Citation Nr: 1321652 Decision Date: 07/05/13 Archive Date: 07/12/13 DOCKET NO. 07-37 374 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Montgomery, Alabama THE ISSUES 1. Entitlement to service connection for a disability manifested by visual problems. 2. Entitlement to service connection for tinnitus. 3. Entitlement to service connection for a neck disability. 4. Entitlement to service connection for a left shoulder disability. 5. Entitlement to service connection for a right knee disability. REPRESENTATION Veteran represented by: Disabled American Veterans ATTORNEY FOR THE BOARD J. H. Nilon, Counsel INTRODUCTION Pursuant to 38 C.F.R. § 20.900(c), the appeal has been advanced on the Board's docket. The Veteran, who is the appellant, served on active duty from May 1953 to September 1958, following which he served in the National Guard until May 1978. This matter is before the Board of Veterans' Appeals (Board) on appeal of a rating decision in March 2006 of a Department of Veterans Affairs (VA) Regional Office (RO). While the claim was on appeal, in a rating decision in September 2011, the RO granted service connection for PTSD, which was a complete grant of the benefit and the claim is no longer on appeal to the Board. The Veteran did not express disagreement with the assigned effective date or with the assigned staged ratings. In April 2012 and in October 2012, the Veteran failed to appear for a hearing before Board, which he had requested. In the absence of a timely request for postponement, the request for a hearing is deemed withdrawn. 38 C.F.R. § 20.704(d). While the claim was on appeal, in a decision in October 2012, the Board granted service connection for headaches, which was a complete grant of the benefit and the claim is no longer on appeal to the Board. The Veteran has not expressed disagreement with the assigned effective date or with the assigned rating. In the decision in October 2012, the Board remanded the remaining claims on appeal for further development. As the development was completed, no further action to ensure compliance with the Board's remand directive is required. Stegall v. West, 11 Vet. App. 268, 271 (1998). FINDINGS OF FACT 1. The current visual disability, right homonymous hemianopia, is not a residual of head trauma in service and the current visual disability, right homonymous hemianopia, is otherwise unrelated to an injury, disease, or event in service. 2. Tinnitus is not currently shown. 3. A neck disability, degenerative disc disease of the cervical spine, is unrelated to to an injury, disease, or event in service. 4. A left shoulder disability, degenerative joint disease, is unrelated to an injury, disease, or event in service, and the current degenerative joint disease as a chronic disease was not manifested to a compensable degree within one year after the separation from service. 5. Right knee disability is not currently shown. CONCLUSIONS OF LAW 1. The current visual disability, right homonymous hemianopia, was not incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 1131, 5107(b) (West 2002); 38 C.F.R. § 3.303 (2012). 2. Tinnitus was not incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 1131, 5107(b) (West 2002); 38 C.F.R. § 3.303 (2012). 3. A neck disability, degenerative disc disease of the cervical spine, was not incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 1131, 5107(b) (West 2002); 38 C.F.R. § 3.303 (2012). 4. A left shoulder disability, degenerative joint disease, was not incurred in or aggravated by service and service connection for degenerative joint disease as a chronic disease not be presumed to have been incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 1112, 1131, 1137, 5107(b) (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2012). 5. A right knee disability was not incurred in or aggravated by service. 38 U.S.C.A. §§1110, 1131, 5107(b) (West 2002); 38 C.F.R. § 3.303 (2012). The Veterans Claims Assistance Act of 2000 (VCAA) The VCAA, codified in part at 38 U.S.C.A. §§ 5103, 5103A, and implemented in part at 38 C.F.R § 3.159, amended VA's duties to notify and to assist a claimant in developing information and evidence necessary to substantiate a claim. Duty to Notify Under 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) , when VA receives a complete or substantially complete application for benefits, it will notify the claimant of the following: (1) any information and medical or lay evidence that is necessary to substantiate the claim, (2) what portion of the information and evidence VA will obtain, and (3) what portion of the information and evidence the claimant is to provide. Also, the VCAA notice requirements apply to all five elements of a service connection claim. The five elements are: 1) veteran status; 2) existence of a disability; 3) a connection between the Veteran's service and the disability; 4) degree of disability; and 5) effective date of the disability. Dingess v. Nicholson, 19 Vet. App. 473, 484-86 (2006). The VCAA notice, as required by 38 U.S.C.A. § 5103(a), must be provided to a claimant before the initial unfavorable adjudication by the RO. Pelegrini v. Principi, 18 Vet. App. 112, 119 (2004). The RO provided pre-adjudication VCAA notice by letters dated in October 2004 and in March 2006. As for the content and the timing of the VCAA notice, the documents complied with the specificity requirements of Quartuccio v. Principi, 16 Vet. App. 183, 186-87 (2002) (identifying evidence to substantiate a claim and the relative duties of VA and the claimant to obtain evidence); of Charles v. Principi, 16 Vet. App. 370, 374 (2002) (identifying the document that satisfies VCAA notice); of Pelegrini v. Principi, 18 Vet. App. 112, 119-120 (2004) (pre-adjudication VCAA notice); of Dingess v. Nicholson, 19 Vet. App. 473, 484-86 (2006) (notice of the elements of the claim). Duty to Assist Under 38 U.S.C.A. § 5103A, VA must make reasonable efforts to assist the claimant in obtaining evidence necessary to substantiate a claim. The RO has obtained service treatment records, VA records, private medical records, and records of the Social Security Administration . `` The Veteran was afforded a VA examination in September 2005. In November 2012, the Board obtained a medical expert opinion from the Veterans Health Administration (VHA). The Board has reviewed the VA examination report and the VHA opinion. As the examination report and the VHA opinion are based on a review of the Veteran's history and described the current findings in sufficient detail so that the Board's review is a fully informed one, the examination report and the VHA opinion are adequate to decide the claims. See Stefl v. Nicholson, 21 Vet. App. 120, 124-25 (2007) (holding an examination is considered adequate when it is based on consideration of the appellant's prior medical history and examinations and also describes the disability in sufficient detail so that the Board's evaluation of the disability will be a fully informed one). As there is no indication of the existence of additional evidence to substantiate the claims, the Board concludes that no further assistance to the Veteran in developing the facts pertinent to the claims is required to comply with the duty to assist. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Principles of Service Connection A Veteran is entitled to VA disability compensation if there is a disability resulting from personal injury suffered or disease contracted in line of duty in active military service or for aggravation of a preexisting injury suffered or disease contracted in line of duty in active military service. 38 U.S.C.A. § 1110 (wartime service). Generally, to establish entitlement to compensation for a present disability, a Veteran must show: (1) a present disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service, the so-called "nexus" requirement. All three elements must be proved. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed.Cir. 2004). Several legal theories operate in conjunction with 38 U.S.C.A. § 1110 as implemented in 38 C.F.R. § 3.303 . Service connection means that the facts, shown by evidence, establish that a particular injury or disease resulting in disability was incurred coincident with service, or if preexisting such service, was aggravated by service. This may be accomplished by affirmatively showing inception or aggravation during service. 38 C.F.R. § 3.303(a) . For the showing of chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word "chronic." Continuity of symptomatology after discharge is required where the condition noted during service is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. 38 C.F.R. § 3.303(b) . Service connection may also be granted for disability shown after service, when all of the evidence, including that pertinent to service, shows that it was incurred in service. 38 C.F.R. § 3.303(d) . If a Veteran served 90 days or more on active duty, service incurrence will be presumed for certain chronic diseases, including arthritis, if manifest to a compensable degree within the year after active service. 38 U.S.C.A. § 1112 ; 38 C.F.R. §§ 3.307(a) , 3.309(a). Additionally, service connection may be established on a secondary basis for a disability that is proximately due to or the result of service-connected disease or injury, that is, either caused by or aggravated by a service-connected disability. 38 C.F.R. § 3.310(a) . Evidentiary Standards VA must give due consideration to all pertinent lay and medical evidence in a case where a Veteran is seeking service connection. 38 U.S.C.A. § 1154(a) . As the Veteran did not serve in combat, the combat provision of 38 U.S.C.A. § 1154(b) do not apply. Competency is a legal concept in determining whether lay or medical evidence may be considered, in other words, whether the evidence is admissible as distinguished from credibility and weight, factual determinations going to the probative value of the evidence, that is, does the evidence tend to prove a fact, once the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997). Competency is a question of fact, which is to be addressed by the Board. Jandreau, v. Nicholson, 492 F.3d 1372, 1377 (2007). When the evidence is admissible, the Board must then determine whether the evidence is credible. "Credible evidence" is that which is plausible or capable of being believed. See Caluza v. Brown, 7 Vet. App. 478, 511 (1995), aff'd per curiam, 78 F. 3d 604 (Fed. Cir. 1996) (the determination of credibility is a finding of fact to be made by the Board in the first instance). If the evidence is credible, the Board, as fact finder, must determine the probative value or weight of the admissible evidence, that is, does the evidence tend to prove a material fact. Washington v. Nicholson, 19 Vet. App. 362, 369 (2005). If the evidence is not credible, the evidence has no probative value. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the Veteran. 38 U.S.C.A. § 5107(b) . REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Duties to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA), codified in pertinent part at 38 U.S.C.A. §§ 5103, 5103A (West 2002 & Supp 2012), and the pertinent implementing regulation, codified at 38 C.F.R. § 3.159 (2012), provide that VA will assist a claimant in obtaining evidence necessary to substantiate a claim but is not required to provide assistance to a claimant if there is no reasonable possibility that such assistance would aid in substantiating the claim. They also require VA to notify the claimant and the claimant's representative, if any, of any information, and any medical or lay evidence, not previously provided to the Secretary that is necessary to substantiate the claim. As part of the notice, VA is to specifically inform the claimant and the claimant's representative, if any, of which portion, if any, of the evidence is to be provided by the claimant and which part, if any, VA will attempt to obtain on behalf of the claimant. The Board also notes the United States Court of Appeals for Veterans Claims (Court) has held that the plain language of 38 U.S.C.A. § 5103(a) (West 2002), requires that notice to a claimant pursuant to the VCAA be provided "at the time" that or "immediately after" VA receives a complete or substantially complete application for VA-administered benefits. Pelegrini v. Principi, 18 Vet. App. 112, 119 (2004). Although full VCAA notice was not provided to the Veteran until after the initial adjudication of these claims, the Board finds that there is no prejudice to the Veteran in proceeding with the issuance of a final decision. See Bernard v. Brown, 4 Vet. App. 384, 394 (1993). In this regard, the Board notes that following the provision of the required notice and the completion of all indicated development of the record, the originating agency readjudicated the Veteran's claims based on all evidence of record. There is no indication in the record or reason to believe that any ultimate decision of the originating agency would have been different had complete VCAA notice been provided at an earlier time. See Overton v. Nicholson, 20 Vet. App. 427, 437 (2006) (A timing error may be cured by a new VCAA notification followed by a readjudication of the claim). In any event, the Veteran has not alleged any prejudice due to the timing or content of the notice provided. See Shinseki v. Sanders, 129 S.Ct.1696 (2009) (reversing prior case law imposing a presumption of prejudice on any notice deficiency, and clarifying that the burden of showing that an error is harmful, or prejudicial, normally falls upon the party attacking the agency's determination). The record also reflects that service treatment records (STRs) and all available post-service medical evidence identified by the Veteran have been obtained. Review of the file shows the Veteran was awarded Social Security Administration (SSA) disability benefits effective from January 1999; where there is actual notice to VA that the appellant is receiving disability benefits from the SSA, VA has the duty to acquire a copy of the decision granting SSA disability benefits and the supporting medical documentation relied upon. Baker v. West, 11 Vet. App. 163 (1998); Hayes v. Brown, 9 Vet. App. 67 (1996). VA has attempted to obtain SSA disability records, but SSA has notified VA that there are no disability records pertaining to this Veteran. Further, under 42 U.S.C. § 402, SSA disability award automatically converts to "old age" pension when the beneficiary turns 65, and SSA's document retention schedule requires the destruction of disability records when the beneficiary turns 72. The file contains a Memorandum of Unavailability dated in May 2013 showing that all reasonable efforts have been made to obtain SSA records, and further efforts would be futile. Remands that would only result in imposing additional burdens on VA, with no benefit flowing to the claimant, are to be avoided. Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). Also, VA has no duty to seek to obtain that which does not exist. Counts v. Brown, 6 Vet. App. 473, 477 (1994); Porter v. Brown, 5 Vet. App. 233, 237 (1993). The Veteran has not been afforded specific VA examinations in regard to the claimed visual disorder, tinnitus, right shoulder disorder, neck disorder and right knee disorder. However, medical examination is not required if the appellant has not presented a prima facie case for the benefit claimed. See 38 U.S.C.A. § 5103A(d); 38 C.F.R. § 3.159(c)(4). See also Wells v. Principi, 326 F. 3d. 1381, 1384 (Fed. Cir. 2003); Duenas v. Principi, 18 Vet. App. 512 (2004) (per curiam). The Veteran has not presented prima facie claims for service connection for these disabilities because there is no diagnosed tinnitus or right knee disorder, and no medical or credible lay evidence showing in-service visual disorder, right shoulder injury or neck/cervical spine injury. Accordingly, the evidence of record does not mandate remand for VA examination for those disorders. Finally, neither the Veteran nor his representative has identified any outstanding evidence that could be obtained to substantiate the claim; the Board is also unaware of any such evidence. Accordingly, the Board will address the merits of the Veteran's claims on appeal. Applicable Laws and Regulations Service connection is granted for disability resulting from disease or injury incurred in or aggravated by active duty. 38 U.S.C.A. § 1110; 38 C.F.R. §§ 3.303, 3.304. Certain chronic disabilities such as arthritis are presumed to have been incurred in service if manifest to a compensable degree within one year of discharge from active duty. 38 U.S.C.A. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309. Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. See Davidson v. Shinseki, 581 F.3d 1313 (Fed.Cir.2009); Hickson v. West, 12 Vet. App. 247, 253 (1999); Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd per curiam, 78 F.3d 604 (Fed.Cir.1996) (table). The second and third elements may be established by showing continuity of symptomology. Continuity of symptomatology may be shown by demonstrating "(1) that a condition was 'noted' during service or any applicable presumption period; (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." Barr v. Nicholson, 21 Vet. App. 303, 307 (2007); see also Davidson, 581 F.3d at 1316; Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007) (holding that "[w]hether lay evidence is competent and sufficient in a particular case is a factual issue to be addressed by the Board"). In making all determinations, the Board must fully consider the lay assertions of record. A layperson is competent to report on the onset and continuity of his current symptomatology. See Layno v. Brown, 6 Vet. App. 465, 470 (1994) (a Veteran is competent to report on that of which he or she has personal knowledge). Lay evidence can also be competent and sufficient evidence of a diagnosis or to establish etiology if (1) the layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Davidson, 581 F.3d 1313, 1316; Jandreau, 492 F.3d 1372, 1376-77. When considering whether lay evidence is competent the Board must determine, on a case by case basis, whether the Veteran's particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau, 492 F.3d 1372, 1376-77. The Board is charged with the duty to assess the credibility and weight given to evidence. Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997), cert. denied, 523 U.S. 1046 (1998); Wensch v. Principi, 15 Vet. App. 362, 367 (2001). Indeed, in Jefferson v. Principi, 271 F.3d 1072 (Fed. Cir. 2001), the United States Court of Appeals for the Federal Circuit (Federal Circuit), citing its decision in Madden, recognized that that Board had inherent fact-finding ability. Id. at 1076; see also 38 U.S.C.A. § 7104(a) (West 2002). Moreover, the United States Court of Appeals for Veterans Claims (Court) has declared that in adjudicating a claim, the Board has the responsibility to weigh and assess the evidence. Bryan v. West, 13 Vet. App. 482, 488-89 (2000); Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992). As a finder of fact, when considering whether lay evidence is satisfactory, the Board may also properly consider internal inconsistency of the statements, facial plausibility, and consistency with other evidence submitted on behalf of the Veteran, and the Veteran's demeanor when testifying at a hearing. See Dalton v. Nicholson, 21 Vet. App. 23, 38 (2007); Caluza , 7 Vet. App. 498, 511. In determining the probative value to be assigned to a medical opinion, the Board must consider three factors. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). The initial inquiry in determining probative value is to assess whether a medical expert was fully informed of the pertinent factual premises (i.e., medical history) of the case. A review of the claims file is not required, since a medical professional can also become aware of the relevant medical history by having treated a Veteran for a long period of time or through a factually accurate medical history reported by a Veteran. See id. at 303-04. The second inquiry involves consideration of whether the medical expert provided a fully articulated opinion. See Id. A medical opinion that is equivocal in nature or expressed in speculative language does not provide the degree of certainty required for medical nexus evidence. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). The third and final factor in determining the probative value of an opinion involves consideration of whether the opinion is supported by a reasoned analysis. The most probative value of a medical opinion comes from its reasoning. Therefore, a medical opinion containing only data and conclusions is not entitled to any weight. In fact, a review of the claims file does not substitute for a lack of a reasoned analysis. See Nieves-Rodriguez, 22 Vet. App. at 304; see also Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A] medical opinion ... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions."). When there is a proximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102. To deny a claim on its merits, the preponderance of the evidence must be against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). Evidence and Analysis Service connection for visual problems The Veteran asserts he has had visual problems including loss of peripheral vision and double vision since he suffered a head trauma while performing Active Duty for Training. The accident itself (in which the Veteran was struck on the head by a helicopter rotor blade in June 1970) is documented in the record and is not in dispute. Service Treatment Records (STRs) show that the nature of the head injury was as follow: on June 29, 1970, the Veteran was struck on the front of his helmet by a helicopter rotor blade; the force of the blow was sufficient to crack the helmet. The Veteran was knocked briefly unconscious, hospitalized, and discharged the next day without apparent sequelae. However, he had a brief period of unconsciousness the following afternoon and was taken to a United States Public Health Services (USPHS) hospital in New Orleans, where he complained of dizziness and headaches (frontal and right occipital); he also complained of nausea with vomiting and several episodes of diplopia. The diagnosis on admission was post concussive syndrome. The Veteran was treated by USPHS for eleven days. On the third day his dizziness resolved, and on the fourth day his headaches resolved. The Veteran was examined by a neurologist on the seventh day and was found to be significant only for positive Babinski sign on the right. Electroencephalogram (EEG) and brain scan were negative. The Veteran remained asymptomatic for seven days. On the day of his discharge he was given a thorough neurological examination including motor, sensory, cranial nerves and examination of the fundi and optic discs, all of which were negative, and Babinski sign was no longer present. The Veteran was discharged from inpatient treatment as medically fit to return to active military service, to include flying. The discharge diagnosis was cerebral contusion. In a self-reported Report of Medical History in November 1976, six years after the accident described above, the Veteran specifically denied history of eye trouble. The corresponding Report of Medical Examination in November 1976 showed clinical evaluation of the eyes (including general, opthalmoscopic, pupils and ocular motility) as "normal." Post-service, the Veteran was examined in the emergency room (ER) of Baptist Health in March 2006 and October 2006 in conjunction with inpatient admission for psychiatric problems. Relevant to this issue is that on both occasions review of symptoms was negative for visual disturbances. The file contains a January 2007 letter from Dr. Mark Stafford, stating in relevant part that the Veteran reportedly had progressive difficulty with his vision, especially peripheral vision; he also reported having had a head injury in service in the 1970s due to a helicopter accident. Dr. Stafford asserted the Veteran had numerous medical problems (atrial fibrillation, ischemic heart disease, diabetes mellitus, hypertension, bladder and prostate cancer, chronic kidney disease, history of stroke and depression) and asked VA to assist the Veteran in his medications or medical care, since some of those problems may be attributable to injuries that may have occurred during military service. The file includes a new patient clinic note in December 2008 by Dr. James Halsey of University of Alabama at Birmingham (UAB). Dr. Halsey noted the Veteran had a helicopter accident in service 30 years previously in which he likely suffered a pre-frontal brain contusion. At the time of the accident the Veteran was unconscious for a few hours; on awakening he was unable to see but he recovered over several years. The Veteran reported persisting visual field defect. Dr. Halsey stated the Veteran would be referred for magnetic resonance imaging (MRI) to document the current state of the brain. Current examination of the eyes showed right homonymous hemianopic optic discs but pupils and cranial nerves normal. The Veteran subsequently had MRI of the brain at UAB Health System in April 2009. Comparison to an earlier MRI in July 2002 showed impression of old basal ganglia lacunar infarct and slight interval progression of microangiopathic changes, with no acute abnormality. The file also contains a patient summary list, apparently prepared by the UAB in November 2010, which lists problems including history of stroke in 1999 with right field visual defect. The Veteran had a VA traumatic brain injury (TBI) examination in May 2011; the examiner did not have access to the claims file but noted he had reviewed the UAB records cited above. The Veteran stated that his field of vision had decreased but was unable to articulate when that began. Neurological examination showed right-side weakness and also showed reduced hearing and reduced ability to distinguish smells, although sensory examination was otherwise normal. Visual examination showed right homonymous hemianopia and normal pupils. The examiner did not provide any opinion regarding diagnosis or etiology of a current visual disorder. On review of the evidence above, the Board finds initially that the Veteran is shown to have had head trauma in service. The Veteran is also shown to have current visual defect of right homonymous hemianopia, which is a visual disability ratable under 38 C.F.R. § 4.79, Diagnostic Code 6080. Accordingly, the Veteran has satisfied the first element of service connection (medical evidence of a claimed disability) However, a veteran seeking disability benefits must establish not only the existence of a disability, but also an etiological connection between his military service and the disability. Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000); D'Amico v. West, 209 F.3d 1322, 1326 (Fed. Cir. 2000). Where an opinion is used to link the current disability to a cause during service, a competent opinion of a medical professional is required. Caluza, 7 Vet. App. 498. In this case, there is no medical opinion of record showing that the Veteran's claimed hemianopia is due to trauma, versus aging, stroke or other intercurrent cause. The Board notes in that regard that the treatment records from UAB (Dr. Halsey) showed an early impression of visual field impairment due to concussion, but after MRI of the brain the UAB assessment was "history of stroke in 1999 with right field visual defect." This is the clearest medical notation of record regarding the etiology of the disorder. The Veteran has asserted his personal belief that his visual impairment is due to the head trauma during service, but a layperson is not considered capable of opining, however sincerely, in regard to causation of a disability. Routen v. Brown, 10 Vet. App. 183, 187 (1997), aff'd sub nom Routen v. West, 142 F3d 1434 (Fed. Cir. 1998), cert denied, 119 S. Ct. 404 (1998). VA must consider all favorable lay evidence of record. 38 USCA § 5107(b); Caluza, 7 Vet. App. 498. The Board has accordingly carefully considered the lay evidence offered by the Veteran, especially his account of visual impairment ever since the head trauma in service. A layperson is competent to testify in regard to the onset and continuity of symptomatology. Heuer v. Brown, 7 Vet. App. 379, 384 (1995); Falzone v. Brown, 8 Vet. App. 398, 403 (1995); Caldwell v. Derwinski, 1 Vet. App. 466 (1991). However, once evidence is determined to be competent, the Board must determine whether such evidence is also credible. See Layno, 6 Vet. App. 465 (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"). In weighing credibility, VA may consider interest, bias, inconsistent statements, bad character, internal inconsistency, facial plausibility, self interest, consistency with other evidence of record, malingering, desire for monetary gain, and demeanor of the witness. Caluza, 7 Vet. App. 498. The Board may weigh the absence of contemporaneous medical evidence against the lay evidence in determining credibility, but the Board cannot determine that lay evidence lacks credibility merely because it is unaccompanied by contemporaneous medical evidence. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). The Board may not ignore a veteran's testimony simply because he or she is an interested party and stands to gain monetary benefits; personal interest may, however, affect the credibility of the evidence. Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991). In this case, the Board finds the Veteran's current account of chronic visual problems since the in-service head trauma in 1970 is inconsistent with the medical evidence of record and accordingly not credible. The Veteran demonstrably had no residual visual impairment immediately after the head trauma, as demonstrated by the thorough examination he had prior to discharge by the USPHS hospital at which he was treated. Further, the Veteran was returned to flight status, which requires perfect vision, and he also worked after service as a commercial airline pilot, which again requires perfect vision. The Board cannot believe the Veteran would have been allowed to fly, or would have allowed himself to fly, had he actually been subject to the visual impairments he now says were chronic since June 1970. In assessing the Veteran's credibility the Board also notes that a VA psychologist in August 2011 stated the Veteran has severe cognitive deficits that make evaluation less than reliable. The Board accordingly affords less credibility to the Veteran's current account than to the contemporaneous medical records that are associated with the claims file. Finally, the Veteran's assertion in his correspondence to VA that he has had chronic visual problems since the head trauma is internally consistent with his statement to the VA TBI examiner that he could not recall when his visual problems started. In sum, the Board has found the Veteran did not have an eye injury during service (no eye injury is documented in the June 1970 crash). The Veteran's current visual disorder, diagnosed as right homonymous hemianopia, is not shown to be etiologically related to service. Accordingly, the criteria for service connection are not met and the claim must be denied. Service connection for bilateral tinnitus The Veteran asserts he has bilateral tinnitus that is residual to head trauma in June 1970. As noted above, the in-service accident is not in dispute. The Veteran also asserted in his substantive appeal, received in November 2007, that he had flown the old OH-13 and OH-23 observation helicopters for many years with only headphones and without ear protection until flight helmets were issued. STRs show that in a self-reported Report of Medical History in November 1976 the Veteran specifically denied history of ear, nose or throat trouble. The corresponding Report of Medical Examination in November 1976 showed clinical evaluation of the ears and neurological evaluation as "normal." There is no documentation in STRs or in post-service treatment records of any complaint or diagnosis of tinnitus. The file contains an initial psychiatric evaluation by Dr. A. Almon Ward, a private psychiatrist, noting that the Veteran had suffered a cerebrovascular accident (CVA) in 1999 and complained of current "buzzing in the brain." The Veteran had a VA TBI examination in May 2011 in which he reported intermittent ringing in the ears since the in-service head injury. However, the examiner articulated no opinion regarding the presence or etiology of current tinnitus. On review of the evidence above, the Board notes that tinnitus is a subjective neurological disorder. Tinnitus is not documented in STRs or diagnosed in post-service treatment records. The file contains letters from the Veteran's current wife and his ex-wife describing the Veteran's observed symptoms and complaints, but those letters are silent in regard to any complaint of tinnitus. The only evidence of a tinnitus disorder of record is the Veteran's own complaint thereof, but as noted above the Veteran is not considered to be credible in reporting the history of his claimed symptoms. "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, 3 Vet. App. 223, 225. There being no medical evidence of diagnosed tinnitus in this case, the Board finds the Veteran has not shown a disability for which service connection can be considered; accordingly, the claim must be denied. Because the evidence preponderates against the claim the benefit-of-the-doubt rule does not apply. Gilbert, 1 Vet. App. 49, 54. Service connection for a neck disorder and left shoulder disorder The Veteran asserts he has had neck pain and left shoulder pain since a June 1970 accident during ADT in which he also suffered a head trauma. As noted above, the accident during ADT is not in dispute. Also, STRs show that in a self-reported Report of Medical History in August 1961 the Veteran endorsed having had a cyst removed from his neck when he was 24 years old, but he asserted that he had no complications and no sequelae, and it was noted by the examiner as not considered disabling (NCD); the corresponding Report of Medical Examination noted clinical impression of the neck, spine and neurological evaluation as "normal." In self-reported Reports of Medical History in October 1972 and November 1976 the Veteran specifically denied history of painful or "trick" shoulder. The corresponding Reports of Medical Examination in October 1972 and November 1976 show clinical evaluation of the upper extremities, neck and spine, and neurological evaluation as "normal." The Veteran was examined in the ER of Baptist Health in March 2006 in conjunction with inpatient admission for psychiatric problems. Relevant to this issue is that review of symptoms (ROS) showed the upper extremities, neck and back to be supple and normal on inspection, and in fact the Veteran denied pain on admission. The Veteran was examined again by the Baptist Health ER in October 2006, again in conjunction with inpatient admission for psychiatric problems. Again there was no indication on examination of a current disorder of the neck or spine, again the extremities were found to be normal on examination, and again the Veteran denied current pain. The file contains a patient summary list, apparently prepared by the UAB in November 2010, which lists problems including chronic right (not left) shoulder pain. The Veteran had a VA TBI examination in May 2011 in which he reported a number of symptoms that he attributed to service. He did not cite neck pain, but did cite pain in the left shoulder since the helicopter accident in service. The Veteran denied any other shoulder trauma and denied having received treatment for a shoulder disorder; he characterized the problem as shoulder pain and intermittent popping in-and-out. The left shoulder was tender on examination, and X-ray of the left shoulder showed an impression of mild degenerative joint disease (DJD). X-ray of the cervical spine showed desiccation at C2-3 and C3-4 as well as degenerative changes at C4-5 and C5-6. The examiner diagnosed degenerative disc disease (DDD) of the cervical spine and mild degenerative arthritis of the left shoulder, and stated an opinion that cervical spine and left shoulder diagnoses were not likely related to the head injury. (The Board acknowledges at this point that the opinion of the VA TBI examiner cited above is not adequate as a basis for rating, in that the examiner stated a conclusory opinion without clinical rationale; see Nieves-Rodriguez, 22 Vet. App. at 304. However, the clinical determinations in the examination report, such as X-ray impressions and diagnoses of the current cervical spine disorder and left shoulder disorders, are competent and credible. See Hilkert v. West, 12 Vet. App. 145 (1999), holding that the competency of a VA examiner is presumed, absent a showing of some evidence to the contrary.) On review of the evidence above, the Board finds the Veteran has presented evidence of current disorders of the left shoulder (DJD) and cervical spine (DDD). However, there is no evidence of either a left shoulder or cervical spine injury or disease in service. The contemporaneous treatment records regarding the head trauma in June 1970 disprove any immediate left shoulder or cervical spine residuals of the accident, and the subsequent November 1976 Report of Medical History (in which the Veteran denied symptoms) and Report of Medical Examination (in which the neck and upper extremities were normal on examination) further disprove neck or shoulder problems at the time of discharge from service. The Veteran has asserted chronic left shoulder and neck pain since service, but as explained above the Veteran is not a credible historian, as his account is inconsistent with contemporaneous medical evidence and internally inconsistent with his contemporaneous statements to examiners; further, the Veteran is shown by medical opinion to be delusional and thus not credible. The Veteran is diagnosed with arthritis of the left shoulder, so the Board must consider whether presumptive service connection is warranted under 38 C.F.R. § 3.309(a). In this case there is no documentation of arthritis at the time of discharge from service, and there is no documentation of left shoulder pain or diagnosis of "mild" arthritis until 2011, several decades after discharge from service. The Board concludes that arthritis was not present to a compensable degree within the first year after discharge from service, and that presumptive service connection for chronic arthritis is not applicable. In sum, the Board has found the Veteran's diagnosed DDD of the cervical spine and DJD of the left shoulder are not etiologically related to service, to include the June 1970 accident in which the Veteran incurred head trauma. Accordingly, the criteria for service connection are not met and the claim must be denied. Because the evidence preponderates against the claims the benefit-of-the-doubt rule does not apply. Gilbert, 1 Vet. App. 49, 54. Service connection for a right knee disorder In his claim for service connection, the Veteran asserted that he has a current right disability residual to removal of bone fragment from the right knee at Fort Belvoir, Virginia in 1959. The Veteran asserted in his notice of disagreement (NOD), dated in May 2006, that he had injured both knees in service. He initially injured both knees by falling out of a three-quarter ton truck during basic training at Fort Sill, Oklahoma. Later he had right knee surgery at Fort Belvoir in 1959, although the knee had actually been the most damaged in the earlier incident at Fort Sill. Finally, the Veteran asserted in his substantive appeal, received in November 2007, that he cracked two moon-shaped bones in the right knee at Fort Sill, but was not treated at the time because he was within two weeks of reassignment. Thereafter, he reinjured the knee at Fort Belvoir and dislodged the same bones, resulting in surgery. The Veteran lost his job as an airline pilot in 1976 because his right knee had become too weak to operate the rudder of the aircraft in case of power loss. STRs confirm the Veteran tripped and landed on his right knee while participating in physical training (PT) at Fort Belvoir in May 1959. He underwent surgery for removal of loose body in the right knee the same month. Thereafter, in August 1961 physical examination the Veteran asserted he had no problem with the knee since that time, and it was noted by the examiner as not considered disabling (NCD). Similarly, in self-reported Reports of Medical History in September 1959, April 1961, August 1961, October 1972 and November 1976 the Veteran specifically denied history of "trick" or locked knee. The corresponding Reports of Medical Examination show clinical evaluation of the lower extremities as "normal" although the November 1976 examination noted a 4-inch scar on the right knee as an identifying body mark or scar. The file contains an initial psychiatric evaluation by Dr. A. Almon Ward, a private psychiatrist, noting that the Veteran had suffered a cerebrovascular accident (CVA) in 1999, and currently had right-side weakness and ambulated with a cane. The file also contains a March 2005 letter from Dr. Ward stating that the Veteran had received injuries to his knees (plural in the original) and concluded that the Veteran was severely disabled with service-connected PTSD and knees. The Veteran was examined in the ER of Baptist Health in March 2006 in conjunction with admission for psychiatric problems. Relevant to this issue is that review of symptoms showed the extremities to be non-tender and to have normal ROM, and in fact the Veteran denied pain on admission. During inpatient psychiatric treatment the Veteran complained of pain in the left knee (not right knee) and was noted to have a history of arthritis in the knee (which knee was not specified). The Veteran was noted to ambulate with a cane and to complain of slight imbalance with knee pain; there was no current diagnosis or clinical impression noted regarding the knees in general or the right knee in particular. The Veteran was examined again by the Baptist Health ER in October 2006, again in conjunction with inpatient admission for psychiatric problems. Again the extremities were found to be normal on admission and the Veteran denied current pain. The file contains a January 2007 letter from Dr. Mark Stafford, stating in relevant part that the Veteran reported recently that he had difficulty ambulating due to right knee pain; the Veteran also reported having injured that knee initially during basic training in service. Dr. Stafford asserted the Veteran had numerous medical problems (atrial fibrillation, ischemic heart disease, diabetes mellitus, hypertension, bladder and prostate cancer, chronic kidney disease, history of stroke and depression) and asked VA to assist the Veteran in his medications or medical care, since some of those problems may be attributable to injuries that may have occurred during military service. On review of the evidence above, the Board notes at the outset that although the STRs show a right knee injury in service there is no indication of a diagnosed right knee disorder after discharge from service. The Veteran has asserted subjective right knee pain, but pain alone, without a diagnosed or identifiable underlying malady or condition, does not constitute a disability for which service connection can be granted. Sanchez-Benitez v. Principi, 259 F.3d 1356 (Fed. Cir. 2001). There being no current diagnosed left knee disorder, the Veteran has not presented a claimed disability for which service connection can be considered. Brammer, 3 Vet. App. 223, 225. The Board also notes that although there was a right knee injury in service, resulting in surgery in 1959, the Veteran continued to serve in the active forces and in the Reserve Component until 1978, to include serving as a pilot, without documentation of any right knee problems, and in fact the Veteran's physical examination reports and self-reported medical histories between 1959 and 1976 disprove any residual knee problems. To the degree that the Veteran now asserts chronic knee problems since his injury in 1959, such reports are inconsistent with the contemporaneous medical records; also, as noted above, the Veteran is shown to not be a credible historian. In sum, that Board has found the Veteran has not shown a right knee disorder for which service-connected disability can be considered. Accordingly, the criteria for service connection are not met and the claim must be denied. Because the evidence preponderates against the claim the benefit-of-the-doubt rule does not apply. Gilbert, 1 Vet. App. 49, 54. ORDER Service connection for a disability manifested by visual problems is denied. Service connection for bilateral tinnitus is denied. Service connection for a neck disorder is denied. Service connection for a left shoulder disorder is denied. Service connection for a right knee disorder is denied. ____________________________________________ MICHAEL E. KILCOYNE Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs