Citation Nr: 1320854 Decision Date: 06/27/13 Archive Date: 07/05/13 DOCKET NO. 10-27 345A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Jackson, Mississippi THE ISSUE Entitlement to service connection for a right elbow disability. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESSES AT HEARING ON APPEAL The Veteran & his wife ATTORNEY FOR THE BOARD Michael T. Osborne, Counsel INTRODUCTION The Veteran had active service from June 1953 to April 1955. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a December 2008 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Jackson, Mississippi, which determined, in pertinent part, that, because new and material evidence had not been received, the previously denied claim of service connection for a right elbow disability (which was characterized as derangement, right elbow) would not be reopened. A Travel Board hearing was held at the RO in September 2011 before the undersigned Veterans Law Judge and a copy of the hearing transcript has been added to the record. In February 2012, the Board reopened, in pertinent part, the Veteran's previously denied claim of service connection for a right elbow disability (which was characterized as degenerative arthritis of the right elbow) and remanded this matter to the RO via the Appeals Management Center (AMC) in Washington, DC, for additional development. A review of the claims file shows that there has been substantial compliance with the Board's remand directives. The Board directed that the RO/AMC obtain the Veteran's updated VA and private treatment records. These records subsequently were associated with his claims file. The Board also directed that the RO/AMC schedule the Veteran for VA examination to determine the nature and etiology of his claimed right elbow disability. This examination occurred in April 2013. See Stegall v. West, 11 Vet. App. 268 (1998); see also Dyment v. West, 13 Vet. App. 141 (1999) (holding that another remand is not required under Stegall where the Board's remand instructions were substantially complied with), aff'd, Dyment v. Principi, 287 F.3d 1377 (2002). Having reviewed the record evidence, to include the Veteran's most recent VA elbow and forearm conditions Disability Benefits Questionnaire (DBQ) in April 2013, the Board has recharacterized the issue on appeal as stated on the title page of this decision. The Board notes that, in its February 2012 remand, it referred a claim of service connection for bilateral hearing loss to the RO/AMC for appropriate action. See Board remand dated February 10, 2012, at pp. 3. A review of the claims file shows that the Veteran's original claim of service connection for bilateral hearing loss was denied in a February 2007 Board decision which was not appealed and became final. See generally 38 U.S.C.A. § 7104. It appears that the Board inadvertently mischaracterized this referred claim in its February 2012 decision and the RO/AMC should not take any further action on this claim. The AMC subsequently concluded in October 2012 that it did not have jurisdiction over the referred claim of service connection for bilateral hearing loss. A review of the record reasonably raises the issue of whether new and material evidence has been received to reopen a claim of service connection for bilateral hearing loss. The Board does not have jurisdiction over this claim and, as such, this issue is referred to the Agency of Original Jurisdiction (in this case, the RO) for appropriate action. Please note this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2012). 38 U.S.C.A. § 7107(a)(2) (West 2002). FINDING OF FACT The record evidence shows that the Veteran's current right elbow disability (characterized as arthritis causing pain and loss of motion) is not related to active service or any incident of service. CONCLUSION OF LAW A right elbow disability was not incurred in or aggravated by active service nor may arthritis of the right elbow be presumed to have been incurred during service. 38 U.S.C.A. §§ 1110, 1112, 1113, 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309 (2012). REASONS AND BASES FOR FINDING AND CONCLUSION Before assessing the merits of the appeal, VA's duties under the Veterans Claims Assistance Act of 2000 (VCAA) must be examined. The VCAA provides that VA shall apprise a claimant of the evidence necessary to substantiate his claim for benefits and that VA shall make reasonable efforts to assist a claimant in obtaining evidence unless no reasonable possibility exists that such assistance will aid in substantiating the claim. In letters issued in September 2008 and in February 2012, VA notified the Veteran of the information and evidence needed to substantiate and complete his claim, including what part of that evidence he was to provide and what part VA would attempt to obtain for him. See 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b)(1); Quartuccio v. Principi, 16 Vet. App. 183, 187 (2002). These letters informed the Veteran to submit medical evidence relating a right elbow disability to active service and noted other types of evidence the Veteran could submit in support of his claim. The Veteran also was informed of when and where to send the evidence. After consideration of the contents of these letters, the Board finds that VA has satisfied substantially the requirement that the Veteran be advised to submit any additional information in support of his claim. See Pelegrini v. Principi, 18 Vet. App. 112 (2004). Notice of the five elements of a service-connection claim was provided in the September 2008 VCAA notice letter, as is now required by Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). As will be explained below in greater detail, the evidence does not support granting service connection for a right elbow disability. Because the Veteran was fully informed of the evidence needed to substantiate this claim, any failure of the RO to notify the Veteran under the VCAA cannot be considered prejudicial. See Bernard v. Brown, 4 Vet. App. 384, 394 (1993). The Veteran also has had the opportunity to submit additional argument and evidence and to participate meaningfully in the adjudication process. Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006). With respect to the timing of the notice, the Board points out that the Court held that a VCAA notice, as required by 38 U.S.C.A. § 5103(a), must be provided to a Veteran before the initial unfavorable agency of original jurisdiction decision on a claim for VA benefits. See Pelegrini v. Principi, 18 Vet. App. 112 (2004). Here, the September 2008 VCAA notice letter was issued prior to the currently appealed December 2008 rating decision; thus, this notice was timely. Because the Veteran's claim is being denied in this decision, any question as to the appropriate disability rating or effective date is moot. See Dingess, 19 Vet. App. at 473. And any defect in the timing or content of the notice provided to the Veteran and his service representative has not affected the fairness of the adjudication. See Mayfield, 444 F.3d at 1328. The Board also finds that VA has complied with the VCAA's duty to assist by aiding the Veteran in obtaining evidence and affording him the opportunity to give testimony before the RO and the Board. It appears that all known and available records relevant to the issue on appeal have been obtained and associated with the Veteran's claims file; the Veteran has not contended otherwise. The Veteran's Virtual VA claims file has been reviewed. The Veteran also does not contend, and the evidence does not show, that he is in receipt of Social Security Administration (SSA) disability benefits such that a remand to obtain his SSA records is required. In Bryant v. Shinseki, 23 Vet. App. 488 (2010), the Court held that 38 C.F.R. 3.103(c)(2) requires that the Veterans Law Judge (VLJ) who conducts a hearing fulfill two duties to comply with the above regulation. These duties consist of (1) the duty to fully explain the issues and (2) the duty to suggest the submission of evidence that may have been overlooked. Here, during the hearing, the VLJ noted the basis of the prior determination and noted the element of the claim that was lacking to substantiate the claim for benefits. The VLJ specifically noted the issue as including whether new and material evidence had been received to reopen a previously denied claim of service connection for a right elbow disability. The Veteran was assisted at the hearing by an accredited representative from the DAV. The representative and the VLJ then asked questions to ascertain whether the Veteran had submitted evidence in support of this claim. In addition, the VLJ sought to identify any pertinent evidence not currently associated with the claims folder that might have been overlooked or was outstanding that might substantiate the claim. The representative specifically asked the Veteran about continuity of the Veteran's right elbow symptomatology since active service. Moreover, neither the Veteran nor his representative has asserted that VA failed to comply with 38 C.F.R. 3.103(c)(2) nor identified any prejudice in the conduct of the Board hearing. By contrast, the hearing focused on the element necessary to substantiate the claim and the Veteran, through his testimony, demonstrated that he had actual knowledge of the element necessary to substantiate his claim for benefits. The Veteran's representative and the VLJ asked questions to draw out the evidence which related the Veteran's right elbow disability to active service, the only element of the claim in question. As such, and especially in light of the Board's February 2012 decision reopening the Veteran's previously denied service connection claim for a right elbow disability, the Board finds that, consistent with Bryant, the VLJ complied with the duties set forth in 38 C.F.R. 3.103(c)(2) and that any error in notice provided during the Veteran's hearing constitutes harmless error. A review of the claims file shows that, in June 1974, December 1997, and in July 2000, the National Personnel Records Center in St. Louis, Missouri (NPRC), notified VA that the Veteran's service treatment records were missing and likely destroyed in the July 1973 fire at NPRC. In cases where the Veteran's service treatment records (or other pertinent records, for that matter) are unavailable through no fault of the claimant, there is a heightened obligation to assist the claimant in the development of his or her case. O'Hare v. Derwinski, 1 Vet. App. 365 (1991). VA also must provide an explanation to the Veteran regarding VA's inability to obtain his or her service treatment records. Dixon v. Derwinski, 3 Vet. App. 261 (1992). The Court has held that VA's efforts to obtain service department records shall continue until the records are obtained or unless it is reasonably certain that such records do not exist or that further efforts to obtain those records would be futile. Hayre v. West, 188 F.3d 1327 (Fed. Cir. 1999); see also McCormick v. Gober, 14 Vet. App. 39 (2000). Given the consistent responses from the NPRC since 1974 concerning the Veteran's missing (and presumably destroyed) service treatment records, the Board concludes that these records are not available and it is reasonably certain that further efforts to attempt to obtain them would be futile. The Veteran has been provided with a VA examination which addresses the contended causal relationship between the claimed disability and active service. 38 U.S.C.A. § 5103A(d); 38 C.F.R. § 3.159(c)(4) ; McLendon v. Nicholson, 20 Vet. App. 79 (2006). Given that the pertinent medical history was noted by the examiner, this examination report sets forth detailed examination findings in a manner which allows for informed appellate review under applicable VA laws and regulations. Thus, the Board finds the examination of record is adequate for rating purposes and additional examination is not necessary regarding the claim adjudicated in this decision. See also 38 C.F.R. §§ 3.326, 3.327, 4.2. In summary, VA has done everything reasonably possible to notify and to assist the Veteran and no further action is necessary to meet the requirements of the VCAA. Service Connection for a Right Elbow Disability The Veteran contends that he incurred his current right elbow disability during active service. He specifically contends that he injured his right elbow when he was involved in a motor vehicle accident while riding in an armored personnel carrier during service. Law and Regulations Service connection may be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred or aggravated in active military service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Certain chronic diseases, including arthritis, are presumed to have been incurred in service if manifest to a compensable degree within one year of discharge from service. 38 U.S.C.A. §§ 1112, 1113; 38 C.F.R. §§ 3.307, 3.309(a). Establishing service connection generally requires (1) medical evidence of a presently existing 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 present disability. Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)); Hickson v. West, 12 Vet. App. 247, 253 (1999). If there is no evidence of a chronic condition during service or an applicable presumptive period, then a showing of continuity of symptomatology after service may serve as an alternative method of establishing the second and/or third element of a service connection claim. See 38 C.F.R. § 3.303(b); Savage v. Gober, 10 Vet. App. 488 (1997). Continuity of symptomatology may be established if a claimant can demonstrate (1) that a condition was "noted" during service; (2) evidence of post-service continuity of the same symptomatology and (3) medical or, in certain circumstances, lay evidence of a nexus between the present disability and the post-service symptomatology. Evidence of a chronic condition must be medical, unless it relates to a condition to which lay observation is competent. If service connection is established by continuity of symptomatology, there must be medical evidence that relates a current condition to that symptomatology. See Savage, 10 Vet. App. at 495-498. In Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013), the Federal Circuit recently overruled Savage and limited the applicability of the theory of continuity of symptomatology in service connection claims to those disabilities explicitly recognized as "chronic" in 38 C.F.R. § 3.309(a). See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013); see also 38 C.F.R. § 3.309(a). Because arthritis is considered a "chronic" disability under 38 C.F.R. § 3.309(a), the theory of continuity of symptomatology remains valid in adjudicating the Veteran's claim of service connection for right knee arthritis; otherwise, this theory is inapplicable to the Veteran's claim of service connection for a right elbow disability. It is the defined and consistently applied policy of VA to administer the law under a broad interpretation, consistent, however, with the facts shown in every case. When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding service origin, the degree of disability, or any other point, such doubt will be resolved in favor of the claimant. Reasonable doubt is one which exists because of an approximate balance of positive and negative evidence which does not satisfactorily prove or disprove the claim. It is a substantial doubt and one within the range of probability as distinguished from pure speculation or remote possibility. See 38 C.F.R. § 3.102. Factual Background A noted in the Introduction, the Veteran's service treatment records likely were destroyed in the July 1973 fire at the NPRC and are not available for review. The post-service evidence shows that the Veteran submitted several lay statements in support of his claim in November 1997. All of these statements were to the effect that he had incurred multiple injuries following an in-service tank accident. The Veteran submitted a lay statement from his brother in June 1998. In this statement, the Veteran's brother stated that, while he had been on active service, the Veteran had reported "being injured in a tank accident." On private outpatient treatment in August 1998, the Veteran's complaints included elbow pain. The Veteran reported that, during active service, he had been in a tank accident in the winter of 1954. "He says that most of his discomfort comes from the shoulder pain and arm pain." His pain interrupted his sleep and he was required to take medication for his pain so he could sleep. He slept between 3-4 hours "usually." Lifting increased his pain. Physical examination showed increased pain with range of motion testing of the right elbow. The diagnoses included right elbow derangement "by history when injured in the military." The Veteran testified at his February 1999 RO hearing that he had injured his right elbow in an in-service tank accident and was unable to straighten his right arm due to right elbow pain. See RO hearing transcript dated April 12, 1999, at pp. 15. He also testified that he currently experienced right elbow arthritis. Id., at pp. 18. In August 1999, the Veteran submitted color copies of certain awards that he had received during service. A "Certificate of Training" dated in June 1954 shows that the Veteran completed "Armorers School" while on active service in Germany. Review of another award indicates that the Veteran completed a course entitled "Leadership & Command # 6" in September 1954 while assigned to Headquarters, 2nd Armored Division, U.S. Army. In a March 2004 statement, the Veteran's wife contended that the Veteran had been injured in an accident involving an armored personnel carrier while on active service in Germany. She also contended that her husband had experienced a right elbow injury following this alleged in-service accident. On private outpatient treatment in June 2005, the Veteran's complaints included right elbow arthritis. "He was involved in an accident in the military service. He was in an armored personnel carrier that had a wreck. He...hurt his right elbow." His right elbow had worsened progressively "over the years. He now has difficulty straightening his right elbow." In a February 2008 statement, B.H.M. stated that she recalled that the Veteran had been "in a tank injury" while on active service in Germany. On private outpatient treatment in April 2008, no relevant complaints were noted. The Veteran was right-hand dominant. A history of right elbow pain "for many years" was noted. The Veteran reported injuring his right elbow in an accident involving an armored personnel carrier during active service. Physical examination of the right elbow showed a "poor" range of motion "with incomplete extension to 120 degrees." The assessment included right elbow pain. In a May 2008 letter, B.J., M.D., stated that he had been treating the Veteran for right elbow pain. The Veteran had reported to Dr. B.J. "that his injuries were probably related to an injury he received while serving in the military from 1953-1955 where he was involved in an accident in an armored carrier." Dr. B.J. also stated that the Veteran's right elbow had a reduced range of motion. On VA outpatient treatment in June 2008, the Veteran's complaints included injuries to the right upper extremity "due to a wreck in an 'armored personnel carrier' in service in Germany in [the] winter of 1954." Physical examination showed tenderness to palpation "and somewhat swollen" joints of the right upper extremity, including the elbow. The assessment included joint pain "due to remote injury." In December 2008, no relevant complaints were noted. Physical examination showed that the right arm did not extend fully at the elbow. The Veteran "again reminds me that he is sure these are due to a service injury." The assessment was arthritis/joint pain. On private outpatient treatment in August 2010, the Veteran's complaints included right elbow pain although "his focus is on his lower back." His right elbow pain had begun during active service. Physical examination of the right elbow showed it was hypertrophic with poor range of motion on flexion and extension. The assessment was arthritis, unchanged. In an August 2010 letter, Dr. B.J. stated that the Veteran had pain in his right elbow "that he believes were related to an injury that he received serving in the Armed Forces while stationed in Germany...where he was involved in an armored carrier accident. I have known [the Veteran] for years and I have no reason to doubt the validity of those claims, but I have no way to prove that they occurred either, because his records have been destroyed." The Veteran had a reduced range of motion in the right elbow. The Veteran testified at his September 2011 Board hearing that he was unable to straighten his right arm as a result of an in-service right elbow injury sustained while he was a passenger in an armored personnel carrier. See Board hearing transcript dated September 20, 2011, at pp. 6. In a January 2012 statement, the Veteran asserted that his right elbow had worsened since his Board hearing. He also asserted that he hardly was able to write, hold a toothbrush to brush his teeth, or put on clothes. "The pain is a lot worse and I don't have much use of that...elbow." He finally asserted that he injured his right elbow while on active service in Germany. On VA elbow and forearm conditions DBQ in April 2013, it was noted that the Veteran was status-post right elbow injury in 1954 "when thrown against [a] wall" in an armored personnel carrier accident. It also was noted that he was not treated for any fracture or dislocation at the time of this reported injury although he was assigned to light duty "for contusions." The VA examiner reviewed the Veteran's claims file, including his post-service VA treatment records. He denied experiencing any flare-ups that impacted the function of the right elbow or forearm. Range of motion testing showed right elbow flexion to 100 degrees with objective evidence of painful motion beginning at 90 degrees, right elbow extension to 20 degrees with an inability to fully extend the elbow, and an ability to perform repetitive use-testing with no additional limitation of motion in the right elbow. Physical examination of the right elbow showed functional impairment due to less movement than normal, weakened movement, and pain on movement, localized tenderness or pain on palpation of the joints/soft tissue, 5/5 muscle strength, no elbow ankylosis, limited pronation with motion lost beyond the last quarter of the arc and the hand did not approach full pronation, and no scars. X-rays showed degenerative or traumatic arthritis of the right elbow. The VA examiner opined that the Veteran's right elbow disability (which he characterized as elbow arthritis causing pain and loss of motion) was less likely than not incurred in or caused by any claimed in-service injury, event, or illness. The rationale for this opinion was that, although the Veteran reported being involved in a crash in 1954 "that resulted in him hitting his elbow against the wall" of an armored personnel carrier, there was no documented fracture or diagnosis of an elbow disability at that time although he reported being treated for contusions. "It is unlikely without any known fracture or dislocation injury in 1954 that the injury caused his current elbow arthritis." This examiner also checked a box marked "No" when asked to state whether the Veteran now has or ever had an elbow or forearm condition. No diagnosis was rendered by the VA examiner. Analysis The Board finds that the preponderance of the evidence is against the Veteran's claim of service connection for a right elbow disability. The Veteran contends that he injured his right elbow in an in-service accident while riding either in an armored personnel carrier or a tank. He also contends that he experienced right elbow disability continuously since his service separation. The record evidence does not support his assertions concerning the contended causal relationship between his current right elbow disability (characterized as arthritis causing pain and loss of motion at his most recent VA examination in April 2013) and active service, however. And the theory of continuity of symptomatology is no longer a valid theory of service connection with respect to the Veteran's claimed right elbow disability (other than arthritis). See Walker, 708 F.3d at 1331. It is unfortunate that the Veteran's service treatment records were lost in the 1973 fire at the NPRC. The limited service personnel records submitted by the Veteran in support of his claim suggest that he served in an armored division in the U.S. Army in Germany. The Board acknowledges that the Veteran has reported that he was involved in a motor vehicle accident while riding in either a tank or an armored personnel carrier during service. The Board also acknowledges that the lack of service treatment records demonstrating a right elbow disability is not a bar to granting service connection. See Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006) (finding lack of contemporaneous medical records does not serve as an "absolute bar" to the service connection claim); Barr v. Nicholson, 21 Vet. App. 303 (2007) ("Board may not reject as not credible any uncorroborated statements merely because the contemporaneous medical evidence is silent as to complaints or treatment for the relevant condition or symptoms"). Even assuming for the sake of argument only that the Veteran was involved in an in-service motor vehicle accident while riding either in an armored personnel carrier or a tank, the Board notes that more is required to establish service connection for a right elbow disability. There must be medical evidence of a nexus between the claimed in-service disease or injury and the present disability. See Holton, 557 F.3d at 1366, and Hickson, 12 Vet. App. at 253. The record evidence in this case suggests instead that the Veteran's current right elbow disability (characterized as arthritis causing pain and loss of motion) is not related to active service or any incident of service, to include the alleged in-service motor vehicle accident involving an armored personnel carrier or a tank. It appears that, following his service separation in April 1955, the Veteran first sought treatment for his right elbow disability in August 1998, or more than 43 years later. The Court has held that evidence of a prolonged period without medical complaint, and the amount of time that elapsed since military service, can be considered as evidence against the claim. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). The Board recognizes that, following VA outpatient treatment in June 2008, a VA clinician diagnosed the Veteran as having joint pain "due to remote injury." It appears that this opinion is based entirely on the Veteran's reported in-service "wreck in an 'armored personnel carrier' in service in Germany in [the] winter of 1954" (as the VA clinician noted in this outpatient treatment record). The Board notes in this regard that a bare transcription of lay history, unenhanced by additional comment by the transcriber, does not become competent medical evidence merely because the transcriber is a medical professional. LeShore v. Brown, 8 Vet. App. 406, 409 (1995). The Court also has held that the 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." Bloom v. West, 12 Vet. App. 185, 187 (1999). Thus, a medical opinion is inadequate when it is unsupported by clinical evidence. Black v. Brown, 5 Vet. App. 177, 180 (1995). It does not appear that the VA clinician's diagnosis of joint pain "due to remote injury" in June 2008 was based on "clinical data or other rationale." The Board also notes that this VA clinician subsequently noted in December 2008 that the Veteran "again reminds me that he is sure" that his right elbow pain was "due to a service injury." This lends additional support to a finding that the June 2008 opinion was based entirely on what the Veteran reported. Accordingly, the Board finds that the June 2008 VA outpatient treatment record is not probative on the issue of whether the Veteran's right elbow disability is related to active service. The remaining evidence suggests that, although the Veteran currently experiences right elbow arthritis, his claimed right elbow disability is not related to active service. The Board observes in this regard that, with the exception of right elbow arthritis documented on x-rays (as noted on VA elbow and forearm conditions DBQ in April 2013), it appears that the Veteran does not experience any current right elbow disability which could be attributed to service. The Board finds it significant that, following VA elbow and forearm conditions DBQ in April 2013, the VA examiner checked a box marked "No" when asked to state whether the Veteran now has or ever had an elbow or forearm condition. And no diagnosis of a right elbow disability was rendered by this VA examiner although he also noted that the Veteran's right elbow arthritis caused pain and loss of motion. This evidence persuasively suggests that the Veteran does not experience a current right elbow disability other than arthritis which could be attributed to active service. A service connection claim must be accompanied by evidence which establishes that the claimant currently has a disability. Rabideau v. Derwinski, 2 Vet. App. 141, 144 (1992); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Service connection is not warranted in the absence of proof of current disability. Absent evidence of current right elbow disability (other than arthritis) which could be attributed to active service, the Board finds that service connection for a right elbow disability (other than arthritis) is not warranted. With respect to right elbow arthritis, the Veteran contends that he has experienced this disability continuously since his in-service accident. The Board notes initially that the theory of continuity of symptomatology remains valid for adjudicating a claim of service connection for arthritis as it is recognized as a "chronic" disease under § 3.309(a). See Walker, 708 F.3d 1331; see also 38 C.F.R. § 3.309(a). The record evidence does not support the Veteran's assertions regarding a continuity of symptomatology since active service for right elbow arthritis, however. It again is unfortunate that the Veteran's service treatment records presumably were lost in the 1973 fire at the NPRC and cannot be reconstructed. The post-service evidence does not support a finding that the Veteran experienced continuous right elbow arthritis since his service separation although the Board again acknowledges that the lack of contemporaneous records is not a bar to granting service connection. See Buchanan, 451 F.3d at 1337. Following his service separation in April 1955, it appears that the Veteran initially complained of right elbow arthritis at his RO hearing in February 1999, or approximately 44 years later. See Maxson, 230 F.3d at 1333. It also appears that the Veteran initially was diagnosed as having right elbow arthritis following private outpatient treatment in August 2010, approximately 55 years after he separated from active service. Id. Although x-rays showed degenerative or traumatic arthritis of the right elbow, the April 2013 VA examiner opined that the Veteran's right elbow arthritis was less likely than not incurred in or caused by any claimed in-service injury, event, or illness. The rationale for this opinion was that, although the Veteran reported being involved in a crash in 1954 "that resulted in him hitting his elbow against the wall" of an armored personnel carrier, there was no documented fracture or diagnosis of an elbow disability at that time although he reported being treated for contusions. "It is unlikely without any known fracture or dislocation injury in 1954 that the injury caused his current elbow arthritis." There is no competent contrary opinion of record. The Veteran also has not identified or submitted any evidence, to include a medical nexus, which demonstrates that his current right elbow arthritis is related to active service or any incident of service. In summary, the Board finds that service connection for right elbow arthritis also is not met. In this decision, the Board has considered all lay and medical evidence as it pertains to the issue. 38 U.S.C.A. § 7104(a) ("decisions of the Board shall be based on the entire record in the proceeding and upon consideration of all evidence and material of record"); 38 U.S.C.A. § 5107(b) (VA "shall consider all information and lay and medical evidence of record in a case"); 38 C.F.R. § 3.303(a) (service connection claims "must be considered on the basis of the places, types and circumstances of his service as shown by service records, the official history of each organization in which he served, his medical records and all pertinent medical and lay evidence"). In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. See Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Competency of evidence differs from weight and credibility. Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown,6 Vet. App. 465, 469 (1994); see also Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) ("although interest may affect the credibility of testimony, it does not affect competency to testify"). A Veteran is competent to report symptoms that he experiences at any time because this requires only personal knowledge as it comes to him through his senses. Layno, 6 Vet. App. at 470; Barr v. Nicholson, 21 Vet. App. 303, 309 (2007) (holding that, when a condition may be diagnosed by its unique and readily identifiable features, the presence of the disorder is not a determination "medical in nature" and is capable of lay observation). Although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), as to the specific issue in this case, a right elbow disability falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007) (lay persons not competent to diagnose cancer). The absence of contemporaneous medical evidence is a factor in determining credibility of lay evidence, but lay evidence does not lack credibility merely because it is unaccompanied by contemporaneous medical evidence. See Buchanan, 451 F.3d at 1337, and Barr, 21 Vet. App. at 303. In determining whether statements submitted by a Veteran are credible, the Board may consider internal consistency, facial plausibility, consistency with other evidence, and statements made during treatment. Caluza v. Brown, 7 Vet. App. 498 (1995). As part of the current VA disability compensation claim, in recent statements and sworn testimony, the Veteran has asserted that his symptoms of a right elbow disability have been continuous since service. He asserts that he continued to experience symptoms relating to the right elbow (pain and limited motion) after he was discharged from service. In this case, after a review of all the lay and medical evidence, the Board finds that the weight of the evidence demonstrates that the Veteran did not experience continuous symptoms of a right elbow disability after service separation. Further, the Board concludes that his assertion of continued symptomatology since active service, while competent, is not credible. As discussed above, the post-service medical evidence does not reflect complaints or treatment related to a right elbow disability for several decades following active service. The Board emphasizes the multi-year gap between discharge from active duty service (1955) and initial reported symptoms related to a right elbow disability in approximately 1998 (a 43-year gap). See Maxson, 230 F.3d at 1333; see also Mense v. Derwinski, 1 Vet. App. 354, 356 (1991) (affirming Board's denial of service connection where Veteran failed to account for lengthy time period between service and initial symptoms of disability). The Board notes that the Veteran sought treatment for a myriad of medical complaints since discharge from service, including the right knee, both shoulders, and the right hand fingers. Significantly, during that treatment, when he specifically complained of other problems, he never reported complaints related to the right elbow. Rucker, 10 Vet. App. at 67 (holding that lay statements found in medical records when medical treatment was being rendered may be afforded greater probative value; statements made to physicians for purposes of diagnosis and treatment are exceptionally trustworthy because the declarant has a strong motive to tell the truth in order to receive proper care). The Veteran filed VA disability compensation claims for service connection for a dental disability, a finger disability, and a disability of the left side in 1974 and for degenerative bone disease, systemic lupus erythematosus, and Sjogren's disease in August 1997 but did not claim service connection for a right elbow disability or make any mention of any relevant symptomatology. He did not claim that symptoms of his right elbow disability began in (or soon after) service until he filed his current VA disability compensation claim. Such statements made for VA disability compensation purposes are of lesser probative value than his previous statements made for treatment purposes. See Pond v. West, 12 Vet. App. 341 (1999) (finding that, although Board must take into consideration the Veteran's statements, it may consider whether self-interest may be a factor in making such statements). The Board has weighed the Veteran's statements as to continuity of symptomatology and finds his current recollections and statements made in connection with a claim for VA compensation benefits to be of lesser probative value than the absence of complaints or treatment for years after service and his previous statements made for treatment purposes. For these reasons, the Board finds that the weight of the lay and medical evidence is against a finding of continuity of symptoms since service separation. ORDER Entitlement to service connection for a right elbow disability is denied. ____________________________________________ WAYNE M. BRAEUER Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs