran's attorney waived consideration of this evidence by the agency of original jurisdiction (hereinafter "AOJ") in the first instance. Thus, the Board will proceed with appellate review of this claim. See 38 C.F.R. § 20.1304(c) (2012). FINDINGS OF FACT 1. All notification and development actions needed to fairly adjudicate the matter on appeal have been accomplished. 2. The Veteran's lumbar and thoracic spine disability preexisted his active duty service. 3. The Veteran's preexisting lumbar and thoracic spine disability did not undergo a permanent increase in severity during active duty service. 4. The Veteran's cervical spine disability is not shown to have developed as a result of an established event, injury, or disease during active service. CONCLUSION OF LAW The Veteran does not have a lumbar, thoracic and cervical spine disability that is the result of disease or injury incurred in or aggravated during active military service. 38 U.S.C.A. §§ 101, 1110, 1111, 1153, 5107 (West 2002); 38 C.F.R. §§ 3.6, 3.102, 3.303, 3.304, 3.306 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSION In this decision, the Board will discuss the relevant law which it is required to apply. This includes statutes enacted by Congress and published in Title 38, United States Code (hereinafter "38 U.S.C.A."); regulations promulgated by VA under the law and published in the Title 38 of the Code of Federal Regulations (hereinafter "38 C.F.R.") and the precedential rulings of the Court of Appeals for the Federal Circuit (hereinafter "the Federal Circuit") (as noted by citations to "Fed. Cir.") and the Court (as noted by citations to "Vet. App."). The Board is bound by statute to set forth specifically the issue under appellate consideration and its decision must also include separately stated findings of fact and conclusions of law on all material issues of fact and law presented on the record, and the reasons or bases for those findings and conclusions. See 38 U.S.C.A. § 7104(d); see also 38 C.F.R. § 19.7 (implementing the cited statute); see also Vargas-Gonzalez v. West, 12 Vet. App. 321, 328 (1999); Gilbert v. Derwinski, 1 Vet. App. 49, 56-57 (1990) (the Board's statement of reasons and bases for its findings and conclusions on all material facts and law presented on the record must be sufficient to enable the claimant to understand the precise basis for the Board's decision, as well as to facilitate review of the decision by courts of competent appellate jurisdiction). The Board must also consider and discuss all applicable statutory and regulatory law, as well as the controlling decisions of the appellate courts. Duty to Notify and Assist The VCAA describes VA's duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a) (2012). Upon receipt of a complete or substantially complete application for benefits, VA is required to notify the Veteran and his representative, if any, of any information and medical or lay evidence that is necessary to substantiate the claim, and to indicate 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); 38 C.F.R. § 3.159(b); Quartuccio v. Principi, 16 Vet. App. 183 (2002). VCAA 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/Hartman v. Nicholson, 19 Vet. App. 473, 486 (2006). The notice must be provided to the Veteran prior to the initial adjudication of his claim. Pelegrini v. Principi, 18 Vet. App. 112 (2004). VA has satisfied its duty to notify by issuing pre- and post-adjudication notice letters in July 2001, June 2002, June 2003, July 2004, April 2005, July 2007, September 2009, March 2012 and April 2012. These letters advised the Veteran of what evidence was required to substantiate his claim for service connection, and of his and VA's respective duties for obtaining evidence. The July 2007 letter also provided notice regarding the disability evaluation and effective date elements of a service connection claim. Dingess, 19 Vet. App. at 473. As noted, the claim was most recently readjudicated in the June 2012 SSOC. Accordingly, prejudicial error in the timing or content of VCAA notice has not been established and any error is not outcome determinative. See Shinseki v. Sanders, 129 S. Ct. 1696 (2009) (reversing prior case law imposing a presumption of prejudice on any notice deficiency). Further, if any notice deficiency is present in this case, the Board finds that any prejudice due to such error has been overcome by the following: (1) based on the communications sent to the Veteran over the course of this appeal, he clearly has actual knowledge of the evidence he is required to submit in this case; and (2) based on the Veteran's contentions as well as the communications provided to him by VA, it is reasonable to expect that he understands what was needed to prevail. See Shinseki v. Sanders/Simmons, 129 S. Ct. 1696 (2009); Fenstermacher v. Phila. Nat'l Bank, 493 F.2d 333, 337 (3d Cir. 1974) ("[N]o error can be predicated on insufficiency of notice since its purpose had been served."). In order for the Court to be persuaded that no prejudice resulted from a notice error, "the record must demonstrate that, despite the error, the adjudication was nevertheless essentially fair." Dunlap v. Nicholson, 21 Vet. App. 112, 118 (2007). The duty to assist provisions of the VCAA have been met. The claims file contains the Veteran's, his friend's, his former coworker's and his family's lay statements and hearing testimony, service records, post-service treatment records, and report of VA examination dated in April 2012. Moreover, VA has obtained a VHA medical expert opinion to address the nature and etiology of the Veteran's claimed back disability. The Board finds that the VA examination and VHA opinion, when considered together, are adequate to decide the case because, as shown below, they were based upon consideration of the Veteran's pertinent medical history, lay assertions, and current complaints and because they describe the claimed back disorder in detail sufficient to allow the Board to make a fully informed determination, particularly regarding the origin of the Veteran's back disability and whether his preexisting spine disability was aggravated by his active duty service. Barr v. Nicholson, 21 Vet. App. 303 (2007) (citing Ardison v. Brown, 6 Vet. App. 405, 407 (1994)). VA has determined that the Veteran's service treatment records were unavailable for review. Specifically, in April 2000 and March 2002 requests were made to the National Archives and Records Administration (hereinafter "NARA"). A response from the NARA received in October 2002, shows no records were found related to treatment at the Fort Bliss Army Hospital. A response from the National Personnel Records Center (hereinafter "NPRC"), dated in December 2002, shows the Veteran's service treatment records were likely destroyed in a fire at the NPRC in St. Louis, Missouri in July 1973. In March 2004, the NPRC again responded that the Veteran's records were damaged or destroyed in the 1973 fire. In September 2004 another request was submitted to the NARA. Also, in October 2005 the RO submitted a VA Form 21-8359, Information Re Veteran in Uniformed Services Hospital (Request by Department of Veterans Affairs), and requested records from the William Beaumont Army Medical Center, with negative results. In July 2007, another request was made to the NARA. In August 2009, the RO sent the Veteran notice of the unavailability of his service treatment records, and requested that he submit any records in his possession. Also in August 2009, the RO issued a memorandum on the unavailability of Fort Bliss treatment records after attempts to retrieve them were made in April 2000, May 2002 and June 2002. The Veteran responded in August 2009 that he was not in possession of copies of his service treatment records. Most recently, in March 2012, the NARA was again contacted to locate the missing service treatment records. When service treatment records are lost or missing, the Court has held that VA has a heightened duty "to consider the applicability of the benefit of the doubt rule, to assist the claimant in developing the claim, and to explain its decision when the Veteran's medical records have been destroyed." Cromer v. Nicholson, 19 Vet. App. 215, 217-18 (2005) citing Russo v. Brown, 9 Vet. App. 46, 51 (1996). See also Cuevas v. Principi, 3 Vet. App. 542, 548 (1992); O'Hare v. Derwinski, 1 Vet. App. 365, 367 (1991). All methods appear to have been exhausted in attempting to obtain the missing service treatment records, which are unavailable for consideration. The Board finds no basis for further pursuit of these records, as such efforts would be futile. 38 C.F.R. § 3.159(c)(2), (3). In light of the efforts discussed above, VA has met its heightened obligation to satisfy the duty to assist. See Daye v. Nicholson, 20 Vet. App. 512, 515 (2006); Washington v. Nicholson, 19 Vet. App. 362, 369 (2005). With regard to outstanding VA treatment records, the Board notes that in October 2005 and May 2012 the RO sent inquiries to the El Paso, Texas VA Medical Center (hereinafter "VAMC") to obtain treatment records for the period from December 1956 to February 1957. However, a June 2012 memorandum indicates that these records are unavailable for review. In June 2012, the RO informed the Veteran of their unavailability, and requested that he submit any records in his possession from that facility. The Veteran has failed to do so; hence further development of the claim is not required in this regard. Thus, the Board finds that, to the extent possible, VCAA is satisfied in this appeal. 38 U.S.C.A. § § 5102, 5103, 5103A, 5107; Quartuccio v. Principi, 16 Vet. App. 183 (2002). Additionally, as noted, this case was remanded in January 2004 and March 2012 to ensure all notification and development action was completed in accordance with the VCAA, obtain outstanding treatment records, and to obtain VA examination and medical opinion. Attempts have been made to obtain any identified outstanding treatment records, and the Veteran did not identify any further pertinent evidence that remains outstanding, nor has he submitted a VA Form 21-4142, Authorization and Consent to Release of Information to the Department of Veterans Affairs (hereinafter "Form 21-4142"), to obtain any such records. Also as noted, in April 2012 the Veteran underwent VA examination to determine the nature and etiology of his spine disability. This examination and the subsequent VHA opinion are adequate for VA rating purposes for the reasons articulated above. Therefore, the record shows substantial compliance with the January 2004 and March 2012 remand directives and no further development is required. See Stegall v. West, 11 Vet. App. 268 (1998); Dyment v. West, 13 Vet. App. 141 (1999). At the July 2003 and May 2010 hearings, the undersigned VLJs and representative for the Veteran outlined the issue on appeal and engaged in a colloquy as to substantiation of the claim, including identifying relevant types of evidence. Overall, the hearing was legally sufficient and the duty to assist has been met. 38 U.S.C.A. § 5103A (West 2002 & Supp. 2012); Bryant v. Shinseki, 23 Vet. App. 488 (2010). The Veteran has not made the RO, the AMC or the Board aware of any additional evidence that must be obtained in order to fairly decide the claim on appeal. He has been given ample opportunity to present evidence and argument in support of his claim. Pursuant to 38 C.F.R. § 3.655, all relevant evidence necessary for an equitable disposition of the Veteran's appeal of the issue has been obtained and the case is ready for appellate review. The Board additionally finds that general due process considerations have been complied with by VA. See 38 C.F.R. § 3.103 (2012). The Merits of the Claim Service connection may be granted for a disability resulting from disease or injury incurred coincident with or aggravated by service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303(a). 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 ("nexus") between the present disability and the disease or injury incurred or aggravated during service. See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013); Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Hickson v. West, 12 Vet. App. 247, 253 (1999). The determination as to whether these requirements are met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. Baldwin v. West, 13 Vet. App. 1 (1999); 38 C.F.R. § 3.303(a). A veteran is presumed to have been sound upon entry into active service, except as to defects, infirmities, or disorders noted at the time of the acceptance, examination, or enrollment, or where clear and unmistakable evidence demonstrates that the condition existed before acceptance and enrollment and was not aggravated by such service. 38 U.S.C.A. § 1111; 38 C.F.R. § 3.304(b). The Veteran is not required to show that the disease or injury increased in severity during service before VA's duty under the second prong of this rebuttal standard attaches. See VAOPGCPREC 3-2003. In Wagner v. Principi, the Federal Circuit Court held that, when no preexisting condition is noted upon entry into service, a veteran is presumed to have been sound upon entry, and the burden then shifts to VA to rebut the presumption of soundness. 370 F.3d 1089, 1096 (Fed. Cir. 2004). Therefore, according to the Federal Circuit Court in Wagner, to rebut the presumption of soundness under 38 U.S.C.A. § 1111, there must be clear and unmistakable evidence that (1) a veteran' s disability existed prior to service, and (2) that the preexisting disability was not aggravated during service. See id.; see also VAOPGCPREC 3-2003. The second prong may be rebutted with clear and unmistakable evidence establishing that either (1) the disability underwent no increase in severity during service, or (2) any increase in severity was due to the natural progression of the condition. See Quirin v. Shinseki, 22 Vet. App. 390, 396 (2009) (citing Wagner, 370 F.3d at 1096). By "clear and unmistakable evidence" is meant that which cannot be misunderstood or misinterpreted; it is that which is undebatable. Vanerson v. West, 12 Vet. App. 254 (1999). An important distinction between section 1111's aggravation prong of the presumption of soundness and section 1153's presumption of aggravation is the burden of proof. As noted, under section 1111, the burden is on the Government to show by clear and unmistakable evidence that there was no increase in disability in service or, that any increase was due to the natural progress of the disease. Wagner, 370 F.3d at 1096. Under section 1153, however, the Appellant bears the burden of showing that his preexisting condition worsened in service. Id. Once the veteran establishes worsening, the burden shifts to the Secretary to show by clear and unmistakable evidence that the worsening of the condition was due to the natural progress of the disease. Horn v. Shinseki, 25 Vet. App. 231, 235 (2012). If a condition is noted at the time of service entrance, a veteran is not entitled to the presumption of soundness. 38 U.S.C.A. § 1111; 38 C.F.R. § 3.304. Under such circumstances, service connection is warranted if the preexisting disorder was aggravated by a veteran's active service. A preexisting injury or disease will be presumed to have been aggravated by active service where there is an increase in disability during such service, unless there is a specific finding that the increase in disability was due to the natural progress of the disease. 38 U.S.C.A. § 1153; 38 C.F.R. § 3.306(a). A veteran has the burden of showing that there was an increase in disability. See Wagner, 370 F.3d at 1096. Aggravation of a preexisting injury may not be conceded where the disability underwent no increase in severity during service, on the basis of all the medical evidence of record pertaining to the manifestations of the disability prior to, during, and subsequent to service. 38 U.S.C.A. §1153; 38 C.F.R. § 3.306(b); Falzone v. Brown, 8 Vet. App. 398, 402 (1995). The usual effects of medical and surgical treatment in service, having the effect of ameliorating disease or other conditions incurred before enlistment, including postoperative scars, absent or poorly functioning parts or organs, will not be considered service connected unless the disease or injury is otherwise aggravated by service. 38 C.F.R. § 3.306(b)(1). Similarly, temporary or intermittent flare-ups of the preexisting disorder during service are not sufficient to be considered aggravation unless the underlying disability (as contrasted to symptoms) has worsened. See Crowe v. Brown, 7 Vet. App. 238, 247-48 (1994); Hunt v. Derwinski, 1 Vet. App. 292, 296-97 (1991). If the preexisting disorder underwent an increase in severity during service, clear and unmistakable (obvious or manifest) evidence is required to rebut the presumption of aggravation. Such evidence includes medical facts and principles, which may be considered to determine whether the increase is due to the natural progress of the condition. 38 C.F.R. § 3.306(b). "Congress specifically limits entitlement to service-connected disease or injury where such cases have resulted in a disability. In the absence of a proof of present disability there can be no claim." Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The requirement of a "current disability" is satisfied if a disorder is diagnosed at the time a claim is filed or at any time during the pendency of the appeal; service connection may be awarded even though the disability resolves prior to adjudication of the claim. See McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). In addition to direct service connection, certain chronic diseases, such as arthritis, may be presumed to have been incurred during service if the disease becomes manifest to a compensable degree within one year of separation from qualifying military service. 38 U.S.C.A. §§ 1101, 1112, 1113 (West 2002 & Supp. 2011); 38 C.F.R. §§ 3.307, 3.309 (2012). The evidence shows that the Veteran has degenerative joint disease of the lumbar and cervical spine. However, because qualifying military service in this instance means at least 90 days or more of service, the provisions of presumptive service connection for chronic diseases are not applicable. In any case, the evidence does not suggest that the Veteran had arthritis of any part of the back as early as February 1958-one year after the date of separation. In fact, he has not asserted, nor has the record shown, that he underwent treatment for the back prior to 1961, approximately 4 years after his separation from service. Although not dispositive, a lengthy period without complaint or treatment is considered evidence that there has not been a continuity of symptomatology and weighs heavily against the claim. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). Hence, presumptive service connection is not warranted on the basis of chronicity. 38 U.S.C.A. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. If a disease listed in 38 C.F.R. § 3.309(a) is shown to be chronic in service, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. 38 C.F.R. § 3.303(b). 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. Id. Even if the disease is not diagnosed during the presumptive period, a veteran can still receive presumptive service connection by showing, through acceptable medical or lay evidence, characteristic manifestations of the disease to the required degree during the presumptive period, followed without unreasonable time lapse by definite diagnosis. Symptomatology shown in the prescribed period may have no particular significance when first observed, but, in light of subsequent developments, it may gain considerable significance. Cases in which a chronic condition is shown to exist within a short time following the applicable presumptive period, but without evidence of manifestations within the period, should be developed to determine whether there was symptomatology which in retrospect may be identified and evaluated as manifestation of the chronic disease to the required degree. 38 C.F.R. § 3.307(c). If chronicity in service is not established or where the diagnosis of chronicity may be legitimately questioned, a showing of continuity of symptoms after discharge is required to support the claim. 38 C.F.R. § 3.303(b). A claimant "can benefit from continuity of symptomatology to establish service connection in the ultimate sense, but only if [the] chronic disease is one listed in § 3.309(a)." Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). The standard of proof to be applied in decisions on claims for veterans' benefits is set forth in 38 U.S.C.A. § 5107 (West 2002). A claimant is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence. See 38 C.F.R. § 3.102. When a claimant seeks benefits and the evidence is in relative equipoise, the claimant prevails. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The preponderance of the evidence must be against the claim for benefits to be denied. See Alemany v. Brown, 9 Vet. App. 518 (1996). A Veteran bears the "'evidentiary burden' to establish all elements of a claim, including the nexus requirement." Fagan v. Shinseki, 573 F.3d 1282, 1287-88 (2009). The Board's duty is to first determine the probative value of all pertinent medical and lay evidence of record based on its credibility and competency, and then weigh the probative value of the evidence regarding all material elements of a claim. See 38 U.S.C.A. § 7104(d); Kahana v. Shinseki, 24 Vet. App. 428, 433 (2011); see also Layno v. Brown, 6 Vet. App. 465, 469 (1994) (distinguishing between competency ("a legal concept determining whether testimony may be heard and considered") and credibility ("a factual determination going to the probative value of the evidence to be made after the evidence has been admitted"). A "veteran is given the 'benefit of the doubt' 'regarding any issue material' to the veteran's claim 'when there is an approximate balance of positive and negative evidence.'" Fagan, 573 F.3d at 1287 (quoting 38 U.S.C. § 5107(b)). Thus, if there is conflicting medical evidence, the Board may not ignore or disregard any medical professional's opinion, but may assign greater probative to one medical opinion over by providing an adequate statement of reasons or bases for doing so. See Owens v. Brown, 7 Vet. App. 429, 433 (1995); Willis v. Derwinski, 1 Vet. App. 66, 70 (1991). A medical opinion is most probative if it is factually accurate, fully articulated, and based on sound reasoning. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). In making all determinations, the Board must also fully weigh the probative value of the lay evidence of record against the remaining evidence of record. See King v. Shinseki, No. 2011-7159 (Fed. Cir. Dec. 5, 2012). If credible, 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(a). Thus, a layperson is competent to report on the onset and continuity of his symptomatology. See Kahana, 24 Vet. App. at 438; Layno, 6 Vet. App. at 470 (a veteran is competent to report on that of which he or she has personal knowledge). Moreover, lay evidence must not be categorically dismissed as incompetent evidence of medical causation merely because it is lay evidence. See King v. Shinseki, 700 F.3d 1339, 1345 (Fed. Cir. 2012). Rather, lay evidence may be competent and sufficient evidence of a diagnosis or nexus if (1) the particular condition at issue is the type of condition that is within the competence of a layperson, (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. See Davidson, 581 F.3d at 1316; Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007); see also Kahana, 24 Vet. App. at 433, n.4. The Board must determine on a case-by-case basis whether a particular condition is the type of condition that is within the competence of a lay person. See Jandreau, 492 F.3d 1367-77; see also Kahana, 24 Vet. App. at 438, J. Lance dissenting; Robinson v. Shinseki, 312 Fed. Appx. 336, 339 (Fed. Cir. 2009) (nonprecedential). The Veteran has asserted that he currently experiences a lumbar, thoracic and cervical spine disability related to his active duty service. He and his attorney have argued that he sustained an injury prior to his enlistment in the military, and that while he was in basic training at Fort Bliss, Texas he experienced increased back pain. He has contended that he reported to the base clinic and was prescribed medication to allow him to continue his training, and during that same period of time he volunteered to assist in the mess hall where his back pain increased due to bending required as part of his duties. The Veteran described an incident in which bending caused his back to "catch" and he fell to his hands and knees, and required assistance to return to the barracks so that he could lie down. He indicated that the next morning he was unable to get out of his bunk so a jeep was sent to retrieve him and take him to the hospital where he remained for approximately 1 month. The Veteran noted that he was restricted to his bed except to use the restroom and to occasionally eat in the hospital mess hall. The Veteran reported that prior to his enlistment he was employed as a welder and regularly lifted objects up to 50 pounds without pain, and that after his military service he was unable to continue working as a welder. Ultimately, the Veteran has maintained that his pre-service lumbar, thoracic and cervical spine injury was aggravated by his military service. He filed his initial claim for service connection in February 2000, approximately 43 years after his separation from service. Lay statements from the Veteran's former coworkers, family and friends, received in April 2000, include testimony that the Veteran experienced back problems as a teenager, and had done so ever since his separation from service. They also reported observations of an increase in the severity of the Veteran's symptomatology over the years, which led to his being unable to continue with his employment at "Southwest Porcelain Steel." As discussed in greater detail below, the presumption of soundness has been rebutted in this case as to the Veteran's lumbar and thoracic spine disability because it clearly and unmistakably preexisted his service and was not aggravated by service. See 38 U.S.C.A. § 1111; 38 C.F.R. § 3.304(b); see also VAOPGCPREC 3-2003. However, service connection may still be warranted if the Veteran's preexisting lumbar and thoracic spine disability was aggravated during his active duty service. As noted, a preexisting injury or disease will be considered to have been aggravated by active service where there is an increase in disability during such service, unless there is a specific finding that the increase in disability is due to the natural progress of the disease. 38 U.S.C.A. § 1153; 38 C.F.R. § 3.306(a); Wagner v. Principi, 370 F.3d 1089, 1096 (Fed. Cir. 2004). Clear and unmistakable evidence (obvious or manifest) is required to rebut the presumption of aggravation where the pre-service disability underwent an increase in severity. 38 C.F.R. § 3.306(b). This includes medical facts and principles that may be considered to determine whether the increase is due to the natural progress of the condition. Id. Aggravation may not be conceded where the disability underwent no increase in severity during service on the basis of all the evidence of record pertaining to the manifestations of the disability prior to, during and subsequent to service. 38 C.F.R. § 3.306(b). As to the cervical spine, while there is no clear and unmistakable evidence that this disorder preexisted the Veteran's service, the most probative evidence of record indicates that the Veteran's current cervical spine disorder is not shown to have developed as a result of an established event, injury, or disease during active service. As noted, the Veteran's service treatment records are missing and presumed destroyed. However, he is competent to report complaints or treatment for the lumbar spine, thoracic spine and cervical spine during service, especially given the heightened duty due to his missing service treatment records. Specifically, he is competent to report symptoms for this disease. Washington, 19 Vet. App. at 368; Layno, 6 Vet. App. at 469. See also 38 C.F.R. § 3.159(a)(2). Moreover, the limited service records that have been obtained, including a DD Form 214, Certificate of Release or Discharge from Active Duty, show that the Veteran was discharged from the military by reason of a physical disability after 2 months and 10 days of service. Private treatment records, dated in March 1971, from "Dr. Flanigin" at the "Hillcrest Medical Center," indicate the Veteran underwent a laminectomy with nerve root decompression after being diagnosed with nerve root compression possibly due to herniated intervertebral disc at L5. The Veteran had been admitted after complaining of pain in the lower portion of his back. He noted that he had numbness around both ankles, and that he had back pain for several months duration. He reported performing heavy lifting, but could not give any specific date of injury. He noted that his pain had increased in severity at the time. Spasm of both paralumbar muscles, painful forward flexion and limited hyperextension were observed on physical examination, and he was given an initial impression of possible ruptured intervertebral midline disc. A history obtained prior to the laminectomy included report that the Veteran experienced an onset of aching pain in the lower lumbar region approximately 10 years prior to the evaluation, which he could not attribute to a specific incident. Also, he noted that approximately two years prior to the evaluation he experienced constant discomfort in his lower lumbar spine with pain radiating into the hips and legs bilaterally. He indicated that he continued to work as an automobile salesman despite his back pain, and that he had been treated by a chiropractor in the past. On neurological examination, Dr. Flanigin provided an impression that the Veteran had lumbar disc disease, probably on the basis of degenerative changes, herniation with nerve root irritation, but without compression bilaterally or in the midline might be present. Accompanying X-ray studies revealed findings of no evidence of fracture, dislocation or bony production or destruction in the lateral obliques or spot lateral of the lumbosacral spine. The intervertebral disc spaces were observed to be normal and there was no malalignment of the vertebrae. The apophyseal joints and narrow arches were normally outlined. Dr. Flanigin observed that there was no evidence of herniated intervertebral disc at L4 or L5 levels, although there was slight bulging present at the L5 level without apparent nerve root compression. There was also moderate over-riding of the facets at the L4 inter-space level with encroachment on the neural canal posteriorly. Dr. Flanigin concluded that the findings were consistent with an extra-arachnoidal lesion at the L5 to S1 level, mainly on the right, most likely on the basis of a herniated disc. These records showing that the Veteran reported an injury to his spine 10 years prior to his treatment in 1971 are highly probative as they were generated with a view towards ascertaining the Veteran's then-state of physical fitness and are akin to statements of diagnosis or treatment. Rucker v. Brown, 10 Vet. App. 67, 73 (1997) (observing that although formal rules of evidence do not apply before the Board, recourse to the Federal Rules of Evidence may be appropriate if it assists in the articulation of the reasons for the Board's decision); see also LILLY'S: AN INTRODUCTION TO THE LAW OF EVIDENCE, 2nd Ed. (1987), pp. 245-46 (many state jurisdictions, including the federal judiciary and Federal Rule 803(4), expand the hearsay exception for physical conditions to include statements of past physical condition on the rational that statements made to physicians for purposes of diagnosis and treatment are exceptionally trustworthy since the declarant has a strong motive to tell the truth in order to receive proper care). Private treatment records, dated in January 2000, from the "St. John Medical Center," reflect treatment for the back following a motor vehicle accident in January 2000 after a quad runner flipped over on top of him while he remained on it and he landed on soft gravel. The Veteran described exquisite back pain initially with a sounding of a pop, but indicated that he was able to ambulate with excruciating pain. He did not have a helmet on and did not lose consciousness. He did get back on the quad runner and rode it out of the track. He subsequently complained of pain in his abdomen and back, but denied other injuries, neck pain or extremity pain. A CT scan of the lumbar spine was performed, which indicated an impression of comminuted compression fracture of L2 vertebral body with decrease in height of approximately 40 percent. The rewash also small retropulsion of a small fracture fragment to the anterior portion of the spinal canal, and some diffuse posterior bowing of the posterior margin of the vertebral body resulting in borderline spinal stenosis noted. The Veteran was ultimately diagnosed with an L2 wedge compression fracture, multiple trauma, and ileus secondary to multiple trauma. An April 2000 statement from the Veteran's private physician, "Dr. Heim," shows that the Veteran had a history of a back injury as a teenager when a car fell on him, and that he was later drafted into the military, but was given a medical discharge due to his back problems. The Veteran reported that after being discharged from the service he worked in a sign manufacturing plant, but developed chronic back pain and had to quit his job to find more sedentary employment. He subsequently worked as an automobile salesman and did not have any apparent back problems for a prolonged time. Dr. Heim indicated that the Veteran was "doing well" until December 1999, when a quad runner flipped over backward on him and caused a compression fracture of the second lumbar vertebrae. Dr. Heim noted that the Veteran was examined and treated by a neurosurgeon that had him fitted for a back brace, but that he continued to experience back pain despite wearing the brace. Dr. Heim indicated that reexamination revealed further compression of the lumbar vertebrae to greater than 40 percent of the original vertebral height. Dr. Heim observed that the Veteran continued to wear the back brace, and to use a walker and cane to ambulate. VA treatment records, dated from 2000 to 2012, generally show findings of and treatment for low back pain; 75 percent anterior wedge compressive deformity of L2 vertebrae; osteoporosis; moderate L5 to S1 disc space narrowing with vacuum disc phenomenon as sign of degenerative disc disease; bone mineralization; L3 to L4 disc space narrowing of a moderate degree; atherosclerotic calcification in the aorta; upper back pain; neck pain; pain between the scapula; right shoulder fracture requiring pinning/screws following injury in March 2002; old compression fracture deformity L2; moderate diffuse degeneration; narrowing of L5 to S1; degenerative disc disease of the lumbosacral spine; and severe bone loss which fulfills the World Health Organization's criteria for osteoporosis of the hip, and normal bone mass in the anterior posterior spine. Significantly, in November 2006, the Veteran submitted an independent medical examination report from "Dr. Hastings." Dr. Hastings reviewed the Veteran's medical and lay records, took a thorough medical history and performed a physical examination of the Veteran. The Veteran reported a history of joining the Army in 1956, during which time he was found to be physically fit to enlist. By his own admission, he reported that he sustained an injury to an area between his shoulder blades prior to his enlistment, but noted that it had resolved prior to his being drafted into the Army and he was found to be fit for duty. Dr. Hastings noted that lay testimony from the Veteran's friends and family confirmed that the Veteran was medically discharged from the military and that he had ongoing pain and problems with his back since that time. Dr. Hastings opined that, given the fact that the Veteran was admitted to the Army without any type of limitation or physical restriction and passed a medical examination, and given that he sustained injuries in the military during his basic training that required hospitalization for an intense and severe back problem, for which he received a military medical discharge, the Veteran's preexisting back disability rose to the level of severity, intensity and chronicity that required medical discharge, which was evidence of aggravation. Dr. Hastings noted that the Veteran sustained no injuries to his back between 1957 and 1971, but also concluded that the Veteran's preexisting back injury was so aggravated by his service as to cause chronic and permanent impairment requiring surgery. Dr. Hastings opined that the Veteran's severe, chronic and permanent intervertebral disc syndrome with sciatic neuropathy, muscle spasm and neurological compromise in the form of neurological motor weakness involving the lower extremities was the result of a chronic and permanent injury to the lumbar spine. Dr. Hastings indicated that the Veteran was admitted to service and deemed sound and fit for duty. Dr. Hastings noted that there was no documentable evidence that at the time of the Veteran's entrance into service that he was experiencing any limitations involving his back. Dr. Hastings relied upon the fact that the Veteran received a medical disability discharge as evidence that the Veteran's preexisting back disability had been aggravated by service. Dr. Hastings also relied upon lay statements from the Veteran's friends and family that indicated that since the Veteran left the military he experienced a chronic and permanent back disability that has progressed in intensity over the years. The Board finds this opinion lacking in a few respects. First, despite Dr. Hastings's thorough review of the evidence of record, he relied almost exclusively on his own interpretation of VA law to determine that the Veteran unequivocally entered service in sound medical condition despite the Veteran's repeated assertion that he was injured prior to entering into service. Second, he based his conclusion that the Veteran's spine disability was aggravated by service on the fact that the Veteran was separated from service for a medical disability, but failed to address the Veteran's contentions that he did not sustain a specific injury during his brief time in service. Third, Dr. Hastings entirely ignored the Veteran's post-service injuries and their impact on his current spine disability. Nieves- Rodriguez v. Peake, 22 Vet. App. 295 (2008) (the probative value of a medical opinion comes from when it is the factually accurate, fully articulated, and sound reasoning for the conclusion, not the mere fact that the claims file was reviewed). It is the Board's fundamental responsibility to evaluate the probative value of all medical and lay evidence. See Owens v. Brown, 7 Vet. App. 429 (1995); Gabrielson v. Brown, 7 Vet. App. 36 (1994); see also Guerrieri v. Brown, 4 Vet. App. 467, 470-471 (1993) (observing that the evaluation of medical evidence involves inquiry into, inter alia, the medical expert's personal examination of the patient, the physician's knowledge and skill in analyzing the data, and the medical conclusion that the physician reaches). In the evaluation of evidence, VA adjudicators may properly consider internal inconsistency, facial plausibility and consistency with other evidence submitted on behalf of the Veteran. See Caluza v. Brown, 7 Vet. App. 498, 510-511 (1995), aff'd, 78 F.3d 604 (Fed. Cir. 1996)(holding that credibility can be impeached generally by a showing of interest, bias, inconsistent statements, or, to a certain extent, bad character). It has also been observed that the Board has the "authority to discount the weight and probative value of evidence in light of its inherent characteristics in its relationship to other items of evidence." Madden v. Brown, 125 F. 3d 1447, 1481 (Fed. Cir. 1997). In his February 2008 notice of disagreement (hereinafter "NOD"), the Veteran reported that had he not enlisted, he would have continued to work as a welder despite his pre-service back injury. He noted that prior to enlistment he was able to bend over and pick up 50 pounds without pain while at work; however, after his separation from service he could no longer continue to physically perform his job. During his Board hearings in July 2003 and May 2010, the Veteran and his spouse testified that he sustained injury to his back 5 months prior to his enlistment in the military, after a car fell on him. He reported that he fractured three discs between his shoulders and two below which resolved prior to his entry into active service. The Veteran claimed he was told his back was broken but that he was young and would be alright. He indicated that at that point he had been working for 2 years as a welder with a company, and that he was drafted into the military at the age of 18. The Veteran noted that following a short recuperative period he returned to his pre-service employment as a welder, which he was able to do until he was drafted. He claimed he informed the physician who examined him at the time of his enlistment of his back injury. He reported that he struggled during basic training, and that approximately one month in, he could barely rise from bed because of his back pain. He indicated that he was lifting pans while volunteering in the kitchen in the mess hall when he felt his back snap. He noted that when he was treated in the military hospital the doctors did not treat him with a back wrap, physical therapy or by putting him in traction, but instead prescribed him a few days of bed rest. He subsequently reported that he was in treatment for approximately a month and was prescribed medication. The Veteran testified that he was discharged from service due to medical disability, and that he resumed his previous line of work, full time, soon after he was separated from service. He noted that he was forced to quit his job after approximately 3 to 4 years due to his back pain. He denied having any specific injury to his back in service, and attributed his problems to the daily wear and tear related to his duties. He also testified that he was injured again in 1999. The Veteran's wife testified that she knew him since he was 15 years old, but noted that she was unaware that he had any back problems until his separation from service. The Veteran argued that because he was able to return to his pre-service employment as a welder after his pre-service back injury, it was likely that his back disorder was aggravated by his military service. In April 2012, the Veteran underwent VA examination of the thoracolumbar spine. Here, the examiner diagnosed the Veteran with anterior wedge compression fracture of L2 vertebra, and with diffuse degenerative changes of the lumbar spine. He was not diagnosed with intervertebral disc syndrome; however arthritis was documented on examination. The Veteran reported a history of injuring his back after a car fell on him prior to service. He indicated that he also experienced back problems while in the military and was medically discharged due to his back problems. He reported that after discharge from service, he worked as a welder at "Porcelain Steel Manufacturing" plant for 8 years, but that he had to quit his job due to his back pain. He indicated that he then worked as a self-employed car salesman, and that he continued to experience back pain, for which he required surgery in 1970 or 1971. The Veteran also reported that he reinjured his back in 2000 after a 4 wheeler that he was riding flipped over onto him and fractured his vertebrae. He reported that since then he was unable to work. He also noted that a few years prior to the examination he reinjured his back once again when his cow knocked him down. The Veteran also noted that he was diagnosed with Parkinson disease several years prior to the examination. On X-ray evaluation, the Veteran was observed to have an old anterior compression deformity of L2, but the remaining vertebral body heights were found to be well-maintained. There were no acute fractures or dislocations observed, the bones were normally mineralized, and there was grade 1 posterolisthesis of L2 on L3 and L3 on L4. There was a severe loss of intervertebral disc space at L1 to L2 and L5 to S1, and mild loss of intervertebral disc space at L3 to L4. There was also facet anthropathy at L4 to L5 and L5 to S1, and multilevel anterior and lateral small marginal endplate osteophyte formation. The Veteran was given an impression of moderate to severe degenerative changes and an old anterior compression deformity of L2. The Veteran's neck was also examined, and the examiner diagnosed him with degenerative changes of the cervical spine. He was not observed to have intervertebral disc syndrome of the cervical spine; however, arthritis was documented on examination. The Veteran reported a medical history of pain in his neck for several years. He denied experiencing any previous trauma or injury to his neck. On X-ray evaluation, the examiner noted that on lateral view, levels C1 through C5 and the superior endplate of C6 were seen; however, the inferior aspect of C6, C7 and the superior endplate of T1 were not seen. There were no fractures or dislocations observed, the prevertebral soft tissue was normal, and the bones were normally mineralized. The vertebral body heights were well maintained and the intervertebral disc spaces were normal. There was diffuse facet arthropathy observed, most pronounced a C2 to C3 and C3 to C4. There was also moderate narrowing of the right C3 to C4 neural foramen. The remaining right neural foramen was fairly well-maintained, and there was diffuse moderate to severe narrowing of the left neural foramen, which was most pronounced at C3 to C4. The examiner noted that the Veteran's claims file was reviewed, and that his service treatment records were unavailable. The examiner observed that the Veteran was discharged from service due to a physical disability. The examiner indicated that the Veteran had a back problem for which he underwent a decompressive laminectomy in March 1971. The examiner noted that the Veteran had reported experiencing an onset of aching pain in his lower lumbar region 10 years prior to his surgery. The examiner discussed the lay statement indicating the Veteran had back problems since he was a teenager. The examiner also discussed the Veteran's 4 wheeler injury in 1999, and the CT scan in 2000 in which the Veteran was diagnosed with a comminuted compression fracture of L2 vertebra with decrease in height of approximately 40 percent. The examiner opined that the Veteran's claimed lumbar, thoracic and cervical spine disability was less likely than not incurred in or caused by his claimed in-service injury, event or illness. The examiner observed that after reviewing the claims file and medical records, including private and VA treatment records, there was clear and unmistakable evidence that the Veteran's thoracic and lumbar spine condition, status-post decompressive laminectomy and compression fracture with deformity of L2 vertebra, was not likely related to, or a result of, or aggravated by the Veteran's brief period of military service. The examiner observed that there was clear and unmistakable evidence that the Veteran's thoracic and lumbar spine condition, status-post decompressive laminectomy and compression fracture with deformity of L2 vertebra was most likely related to the injury sustained when the car fell on the Veteran prior to his military service, and to his occupation after separation from service at the Porcelain Steel manufacturing plant, which required heavy lifting. The examiner also related the Veteran's spine disability to the 4 wheeler accident, as well as other events or injuries that occurred after separation from service, including when he was knocked over by his cow. The examiner based this conclusion on the fact that an April 2000 private medical record revealed that the Veteran gave a history of injuring his back as a teenager, and the Veteran's family also noted that he injured his back prior to service. The examiner concluded that the Veteran's preexisting back disability was not aggravated by his brief period of military service, and related the Veteran's back disability to post-service aggravating factors. As to the Veteran's cervical spine, the examiner stated that it was his opinion that there was clear and unmistakable evidence that the Veteran's current cervical spine condition with degenerative changes was not likely related to or the result of the Veteran's brief period of military service as there was no evidence that the Veteran had any neck condition until 2001 when the x-ray of his neck was unremarkable. The examiner noted further that the Veteran had sustained multiple injuries in a 4 wheeler accident and when knocked down by a cow. The examiner concluded that the Veteran's cervical spine condition was most likely related to his age, occupation and other events or injuries that occurred after discharge from service including the above mentioned injuries. As noted, in November 2012, the Board sought to obtain VHA medical expert opinion. In December 2012, a VHA neurosurgeon (hereinafter "neurosurgeon") provided a response to the Board's request and answered the questions posed therein. Specifically, after reviewing the claims file, the neurosurgeon summarized the evidence, including the November 2006 IME report from Dr. Hastings containing the opinion that the Veteran's spine injuries arose out of his brief period of military service; the June 2004 X-ray report indicating an old compression fracture of L2 and moderate degeneration and narrowing at L5 to S1; the September 2002 X-ray report indicating a 75 percent to 90 percent wedge compression anteriorly at L2 with multi-level lumbar disc narrowing; the April 2000 note from Dr. Heim reflecting descriptions of a pre-service back injury and a post-service back injury; and the 1971 pre-operative and operative reports from Dr. Rupp and Dr. Flanigin indicating a 10-year history of back pain and an L4 decompression or facet syndrome. The neurosurgeon also acknowledged the Veteran's reported medical history of sustaining injury to his spine prior to his military service, his separation from the military for back problems, his pain free interval for approximately 10 years post-service until his back surgery in 1971, and his current diagnosis of degenerative joint disease of the spine in multiple areas including the thoracic and lumbar spine. The neurosurgeon also noted the Veteran sustained an L2 burst fracture in 1999 from a 4 wheeler accident. The neurosurgeon opined that the Veteran had a lumbar and thoracic spine disability that clearly and unmistakable pre-existed his military service. The neurosurgeon observed that the Veteran admitted to a back injury prior to his military service when a car fell on top of him and injured his back. The neurosurgeon indicated that the Veteran's description of the location of the injury revealed that the thoracic and lumbar regions of the back were affected, and that he had taken two weeks off of work due to his injury at the time. The neurosurgeon noted that the Veteran reported that he did not know how he injured his back during his military service, and that he was washing pots and pans on the day that he felt his back "lock up." The neurosurgeon noted that the Veteran was subsequently admitted to a military hospital due to his back pain, and was later discharged due to a back disability. The neurosurgeon concluded that, although it would be speculative to try to localize the area of the pre-existing spine pathology that occurred in the Veteran as a teenager, it would not be speculative to attribute a back injury and pre-existing disability to that event. The neurosurgeon explained that when considering the mechanism of the Veteran's back injury when the car landed on him, as well as the duration of symptoms which kept him from working for weeks, and his own statement that the injury "messed his back up" that a conclusion with reasonable medical probability could be drawn that the Veteran's back incurred a significant traumatic event and that permanent injury would not only be possible, but would be likely based on the given facts. The neurosurgeon noted that, conversely, when considering the short duration of the Veteran's enlistment in the military (less than two months), and that there was no mechanism of injury during his brief time in the service, that it was less likely that the Veteran sustained an actual injury while in the military. The neurosurgeon disagreed with Dr. Hastings's 2006 independent medical opinion, which concluded that since the Veteran was cleared as "normal" during his military entrance examination, that he must have been normal, and that the injury must somehow be related to his military service. The neurosurgeon explained that orthopedic injuries and musculoskeletal injuries to the spine often have symptoms that are episodic rather than constant, and it is not uncommon to sustain a significant back injury with symptoms that come and go, which is likely the case with the Veteran. The neurologist noted that it made no orthopedic or neurological sense that in the Veteran's case a vertebral injury could have occurred insidiously while he was washing dishes, but that it was much more likely than not that his pre-existing spine injury became symptomatic again while he was in the military. The neurosurgeon also opined that the Veteran's pre-existing back injury was not aggravated by his time in service. The neurosurgeon noted that the Veteran's back disorder was not an aggravation, or permanent worsening, but rather was a short-term episodic return of symptoms. The neurosurgeon observed that after his discharge, the Veteran's back worsened again, according to the medical record, when he resumed performing manufacturing labor work. The neurosurgeon also observed that the Veteran's pain remitted for many years, and that he was asymptomatic for approximately 10 years according to Dr. Rupp's pre-operative note in 1971, while he worked in sedentary employment as an auto-salesman. The neurosurgeon concluded that it was clear after review of the Veteran's claims file that it was more likely than not that the Veteran had an ongoing pre-existing back injury prior to his brief time in the military; and that although he may have suffered a short-term exacerbation in the military, his back injury subsequently became asymptomatic again after discharge from the military and after terminating his labor job in favor of more sedentary employment as a salesman. The neurosurgeon further concluded that the rigors of basic training did not aggravate the Veteran's condition as evidence by the fact that he was asymptomatic for many years after his time in the military. The neurosurgeon also opined that it was likely that the Veteran's back disorder was aggravated after his military service after his 4 wheeler accident in 1999, which led to an L2 spinal fracture. The neurosurgeon explained that the body of medical evidence in this leaned more towards a finding that the Veteran's injury as a teenager was the root cause of his back pain and back degeneration, rather than from an original injury or an aggravation of an injury while he was on active duty. Absent a challenge to the expertise of an examiner, the Board may assume the competence of VA examiners. Cox v. Nicholson, 20 Vet. App. 563, 569 (2007); see also Rizzo v. Shinseki, 580 F.3d 1288, 1291 (Fed. Cir. 2009) (finding that where a Veteran does not challenge a VA medical expert's competence or qualifications, VA need not affirmatively establish that expert's competency). Although the VA and VHA examiners' opinions do not expressly discuss the Veteran's own report of having an increase in his symptomatology during service, this omission is nonconsequential for a few reasons. First, as a general matter, a medical examiner is not required to comment on every favorable piece of evidence in a claims file. See Monzingo v. Shinseki, 26 Vet. App. 97, 105-06 (2012). Furthermore, for the reasons discussed above, the lay statements asserting an aggravation of symptoms are found not competent or credible, as the Veteran has failed to consistently report on the severity of his symptoms in service, or to explain how and why his back disability was permanently aggravated. In this regard, he could only point to bending over to pick up a pot as the first time that he noticed back problems. Also significant, an overall reading of the VA and VHA examiners' opinions is that it is very unlikely that any current lumbar, thoracic and cervical spine disability is related to his military service, and that there was no diagnosis of arthritis in service or shortly thereafter. Any deficiency in the VA examiner's factual foundation or explanation is consequently immaterial. See Monzingo v. Shinseki, 26 Vet. App. 97, 106 (2012) (a VA examination report "must be read as a whole" to determine an examiner's rationale); Acevedo v. Shinseki, 25 Vet. App. 286, 293-942012); see also Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007). Accordingly, the probative value of the VA and VHA examiners' opinions is not materially diminished in this respect. See Nieves-Rodriguez, 22 Vet. App. at 304. Such a medical opinion, which is factually accurate, fully articulated, and based on sound reasoning, carries significant weight. See Nieves-Rodriguez, 22 Vet. App. at 304. The Board, in its own lay capacity (as with the Veteran), is not otherwise qualified to call into question the VA examiner's medical judgment, nor does the Board find any reason to do so. See, e.g., Monzingo, 26 Vet. App. 97, 106 (2012). In consideration of the evidence of record, the Board finds that there is clear and unmistakable evidence that the Veteran had preexisting lumbar and thoracic spine disabilities that existed prior to service based on the most probative evidence of record as outlined above. The Board finds further that there is also clear and unmistakable evidence that the Veteran's preexisting lumbar and thoracic spine disability did not undergo a permanent increase in severity during active duty service that was not otherwise due to the natural progress of the disease. The Board finds the December 2012 VHA opinion to be the most persuasive and probative evidence concerning this aspect of the Veteran's claim for reasons outlined above. See Hayes v. Brown, 5 Vet. App. 60, 69-70 (1993) (it is the responsibility of the Board to assess the credibility and weight to be given the evidence) (citing Wood v. Derwinski, 1 Vet. App. 190, 192-93 (1992)); see also Guerrieri v. Brown, 4 Vet. App. 467, 470-471 (1993) (the probative value of medical evidence is based on the physician's knowledge and skill in analyzing the data, and the medical conclusion he reaches; as is true of any evidence, the credibility and weight to be attached to medical opinions are within the province of the Board). The report found no aggravation of the preexisting lumbar and thoracic spine disability, the circumstances were explained in full, and the neurologist satisfactorily refuted any express evidence to the contrary, including Dr. Hastings November 2006 opinion. Moreover, the December 2012 VHA opinion is consistent with the Veteran's, his family's and his friends' testimony regarding the onset and nature of his spine symptomatology. The Board finds the Veteran's statements concerning any in-service back problems from military training not to be credible due to the records showing that he was discharged after approximately only two months of service, and that he has also stated that he was in the hospital for up to one month at that time. Also, at no point in time has the Veteran been able to identify any injury sustained to the back. Because there was no permanent increase in severity of the disability, the presumption of aggravation does not apply. In light of this finding the Board concludes that service connection is not warranted for a lumbar and thoracic spine disability as it preexisted service and was not aggravated therein. See 38 U.S.C.A. § 1153; 38 C.F.R. § 3.306. Further, the Board finds that while the evidence indicates that the Veteran did not have a cervical spine disability that preexisted service, the only competent, credible and probative evidence of record on this point is the April 2012 VA opinion which concluded based on a review of the record and examination of the Veteran that the onset of such disorder was decades after service and thus, did not develop as a result of an established event, injury, or disease during active service. For the foregoing reasons, the Board finds that the claim of service connection for a lumbar, thoracic and cervical spine disability must be denied. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the Veteran's claim of service connection, that doctrine is not applicable. See 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102; Ortiz v. Principi, 274 F.3d 1361, 1365 (Fed. Cir. 2001). ORDER Service connection for a lumbar, thoracic and cervical spine disability is denied. _______________________________ ______________________________ S. L. KENNEDY F. JUDGE FLOWERS Veterans Law Judge, Veterans Law Judge, Board of Veterans' Appeals Board of Veterans' Appeals ____________________________________ ROBERT E. SULLIVAN Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs