Citation Nr: 1320636 Decision Date: 06/26/13 Archive Date: 07/05/13 DOCKET NO. 06-05 889 ) DATE ) ) Received from the Department of Veterans Affairs Regional Office in Oakland, California THE ISSUES 1. Entitlement to service connection for residuals of a right eye injury. 2. Entitlement to service connection for bilateral wrist disabilities. 3. Entitlement to service connection for a low back disability. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD N. T. Werner, Counsel INTRODUCTION The Veteran served on active duty from May 1975 to August 1981. This matter came to the Board of Veterans' Appeals (Board) from May 2003 and July 2004 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) first in San Diego, California and thereafter in Oakland, California. In April 2010 and April 2012, the Board remanded the appeal for additional development. In September 2006, the Veteran failed to show for the hearing he had requested before a Veterans' Law Judge traveling to the RO. Therefore, the Board finds this hearing request withdrawn. Although in prior Board 2010 and 2012 remands, the Veteran's claims of service connection for residuals of a right eye injury and bilateral wrist disabilities were characterized as being in a finality status, the claims will be adjudicated on a de novo basis below. In December 2003 the RO received timely notice of disagreement of the May 2003 rating decision from the Veteran. See 38 C.F.R. § 20.201 (2012); Gallegos v. Principi, 283 F.3d 1309, 1314 (Fed. Cir. 2002) (holding that, after considering "the pro-claimant nature of the veteran adjudication system" that "a valid NOD must contain 'terms that can be reasonably construed as disagreement with that determination and a desire for appellate review.'"); Fenderson v. West, 12 Vet. App. 119 (1999) (holding that the Board determines de novo whether a document is an NOD). Additionally, as to the residuals of a right eye injury, pertinent medical evidence was added to the claims file within the first year following issuance of the May 2003 rating decision that first denied the claim and these records constitute new and material evidence. See 38 C.F.R. § 3.156(b) (2012). Accordingly, the Board has recharacterized these issues as original claims. The issues on appeal are as listed on the title page of this decision. The Board notes that remands are not final decisions and that given the full adjudication provided below, there is no prejudice to the Veteran. Additionally, in accordance with Clemons v. Shinseki, 23 Vet. App. 1 (2009), the claims of entitlement to service connection for neuropathy, bilateral wrists, claimed as injury to bilateral wrists and low back disability claimed as service connection for lumbosacral strain, have been recharacterized as entitlement to service connection for bilateral wrist disabilities and a low back disability. FINDINGS OF FACT 1. The competent and credible evidence of record shows that the Veteran's refractive error of the right eye was not subjected to a superimposed disease or injury while on active duty which created additional disability or that any current right eye disorder other than refractive error, including dry eye, cataracts, and pavingstone degeneration, is due to his military service. 2. The competent and credible evidence of record shows that the Veteran's bilateral wrist disabilities are not related to service and arthritis of the wrists did not manifest to a compensable degree within one year of service. 3. The competent and credible evidence of record shows that the Veteran's low back disability is not related to service and arthritis of the lumbosacral spine did not manifest to a compensable degree within one year of service. CONCLUSIONS OF LAW 1. A right eye disability was not incurred in or aggravated by military service. 38 U.S.C.A. §§ 1101, 1131, 5100, 5102, 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 4.9 (2012). 2. Bilateral wrist disabilities were not incurred in or aggravated by military service and arthritis of the wrists may not be presumed to have been incurred in service. 38 U.S.C.A. §§ 1112, 1113, 1116, 1131, 5100, 5102, 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309 (2012). 3. A low back disability was not incurred in or aggravated by military service and arthritis of the lumbosacral spine may not be presumed to have been incurred in service. 38 U.S.C.A. §§ 1112, 1113, 1116, 1131, 5100, 5102, 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veterans Claims Assistance Act of 2000 (VCAA) The VCAA describes VA's duty to notify and assist claimants in substantiating a claim for VA benefits. See 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2012). Under 38 U.S.C.A. § 5102 VA first has a duty to provide an appropriate claim form, instructions for completing it, and notice of information necessary to complete the claim if it is incomplete. Second, under 38 U.S.C.A. § 5103(a), VA has a duty to notify the claimant of the information and evidence needed to substantiate and complete a claim, i.e., existence of a current disability, the degree of disability, and the effective date of any disability benefits. The appellant must also be notified of what specific evidence he is to provide and what evidence VA will attempt to obtain. Third, VA has a duty to assist claimants in obtaining evidence needed to substantiate a claim. This includes obtaining all relevant evidence adequately identified in the record and, in some cases, affording VA examinations. 38 U.S.C.A. § 5103A. In Dingess v. Nicholson, 19 Vet. App. 473, 490 (2006), the United States Court of Appeals for Veterans Claims (Court) observed that a claim of entitlement to service connection consists of five elements, of which notice must be provided prior to the initial adjudication: (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. See 38 U.S.C. § 5103(a). Initially, the Board finds that there is no issue as to whether the Veteran was provided an appropriate application form or issue as to whether the claimant has veteran status. Next, the Board finds that letters dated in January 2002, May 2004, March 2006, October 2011, April 2012, May 2012, and June 2012 provided the Veteran with notice that fulfills the provisions of 38 U.S.C.A. § 5103(a) including notice of the laws and regulations governing disability ratings and effective dates as required by the Court in Dingess, supra. While the Veteran was not provided adequate 38 U.S.C.A. § 5103(a) notice prior to the adjudication of the claims, the Board finds that providing him with adequate notice in the above letters followed by a readjudication of the claims in the October 2012 supplemental statement of the case "cures" any timing problem associated with inadequate notice or the lack of notice prior to the initial adjudication. Mayfield v. Nicholson, 20 Vet. App. 537 (2006) (Mayfield III), citing Mayfield II, 444 F.3d at 1333-34. The Board also finds that even if VA had an obligation to provide the Veteran with additional 38 U.S.C.A. § 5103(a) notice and failed to do so this notice problem does not constitute prejudicial error in this case because the record reflects that a reasonable person could be expected to understand what was needed to substantiate the claims after reading the above letters as well as the rating decisions, the statement of the case, the supplemental statements of the case, and the Board remands. See Shinseki v. Sanders, 129 S.Ct. 1696 (2009). As to the duty to assist, VA has secured all available and identified pertinent in-service and post-service evidence including the Veteran's service treatment records and in substantial compliance with the Board's remand instructions his post-service records from the Social Security Administration (SSA); the Martinez, Chico/Palo-Alto, and Ukiah/San Francisco VA Medical Centers including all available pre-January 24, 2002, and post post-October 13, 2011, records; as well as his private treatment records from the Fort Bragg Clinic, Mendocino Community Health Clinic, Ukiah Valley Medical Center, and Shasta Regional Medical Center. See 38 U.S.C.A. § 5103A(b); Stegall v. West, 11 Vet. App. 268 (1998); D'Aries v. Peake, 22 Vet. App. 97 (2008) (holding that only substantial, and not strict compliance with the terms of a remand request, is required); Dyment v. West, 13 Vet. App. 141, 146-47 (holding that there was no Stegall violation when the examiner made the ultimate determination required by the Board's remand, because such determination more than substantially complied with the Board's remand order). In this regard, in April 2012 or May 2012 the AMC was notified that the Shasta Regional Medical Center did not have any records of the Veteran for the period from July 1983 to December 1985; Enloe Medical Center did not have any records of the Veteran for the period from November 1981 to November 1985; Mendocino Coast District Hospital did not have any records of the Veteran for the period from June 1990 to February 2012; Feather River Hospital did not have any records of the Veteran for the period from November 1984 to March 1988; Oroville Hospital did not have any records of the Veteran for the period from January 1985 to December 1988; and Prompt Care Clinic did not have any records of the Veteran for the period from July 1981 to June 1990. Similarly, following the April 2012 Board remand the AMC conducted a search in CAPRI for the Veteran's pre-January 24, 2002, and post-October 13, 2011, VA treatment records and this search revealed no additional records from the Ukiah, Redding, Chico, Mather/Sacramento, and San Francisco VA Medical Centers except for those which it obtained and associated with the claims file. Moreover, in May 2012 the AMC called the San Francisco VA Medical Center and was told that they did not have any pre-April 2003 treatment records of the Veteran. Also in May 2012, the AMC called the Mather/Sacramento VA Medical Center and was told that they did not have any pre-January 24, 2002, or post-November 15, 2002, treatment records of the Veteran. In April 2012, May 2012, and again in June 2012 the AMC notified the Veteran of which of his records could not be obtained by VA. In June 2012, the AMC associated with the claims file a Memorandum outlining the steps it took to obtain all of his identified VA treatment records and why it concluded that some were unavailable. Thereafter, in the October 2012 supplemental statement of the case the Veteran was notified of the unavailability of some of these records. Therefore, the Board finds that adjudication of this appeal may go forward without another request for these additional records. See Gobber v. Derwinski, 2 Vet. App. 470, 472 (1992) (the "'duty to assist' is not a license for a 'fishing expedition' to determine if there might be some unspecified information which could possibly support a claim . . . [and] this duty is limited to specifically identified documents that by their description would be facially relevant and material to the claim"). The Board's April 2012 Remand also directed the AMC to obtain the Veteran's medical records from Womack Army Medical Center (Fort Bragg Clinic). Those records were not obtained and a remand to request those records is not required. Upon further review of the Veteran's March 2012 statement the Veteran notified VA that he was treated at the Fort Bragg Clinic - not Womack Army Medical Center. Moreover, the address provided by the Veteran for the Fort Bragg Clinic corresponded to a private healthcare provider whose records the AMC requested and obtained while the appeal was in remand status. The AMC noted such. Accordingly, no additional development in this regard is needed. As to the claim of service connection for residuals of a right eye disability and a low back disability, the Veteran was provided with VA examinations in June 2010 and May 2012 and addendums to the June 2010 VA eye examination were obtained in July 2010 and June 2011. The examinations are adequate to adjudicate the claims. Of note, the May 2012 VA examination substantially complies with the Board's remand instructions, because after a review of the record on appeal and after taking a detailed medical history from the claimant as well as after an examination, the examiners provided opinions as to the origins of the Veteran's right eye disability and low back disability. The opinions were based on citation to relevant evidence found in the claims file. See 38 U.S.C.A. § 5103A(d); Barr v. Nicholson, 21 Vet. App. 303 (2007); Stegall; D'Aries; Dyment, supra. As to the claims of service connection for bilateral wrist disabilities, the Veteran was not afforded a VA examination to obtain a nexus opinion. In this regard, the Federal Circuit has addressed the appropriate standard to be applied in determining whether an examination is warranted under this statute. In Waters v. Shinseki, 601 F.3d 1274 (Fed. Cir. 2010) and Colantonio v. Shinseki, 606 F.3d 1378 (Fed. Cir. 2010), the Federal Circuit held that while there must be "medically competent" evidence of a current disability, "medically competent" evidence is not required to indicate that the current disability may be associated with service. Colantonio, 606 F.3d at 1382; Waters, 601 F.3d at 1277. On the other hand, a conclusory generalized lay statement suggesting a nexus between a current disability and service would not suffice to meet this standard as this would, contrary to the intent of Congress, result in medical examinations being "routinely and virtually automatically" provided to all veterans claiming service connection. Waters, 601 F.3d at 1278-1279. In light of the above, the Board finds that a remand for a VA examination is not required. While service treatment records document a single instance of treatment for right wrist pain, the presence of chronic bilateral wrist disabilities for reasons that will be explained below, the post-service record is negative for the claimed disorders for many years after his separation from active duty, the Board finds the lay statements from the Veteran and others regarding a nexus between current disabilities and service conclusory generalized statements for reasons that will be explained below, and the Board does not find the lay statements from the Veteran and others regarding continuity of symptomatology competent and credible evidence for reasons that will be explained below. See 38 U.S.C.A. § 5103A(d); Also see Bardwell v. Shinseki, 24 Vet. App. 36 (2010) (holding that VA was not required to provide a medical examination when there is no credible evidence of an event, injury, or disease in service when the Board does not find his statements credible); McLendon v. Nicholson, 20 Vet. App. 79 (2006). In summary, the facts relevant to this appeal have been properly developed and there is no further action to be undertaken to comply with the provisions of 38 U.S.C.A. §§ 5103(a), 5103A or 38 C.F.R. § 3.159. Therefore, the Veteran will not be prejudiced as a result of the Board proceeding to the merits of the appeal. See Bernard v. Brown, 4 Vet. App. 384, 392-94 (1993). In adjudicating the claims below, the Board has reviewed all of the evidence in the Veteran's claims file including those found in virtual VA. Although the Board has an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that all the evidence submitted by the Veteran or obtained on his behalf be discussed in detail. Rather, the Board's analysis below will focus specifically on what evidence is needed to substantiate the claims and what the evidence in the Veteran's claims folder shows, or fails to show, with respect to the claims. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000); Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000). Service Connection - Generally The Veteran and his representative claim that the appellant's current right eye problems, bilateral wrist disabilities, and low back disability were caused by his military service. It is also requested that the Veteran be afforded the benefit of the doubt. Service connection is warranted where the evidence of record establishes that a particular injury or disease resulting in disability was incurred in the line of duty in the active military service or, if pre-existing such service, was aggravated thereby. 38 U.S.C.A. § 1131; 38 C.F.R. § 3.303. If a condition noted during service is not shown to be chronic, then generally a showing of continuity of symptomatology after service is required for service connection if the disability is one that is listed at 38 C.F.R. § 3.309(a). 38 C.F.R. § 3.303(b); see also Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013)). In addition, service connection may also be granted on the basis of a post-service initial diagnosis of a disease, where the physician relates the current condition to the period of service. 38 C.F.R. § 3.303(d). Other specifically enumerated disorders, including arthritis, will be presumed to have been incurred in service if they manifested to a compensable degree within the first year following separation from active duty. 38 U.S.C.A. §§ 1101, 1112, 1113 (West 2002); 38 C.F.R. §§ 3.307, 3.309 (2012). In order to establish service connection for the claimed disorder, there must be (1) medical evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. See Hickson v. West, 12 Vet. App. 247, 253 (1999). The requirement of a current disability is "satisfied when a claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim." See McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). In evaluating the evidence in any given appeal, it is the responsibility of the Board to weigh the evidence and decide where to give credit and where to withhold the same and, in so doing, accept certain medical opinions over others. Schoolman v. West, 12 Vet. App. 307, 310-11 (1999). In this regard, the Board has been charged with the duty to assess the credibility and weight given to evidence. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006); Charles v. Principi, 16 Vet. App. 370 (2002); Klekar v. West, 12 Vet. App. 503, 507 (1999); Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). Indeed, the Court has declared that in adjudicating a claim, the Board has the responsibility to do so. Bryan v. West, 13 Vet. App. 482, 488-89 (2000); Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992). In doing so, the Board is free to favor one medical opinion over another, provided it offers an adequate basis for doing so. Evans v. West, 12 Vet. App. 22, 30 (1998); Owens v. Brown, 7 Vet. App. 429, 433 (1995). Refractive Error of the Right Eye Initially, the Board notes that for purposes of entitlement to VA benefits the law provides that refractive errors of the eyes are congenital or developmental defects and not a disease or injury within the meaning of applicable legislation. 38 C.F.R. §§ 3.303(c), 4.9. In the absence of superimposed disease or injury, service connection may not be allowed for refractive error of the eyes even if visual acuity decreased in service, as this is not a disease or injury within the meaning of applicable legislation relating to service connection. 38 C.F.R. §§ 3.303(c), 4.9. Therefore, VA regulations specifically prohibit service connection for refractive errors of the eyes unless such defect was subjected to a superimposed disease or injury which created additional disability. See VAOPGCPREC 82-90 (July 18, 1990) (cited at 55 Fed. Reg. 45,711) (Oct. 30, 1990) (service connection may not be granted for defects of congenital, developmental or familial origin, unless the defect was subject to a superimposed disease or injury). Myopia and presbyopia are refractive disorders. See Dorland's Illustrated Medical Dictionary (28th Ed. 1994) at 1094. Accordingly, to the extent that the Veteran is claiming service connection on a direct basis for the myopia/refractive error seen in his post-service medical records, the Board finds that service connection for a right eye disorder may not be granted on a direct basis because refractive error of the eye is a congenital or developmental defect and not a disease or injury within the meaning of applicable legislation. 38 C.F.R. §§ 3.303(c), 4.9. a. A Superimposed Disease or Injury to the Right Eye As to service connection for refractive error of the right eyes due to a superimposed disease or injury causing additional disability (i.e., aggravation) under VAOPGCPREC 82-90, service treatment records show the Veteran was seen in August 1975 for eye swelling secondary to a skin problem; in April 1979 for eye swelling secondary to an insect sting; in February 1980 for a right eye injury (he had an object strike his eye while cleaning) diagnosed as post traumatic cycloplegia; and in January 1981 for complaints that bright light were hurting his eyes diagnosed as hyper-sensitivity. However, despite the documented eye treatment that the Veteran received while on active duty, the Board notes that his visual acuity at his April 1975 enlistment examination as well as at his June 1981 separation examination was 20/20 uncorrected vision. The June 1981 examiner also opined that the Veteran's ocular motility was normal. These opinions are not contradicted by any other medical opinion of record. See Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991) (VA may only consider independent medical evidence to support its findings and is not permitted to base decisions on its own unsubstantiated medical conclusions). Similarly, the Board notes that the Veteran's service treatment records document his being in three separate motor-cycle accidents -- May 1975, January 1978, and March 1979. Service treatment records also document the fact that the Veteran was injured playing football in January 1981. However, the Board notes that none of the medical records surrounding these incidents document complaints, diagnoses, or treatment for a right eye injury as a result of the incident. Lastly, the Board finds that the Veteran is both competent and credible to report on what he can see and feel while on active duty, such as difficulty seeing and pain, following the above events, even when not documented in his service treatment records. See Davidson, supra. However, diagnosing a superimposed disease or injury causing additional disability requires special medical training that the Veteran does not have and the presence of the disorder is a determination "medical in nature" and not capable of lay observation. Id. Therefore, since laypersons are not capable of opining on matters requiring medical knowledge, the Board finds that his opinions that he sustained a superimposed disease or injury causing additional disability is not competent evidence. Id. Accordingly, the Board finds that service connection for refractive error of the right eye may not be granted based on a superimposed disease or injury causing additional disability under VAOPGCPREC 82-90 despite the documented eye problems the Veteran had while on active duty because the uncontradicted medical evidence of record shows that the Veteran's vision was 20/20 with normal motility on entry onto active duty and when he separated from active duty. b. Other Right Eye Disorders As to a current disability, a review of the post-service record documents the Veteran's complaints and treatment for other right eye disabilities diagnosed as dry eye, cataracts, and pavingstone degeneration (he also has vitreoretinal tufts of the left eye). As to service incurrence under 38 C.F.R. § 3.303(a), as noted above, service treatment records document the Veteran being seen in August 1975 for eye swelling secondary to a skin problem; in April 1979 for eye swelling secondary to an insect sting; in February 1980 for a right eye injury (he had an object strike his eye while cleaning) diagnosed as post traumatic cycloplegia; and in January 1981 for complaints that bright light were hurting his eyes diagnosed as hyper-sensitivity. Moreover, the Board finds that the Veteran is both competent and credible to report on what he can see and feel such as observable symptoms of right eye (i.e., difficulty seeing) while on active duty since the above documented incidents, even when not documented in his medical records, because these symptoms come to him through his own senses. See Davidson, supra. As to the medical evidence, none of the medical records surrounding the motor-cycle accidents and football injury document complaints, diagnoses, or treatment for a right eye injury. The post-January 1981 service treatment records are negative for any complaints regarding the right eye. Furthermore, the June 1981 separation examiner reported that examination of ocular motility was normal. The examiner also reported that the Veteran's vision was 20/20. As to the lay statements from the Veteran, while the claimant is competent to report on his symptoms of right eye disabilities because this requires only personal knowledge as it comes to him through his senses, he is not competent to provide a diagnosis of chronic disabilities because such opinions requires medical expertise which he does not have. See Davidson, supra. The post-1978 and post-1981 service treatment records which show no continued complaints of the claimed disabilities, although they record other complaints for other disabilities, as well as the normal June 1981 separation examination report are more credible and compelling in that they contradict the Veteran's claims that he had problems with his right eye since these injuries. Accordingly, the competent and credible evidence weighs against the claim of entitlement to service connection for other right eye disorders. Therefore, service connection must be denied based on in-service incurrence despite the documented problems noted during service and the Veteran's claims regarding having problems with observable symptoms since these above referenced injuries. 38 U.S.C.A. § 1131; 38 C.F.R. § 3.303(a). As to post-service continuity of symptomatology under 38 C.F.R. § 3.303(b), the Board notes that the Veteran's other right eye disabilities (i.e., dry eye, cataracts, and pavingstone degeneration) are not specifically listed disabilities found at 38 C.F.R. § 3.309(a). Accordingly, 38 C.F.R. § 3.303(b) is not applicable to this claim. See Walker, supra. Entitlement to service connection for other right eye disabilities based on post-service continuity of symptomatology must be denied. 38 U.S.C.A. § 1131; 38 C.F.R. § 3.303(b). As for service connection based on the initial documentation of the disabilities after service under 38 C.F.R. § 3.303(d), the Board notes that a competent and credible opinion finding a causal association or link between the Veteran's other right eye disorders and an established injury, disease, or event of service is not of record. See 38 U.S.C.A. § 1131; 38 C.F.R. § 3.303(d). In fact, the July 2010 addendum to the June 2010 VA eye examination included an opinion that the Veteran's decreased visual acuity is due to the refractive errors. As previously noted, VA regulation prohibits service connection for such. Additionally, the medical opinion is not contradicted by any other medical evidence of record. Colvin, supra. As to the various lay statements from the Veteran and his representative found regarding the claimant's other right eye disabilities being caused by his military service, the Board finds that diagnosing these disabilities requires special medical training that these lay persons do not have. The presence of a chronic eye disability is a determination of medical complexity and is not capable of lay observation. See Davidson, supra. Therefore, since laypersons are not capable of opining on matters requiring medical knowledge, the Board finds that their opinions that these disabilities were caused by service is not competent evidence. Id. The competent and credible evidence of record shows that the Veteran's other right eye disorders were not caused by his military service. Accordingly, the weight of the competent and credible evidence is against finding a causal association or link between the post-service disabilities and an established injury, disease, or event of service origin. The claims must be denied based on the initial diagnosis of the disabilities after service. See 38 U.S.C.A. § 1131; 38 C.F.R. § 3.303(d). Accordingly, the Board must conclude that entitlement to service connection for residuals of a right eye injury must be denied because the weight of the evidence is against the claim. See 38 U.S.C.A. § 1131; 38 C.F.R. § 3.303. In reaching the above conclusion, the Board also considered the doctrine of reasonable doubt. 38 U.S.C.A. § 5107(b). However, as the competent and credible evidence of record is against the claim, the Board finds that doctrine is not for application. See also, e.g., Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Bilateral Wrist Disabilities, & Low Back Disability As to a current disability, a review of the post-service record documents the Veteran's complaints and treatment for wrist disabilities diagnosed as median neuropathy, possibly carpal tunnel syndrome of the right wrist, and arthritis; and low back disabilities diagnosed as lumbosacral spine degenerative joint disease and lumbago. As to service incurrence under 38 C.F.R. § 3.303(a), as noted above, service treatment records document the Veteran being in three separate motor-cycle accidents -- May 1975, January 1978, and March 1979. Service treatment records also document the fact that the Veteran was injured playing football in January 1981. As to his wrists, service treatment records show the Veteran being seen in August 1978 for right wrist pain. As to his low back, service treatment records show the Veteran being seen in December 1978 for low back stiffness and decreased range of motion after lifting weights diagnosed as muscle spasms. Service treatment records also show the Veteran being seen on several occasions in February 1981 for low back pain diagnosed as a strain. It is noted that the Veteran is both competent and credible to report on what he can see and feel such as observable symptoms of the wrist and low back disabilities (i.e., pain and limitation of motion) while on active duty since the above documented incidents, even when claimed events are not documented in his medical records. See Davidson, supra. Nonetheless, the evidence still weighs against the Veteran's claims. None of the medical records surrounding the motor-cycle accidents and football injury document complaints, diagnoses, or treatment for a wrist or low back injury. Moreover, service treatment records are negative for documentation of any left wrist injury or complaints. Likewise, the post-August 1978 service treatment records are negative for any complaints or treatment for the right wrist, and the post-December 1978 service treatment records are negative for any complaints or treatment for the low back. Furthermore, the June 1981 separation examiner reported that examination of the upper extremities, the spine, and neurological system was normal. As to the lay statements from the Veteran, the Board finds that he is not competent to provide a diagnosis of chronic disabilities because such opinions requires medical expertise which he does not have. See Davidson, supra. Indeed the Veteran is competent to report on his symptoms of the wrist and low back disabilities because this requires only personal knowledge as it comes to him through his senses, but the medical complexity of his wrists and back disabilities preclude him from establishing the requisite nexus requirement. In fact, the Board finds more compelling the post-1978 and post-1981 service treatment records which show no continued complaints of the claimed disabilities as well as the normal June 1981 separation examination, all of which factor against the Veteran's claims. Accordingly, the competent and credible evidence weighs against the claims of entitlement to service connection for bilateral wrist disabilities and a low back disability. Service connection must be denied based on in-service incurrence despite the documented problems noted during service and the Veteran's claims of having problems with observable symptoms of these disabilities since these injuries. 38 U.S.C.A. § 1131; 38 C.F.R. § 3.303(a). As to the presumptions found at 38 C.F.R. § 3.309(a), the record does not show the Veteran being diagnosed with arthritis in either wrist or the lumbosacral spine in the first post-service year. In fact, the record does not show a diagnosis of arthritis in his wrists and lumbosacral spine until almost twenty years after the Veteran's separation from active duty. Accordingly, entitlement to service connection for bilateral wrist disabilities and a low back disability must be denied on a presumptive basis. See 38 U.S.C.A. §§ 1101, 1112, 1113, 1131; 38 C.F.R. §§ 3.303, 3.307, 3.309. As to post-service continuity of symptomatology under 38 C.F.R. § 3.303(b), the length of time between the Veteran's separation from active duty in 1981 and his first complaints and treatment for wrist disabilities in 2000 and a low back disability in 1999 is evidence against a finding of continuity. (Parenthetically, the Board notes that while some of the post-service medical records make reference to a work related low back injury in 1994, none of the medical records surrounding this injury appear in the claims file despite the extensive efforts taken by the AMC to obtain all of the claimant's identified post-service medical records while the appeal was in remand status.) See Mense v. Derwinski, 1 Vet. App. 354, 356 (1991) (holding that VA did not err in denying service connection when the Veteran failed to provide evidence which demonstrated continuity of symptomatology, and failed to account for the lengthy time period for which there is no clinical documentation of his low back condition). In this regard, the Board acknowledges, as it did above, that the Veteran is competent to assert what he feels; for example, the claimant is competent to report that he had problems with wrist and low back pain and limitation of motion since service. See Davidson, supra. The Board also acknowledges that the Veteran's representative is competent to give evidence about what he can see such as the claimant appearing to be in pain. Id. However, upon review of the claims file, the Board finds that the Veteran's and his representative's assertions that the claimant has had his current wrist and low back disabilities since service are not credible. In this regard, these lay claims are contrary to what is found in the service treatment records, including the fact that none of the treatment records surround his motor-cycle accidents and football injury document treatment for wrist or low back injuries, service treatment records do not reference any chronic left wrist injury or disability, the post-1978 service treatment records do not reference continued complaints of right wrist or low back problems, and June 1981 separation examination report is normal. Again, all of these are factors against the Veteran's claims. Likewise, the post-service treatment records do not document complaints or treatment for wrist and low back disabilities until almost twenty years after his separation from military service and include medical histories that show he sustained a post-service low back injury at work in 1994 and fractured both wrists in a motor vehicle accident in 1999. Again, such evidence weighs heavily against the claims of continuity. See, for example, Shasta Regional Medical Center record dated in September 2000; Del Norte Clinic record dated in October 2001. In these circumstances, the Board gives more credence and weight to the objective evidence of record which contradicts the Veteran's and his representative's assertions. Therefore, entitlement to service connection for bilateral wrist disabilities and a low back disability based on post-service continuity of symptomatology must be denied. 38 U.S.C.A. § 1131; 38 C.F.R. § 3.303(b). As for service connection based on the initial documentation of the disabilities after service under 38 C.F.R. § 3.303(d), the Board notes that a competent and credible opinion finding a causal association or link between the Veteran's bilateral wrist disabilities and low back disability and an established injury, disease, or event of service is not of record. See 38 U.S.C.A. § 1131; 38 C.F.R. § 3.303(d). The competent and credible medical opinions of record attest to the contrary. As to the low back disability, the May 2012 VA examiner opined that it was less likely than not incurred in or caused by his military service. In support of this opinion, the examiner noted the Veteran's in-service treatment in December 1978 for low back tightness after exercising which was diagnosed as muscle spasm and which resolved without any residual; his subsequent in-service treatment on three occasions in February 1981 for low back pain diagnosed as lumbosacral strain which resolved; the June 1981 separation examination which does not make mention of any back problems; the fact that there is nothing in the record to suggest that the Veteran was having any low back problems during the years following his separation from service; and thereafter concluded that that his current low back problems started about 17 years ago and are due to age compatible degenerative joint disease in the lumbar spine. The medical opinion is not contradicted by any other medical evidence of record. Colvin, supra. As to the various lay statements from the Veteran and his representative regarding the Veteran's wrists and low back disabilities, the Board finds that diagnosing these disabilities requires special medical training that lay persons do not have and therefore the presence of the disorders are complex medical determinations not capable of lay observation. See Davidson, supra. Since laypersons are not capable of opining on matters requiring medical knowledge, their opinions that these disabilities were caused by service is not competent evidence. Id. As to the low back disability, the Board also finds more competent and credible the opinions by the VA examiners. See Bloom v. West, 12 Vet. App. 185, 187 (1999) (the probative value of a physician's statement is dependent, in part, upon the extent to which it reflects "clinical data or other rationale to support his opinion."). In sum, the competent and credible evidence of record shows that the Veteran's bilateral wrist disabilities and low back disability were not caused by his military service. Because the weight of the competent and credible evidence is against finding a causal association or link between the post-service disabilities and an established injury, disease, or event of service origin, the Board finds that the claims must be denied based on the initial diagnosis of the disabilities after service. See 38 U.S.C.A. § 1131; 38 C.F.R. § 3.303(d). Accordingly, entitlement to service connection for bilateral wrist disabilities and a low back disability must be denied because the weight of the evidence is against the claims. See 38 U.S.C.A. § 1131; 38 C.F.R. § 3.303. In reaching the above conclusions, the Board also considered the doctrine of reasonable doubt. 38 U.S.C.A. § 5107(b). However, because the competent and credible evidence of record is against the claims, the Board finds that doctrine is not for application. See also, e.g., Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). ORDER Entitlement to service connection for residuals of a right eye injury is denied. Entitlement to service connection for bilateral wrist disabilities is denied. Entitlement to service connection for a low back disability is denied. ______________________________________________ C. CRAWFORD Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs