Citation Nr: 1322082 Decision Date: 07/10/13 Archive Date: 07/18/13 DOCKET NO. 08-38 060 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Indianapolis, Indiana THE ISSUES 1. Entitlement to service connection for a right elbow disorder. 2. Entitlement to service connection for a low back disorder. ATTORNEY FOR THE BOARD L. Edwards, Associate Counsel INTRODUCTION The Veteran had active service from April 1970 to May 1970. This matter comes before the Board of Veterans' Appeals (BVA or Board) from a March 2008 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Indianapolis, Indiana. In June 2010, October 2011, and September 2012, the Board remanded these claims for additional development. That development having been completed, the claims are now ready for appellate review. FINDINGS OF FACT 1. A right elbow disorder clearly and unmistakably existed prior to service and was not aggravated by service. 2. A low back disorder clearly and unmistakably existed prior to service and was not aggravated by service. CONCLUSIONS OF LAW 1. Service connection for a right elbow disorder is not established. 38 U.S.C.A. §§ 1110, 1111, 1131, 1153 (West 2002); 38 C.F.R. §§ 3.303, 3.304, 3.306 (2012). 2. Service connection for a low back disorder is not established. 38 U.S.C.A. §§ 1110, 1111, 1131, 1153 (West 2002); 38 C.F.R. §§ 3.303, 3.304, 3.306 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Duty to Notify and Assist As set forth in the Veterans Claims Assistance Act of 2000 (VCAA), the Department of Veterans Affairs (VA) has a duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102-5103A, 5106, 5107, 5126 (West 2002 & Supp. 2012). Under the VCAA, when VA receives a claim, it is required to notify the claimant and his representative, if any, of any information and medical or lay evidence that is necessary to substantiate the claim; that VA will seeks to provide; and that the claimant is expected to provide. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b) (2012); Quartuccio v. Principi, 16 Vet. App. 183 (2002). This notice must be provided prior to an initial unfavorable decision on a claim by the regional office. Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006). The notice requirements of the VCAA apply to all five elements of a service-connection claim, including: (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. See Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). Further, this notice must include information that a disability rating and an effective date for the award of benefits will be assigned if service connection is awarded. Id. at 486. The VCAA duty to notify was satisfied by a letter sent to the Veteran in December 2007 that fully addressed the entire notice element. The letter informed him of what evidence was required to substantiate his claims and of his and the VA's respective duties for obtaining evidence. In any event, in his statements and testimony, the Veteran demonstrated his actual knowledge of the elements necessary to substantiate his claims. See Short Bear v. Nicholson, 19 Vet. App. 341, 344 (2005). There is no allegation from the Veteran that he has any evidence in his possession that is needed for full and fair adjudication of these claims, and the Board finds that the notification requirements of the VCAA have been satisfied as to timing and content. To fulfill Dingess requirements, in December 2007, the regional office provided the Veteran with notice as to what type of information and evidence was needed to establish a disability rating and the possible effective date of the benefits. The regional office successfully completed the notice requirements with respect to the issue on appeal. Therefore, adequate notice was provided to the Veteran prior to the transfer and certification of his case to the Board and complied with the requirements of 38 U.S.C. § 5103(a) and 38 C.F.R. § 3.159(b). Additionally, VA has a duty to assist the Veteran in claim development. This includes assisting in the procurement of service treatment and hospitalization records and pertinent medical records, as well as providing an examination when necessary. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159. In this case, the Board finds that all necessary development has been accomplished, and therefore appellate review may proceed without prejudice to the Veteran. See Bernard v. Brown, 4 Vet. App. 384 (1993). The regional office has obtained service treatment records, private treatment records, and VA medical examinations and opinions pertinent to the issues on appeal. Virtual VA records have been reviewed. Therefore, the available medical evidence and records have been obtained in order to make an adequate determination. Neither the Veteran nor his representative has identified any additional existing evidence that has not been obtained or is necessary for a fair adjudication of the claims. The VA's duty to assist in the development of the claims is complete, and no further notice or assistance to the Veteran is required to fulfill the duty. Smith v. Gober, 14 Vet. App. 227 (2000), Dela Cruz v. Principi, 15 Vet. App. 143 (2001). II. Service Connection Claims The Veteran seeks entitlement to service connection for a right elbow disorder and a low back disorder. The Board notes that it has thoroughly reviewed the record in conjunction with this case. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, the extensive evidence submitted by the Veteran or on his behalf. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (the Board must review the entire record, but does not have to discuss each piece of evidence). Rather, the Board's analysis below will focus specifically on what the evidence shows, or fails to show, on the claims. See Timberlake v. Gober, 14 Vet. App. 122, 129 (2000) (noting that 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). Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303(a). Establishing service connection generally requires (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 present disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); see Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd per curiam, 78 F.3d 604 (Fed.Cir.1996) (table); see also Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); Hickson v. West, 12 Vet. App. 247, 253 (1999); 38 C.F.R. § 3.303. Under 38 C.F.R. § 3.303(b), an alternative method of establishing the second and third Shedden/Caluza element is through a demonstration of continuity of symptomatology. Barr v. Nicholson, 21 Vet. App. 303 (2007); see Savage, 10 Vet. App. 488, 495-97 (1997); see also Clyburn v. West, 12 Vet. App. 296, 302 (1999). 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. Savage, 10 Vet. App. at 495-96; see Hickson, 12 Vet. App. at 253 (lay evidence of in-service incurrence sufficient in some circumstances for purposes of establishing service connection); 38 C.F.R. § 3.303(b). With chronic diseases shown as such in service (or within the presumptive period under § 3.307), so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however, remote, are service connected, unless clearly attributable to intercurrent causes. For a 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. When the disease entity is established, there is no requirement of evidentiary showing of continuity. If the condition noted during service (or in the presumptive period) is not shown to be chronic or where the diagnosis of chronicity may be legitimately questioned, then generally a showing of continuity of symptomatology after discharge is required to support the claim. 38 C.F.R. § 3.303(b). In Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013), the Federal Circuit recently limited the applicability of the theory of continuity of symptomatology in service connection claims to those disabilities explicitly recognized as "chronic diseases" in 38 C.F.R. § 3.309(a). Because arthritis is specifically listed as a chronic disease under 38 C.F.R. § 3.309(a), the theory of continuity of symptomatology is for application in the Veteran's claims of service connection. In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). To do so, the Board must assess the credibility and weight of all the evidence, including the medical evidence, to determine its probative value, accounting for evidence that it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the Appellant. See Masors v. Derwinski, 2 Vet. App. 181 (1992). A lay witness is competent to testify as to the occurrence of an in-service injury or incident where such issue is factual in nature. Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). In some cases, lay evidence will also be competent and credible on the issues of diagnosis and etiology. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Specifically, lay evidence may be competent and sufficient to establish a diagnosis where (1) a 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. Jandreau v. Nicholson, 492 F.3d at 1377; see also Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009. A layperson is competent to identify a medical condition where the condition may be diagnosed by its unique and readily identifiable features. Barr v. Nicholson, 21 Vet. App. 303, 307 (2007). Additionally, where symptoms are capable of lay observation, a lay witness is competent to testify to a lack of symptoms prior to service, continuity of symptoms after in-service injury or disease, and receipt of medical treatment for such symptoms. Charles v. Principi, 16 Vet. App 370, 374 (2002). 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). However, although the Veteran is competent in certain situations to provide a diagnosis of a simple condition such as a headache, varicose veins, or tinnitus, the Veteran is not competent to provide evidence as to more complex medical questions, such as the etiology of psychiatric, respiratory, or orthopedic disorders. See Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). In determining whether the Veteran's disability is related to service, the Board will first address whether the presumption of soundness attaches in this instance and, if so, whether it has been rebutted by clear and unmistakable evidence. Every Veteran shall be taken to have been in sound condition when examined, accepted, and enrolled into service, except as to defects, infirmities, or disorders noted at the time of the examination, acceptance, and enrollment, or where clear and unmistakable evidence demonstrates that the injury or disease existed before acceptance and enrollment and was not aggravated by such service. 38 U.S.C.A. 1111; 38 C.F.R. § 3.304(b); see also VAOPGCPREC 3-03 and Wagner v. Principi, 370 F.3d 1089 (Fed. Cir. 2004). The presumption of soundness attaches only where there has been an induction examination that did not detect or note the disability of which the Veteran later complains. See Bagby v. Derwinski, 1 Vet. App. 225, 227 (1991). The regulations expressly provide that the term "noted" signifies "[o]nly such conditions as are recorded in examination reports." 38 C.F.R. § 3.304(b). A "[h]istory of pre-service existence of conditions recorded at the time of examination does not constitute a notation of such conditions." Id. at (b)(1). When no pre-existing condition is noted upon entry into service, the Veteran is presumed to have been sound upon entry. The burden then falls on the government to rebut the presumption of soundness by clear and unmistakable evidence that the Veteran's disability was both pre-existing and not aggravated by service. See VAOPGCPREC 3-03. The government may show a lack of aggravation by establishing that there was no increase in disability during service or that any "increase in disability [was] due to the natural progress of the" pre-existing condition. 38 U.S.C. § 1153. If this burden is met, then the Veteran is not entitled to service-connected benefits. However, if the government fails to rebut the presumption of soundness under 38 U.S.C.A. § 1111, the Veteran's claim is one for service connection. A. Entitlement to Service Connection for a Right Elbow Disorder The Veteran seeks entitlement to service connection for a right elbow disorder. Service treatment records were reviewed. The Veteran's entrance examination from January 1970 noted that the Veteran had surgery on his right elbow when he was 14 years old to remove pins. It was noted that he had full range of motion. At the time, he was qualified for service. In April 1970, he sought treatment for his right elbow. It was noted that he had a history of having sustained injury to his right elbow in a fall from a horse four years prior. A review of x-rays revealed malunion of the distal humerus with loose bodies in the joint. It was noted that the Veteran was unqualified for military duty due to this injury and that he would probably have early degenerative arthritis. It was then recommended that the Veteran be discharged from service by reason of erroneous enlistment. Based on the totality of the evidence, the Board finds that the evidence clearly and unmistakably favors a conclusion that the Veteran had a pre-existing right elbow disorder at the time of his entry into active military service. 38 C.F.R. § 3.304(b). Having found clear and unmistakable evidence of a pre-existing disability, the next inquiry is whether there is clear and unmistakable evidence that the disability was not aggravated during service. VAOPGCPREC 3-03. The government may show a lack of aggravation by establishing that there was no increase in disability during service or that any "increase in disability [was] due to the natural progress" of the pre-existing condition. 38 U.S.C. § 1153; 38 C.F.R. §§ 3.304(b), 3.306(b). If this burden is met, then the Veteran is not entitled to service-connected benefits. However, if the government fails to rebut the presumption of soundness under 38 U.S.C.A. § 1111, the Veteran's claim is one for service connection. Service records do not indicate any additional injury to the Veteran's right elbow. Post-service records were also reviewed. The Veteran was afforded a VA examination in July 2010. The Veteran reported falling off a horse and injuring his right arm when he was fourteen. He stated his arm has become progressively worse. X-rays demonstrated fragmentation of the proximal radius with multiple bodies noted anterior and laterally. The examiner opined that the Veteran's right elbow disorder pre-existed service and naturally progressed. It is not clear whether the examiner considered the clear and unmistakable evidentiary standard in forming this opinion. A VA medical opinion was obtained in October 2011. The examiner stated that the Veteran's activities in service did not include any trauma and would not be sufficient to permanently alter the course of the disease. It is also not apparent whether the examiner utilized the correct evidentiary standard when formulating this opinion. An additional medical opinion was obtained in December 2012. The examiner opined that the Veteran's elbow disorder clearly and unmistakably existed prior to service and was clearly and unmistakably not aggravated beyond the natural progression. The examiner explained that the Veteran's induction examination clearly documented an elbow injury and shortly after, further evaluation elaborated upon this history, including surgery and resultant malunion. There was no history of further injury during his approximately 3-month duration of duty and his condition manifests the expected natural history. The Veteran testified during his July 2009 hearing that although he injured his elbow prior to service, it had healed and he did not experience pain until he did activities in boot camp. The Board notes that the Veteran is competent to give evidence about what he experiences; for example, he is competent to discuss current pain and other experienced symptoms. See Layno v. Brown, 6 Vet. App. 465 (1994). The Board finds the Veteran's testimony to be credible. See Barr v. Nicholson, 21 Vet. App. 303, 307-08 (2007); Washington v. Nicholson, 19 Vet. App. 362, 368-69 (2005). However, the medical evidence indicates that the Veteran's time in service clearly and unmistakably did not aggravate the Veteran's right elbow. The Veteran was only in service for a few months and there was no indication that he suffered an additional injury. Furthermore, the December 2012 VA examiner opined that the Veteran's time in service clearly and unmistakably did not aggravate the Veteran's right elbow disorder beyond the natural progression of the injury. The only evidence of record supporting the Veteran's claim is his own opinion that his pre-existing right elbow disorder was aggravated during service. In this regard, the Veteran is competent to give evidence about observable symptoms such as pain. Layno v. Brown, 6 Vet. App. 465, 469 (1994); Jandreau, supra ("Sometimes the layperson will be competent to identify the condition where the condition is simple, for example a broken leg, and sometimes not, for example, a form of cancer.") However, the Veteran is not competent in this instance to opine that his pre-existing right elbow disorder was aggravated during service, as that is a complex medical question that requires medical expertise and training, including knowledge of the etiology and progression of disease, and correlation with past medical records and reported history. The Veteran's malunion fracture with loose bodies is not a simple medical condition and as a layperson, the Veteran is not qualified through education, training, or experience to provide an opinion on whether such disorder was aggravated during service. The question of aggravation of the underlying condition would not be subject to lay observation, as contrasted with the situations contemplated by Jandreau and Barr v. Nicholson, 21 Vet. App. 303 (2007) (lay testimony is competent to establish the presence of varicose veins). Here, the Veteran's lay opinion on aggravation is not competent evidence and cannot be considered as evidence favorable to the claim. Even if any weight was afforded to the Veteran's lay opinion, the Board gives greater probative value to the medical opinion of a skilled clinical professional, such as the examiner from the December 2012 VA examination, than to the contentions of the Veteran. In light of the above, while the Veteran's right elbow symptomatology may have increased in severity during active service, the Board finds that the evidence of record clearly and unmistakably shows that his right elbow disorder, which existed prior to service, was not chronically worsened during service. It is pertinent to note that temporary or intermittent flare-ups during service of a preexisting injury or disease are not sufficient to constitute "aggravation in service" unless the underlying condition, as contrasted to the symptoms, is worsened. Hunt v. Derwinski, 1 Vet. App. 292, 297 (1991); see also Verdon v. Brown, 8 Vet. App. 529, 538 (1996). The Board observes that it is not necessary to address the issue of aggravation under the provisions of 38 U.S.C.A. § 1153 and 38 C.F.R. § 3.306(b). This statue and regulation do not apply to this case because the Board has determined under 38 U.S.C.A. § 1111 that the evidence clearly and unmistakably demonstrates that the Veteran's pre-existing right elbow disorder was not aggravated by active service. See VAOPGCPREC 3-2003. For the reasons discussed above, the Board finds that the Veteran's right elbow disorder clearly and unmistakably pre-existed active service and clearly and unmistakably was not aggravated during active service. Thus, the preponderance of the evidence is against the claim and the doctrine of reasonable doubt is not for application. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Accordingly, service connection for a right elbow disorder is not warranted. B. Entitlement to Service Connection for a Low Back Disorder The Veteran seeks entitlement to service connection for a low back disorder. Service treatment records were reviewed. The Veteran's Report of Medical History from January 1970 noted that the Veteran had occasional back aches. In April 1970, he sought treatment for his right elbow. It was noted that he had a history of having sustained injury to his right elbow in a fall from a horse four years prior. It was also noted that he had a back injury in 1968. It was noted that he had two chipped vertebrae and currently complained of low back pain. Ultimately, it was recommended that the Veteran be discharged from service by reason of erroneous enlistment, mainly based on his right elbow. The Veteran testified during his July 2009 RO Hearing that he did not experience any back problems until entering service. Importantly, however, before entering service, the Veteran indicated in January 1970 that he experienced occasional backaches. Based on the totality of the evidence, the Board finds that the evidence clearly and unmistakably favors a conclusion that the Veteran had a pre-existing back disorder at the time of his entry into active military service. 38 C.F.R. § 3.304(b). Having found clear and unmistakable evidence of a pre-existing disability, the next inquiry is whether there is clear and unmistakable evidence that the disability was not aggravated during service. VAOPGCPREC 3-03. The government may show a lack of aggravation by establishing that there was no increase in disability during service or that any "increase in disability [was] due to the natural progress" of the pre-existing condition. 38 U.S.C. § 1153; 38 C.F.R. §§ 3.304(b), 3.306(b). If this burden is met, then the Veteran is not entitled to service-connected benefits. However, if the government fails to rebut the presumption of soundness under 38 U.S.C.A. § 1111, the Veteran's claim is one for service connection. Service records do not indicate any additional injury to the Veteran's low back. In April 1970, he sought treatment for low back pain and it was noted that he had two chipped vertebra that existed prior to enlistment. Post-service records were also reviewed. The Veteran underwent surgery on his lumbar spine in May 2007. The Veteran was afforded a VA examination in July 2010. The Veteran reported falling off a horse and injuring his back when he was fourteen. He stated his back has become progressively worse. The Veteran was diagnosed with degenerative disk disease of the lumbar spine with mild forminal narrowing and multilevel spondylocace. The examiner stated that the Veteran's service records indicated he had chip fractures related to a pre-existing injury. The examiner opined that the Veteran's current pain is a result of the natural progression of his injury to the spine. It is not clear whether the examiner considered the clear and unmistakable evidentiary standard in forming this opinion. A VA medical opinion was obtained in October 2011. The examiner stated that the Veteran's activities in service did not include any trauma to the back. It is also not apparent whether the examiner utilized the correct evidentiary standard when formulating this opinion. An additional medical opinion was obtained in December 2012. The examiner opined that the Veteran's low back disorder clearly and unmistakably existed prior to service and was clearly and unmistakably not aggravated beyond the natural progression. The examiner explained that the Veteran's induction examination clearly documented a back injury. There was no history of further injury during his approximately 3-month duration of duty and his condition manifests the expected natural history. The Veteran testified during his July 2009 RO Hearing that he did not experience any back problems until entering service. The Board notes that the Veteran is competent to give evidence about what he experiences; for example, he is competent to discuss current pain and other experienced symptoms. See Layno v. Brown, 6 Vet. App. 465 (1994). However, the Board finds the Veteran's testimony is not credible. See Barr v. Nicholson, 21 Vet. App. 303, 307-08 (2007); Washington v. Nicholson, 19 Vet. App. 362, 368-69 (2005). Importantly, prior to entering service, the Veteran indicated in a January 1970 Report of Medical History that he experienced occasional backaches. As such, the testimony given during the July 2009 Hearing, reporting that he did not experience back pain prior to service, is found to not be credible. Furthermore, the medical evidence indicates that the Veteran's time in service clearly and unmistakably did not aggravate his back. The Veteran was only in service for a few months and there was no indication that he suffered an additional injury. Furthermore, the December 2012 VA examiner opined that the Veteran's time in service clearly and unmistakably did not aggravate the Veteran's low back disorder beyond the natural progression of the injury. The only evidence of record supporting the Veteran's claim is his own opinion that his pre-existing low back disorder was aggravated during service. In this regard, the Veteran is competent to give evidence about observable symptoms such as pain. Layno v. Brown, 6 Vet. App. 465, 469 (1994); Jandreau, supra ("Sometimes the layperson will be competent to identify the condition where the condition is simple, for example a broken leg, and sometimes not, for example, a form of cancer.") However, the Veteran is not competent in this instance to opine that his pre-existing low back disorder was aggravated during service, as that is a complex medical question that requires medical expertise and training, including knowledge of the etiology and progression of disease, and correlation with past medical records and reported history. The Veteran's degenerative disk disease is not a simple medical condition and as a layperson, the Veteran is not qualified through education, training, or experience to provide an opinion on whether such disorder was aggravated during service. The question of aggravation of the underlying condition would not be subject to lay observation, as contrasted with the situations contemplated by Jandreau and Barr v. Nicholson, 21 Vet. App. 303 (2007) (lay testimony is competent to establish the presence of varicose veins). Here the Veteran's lay opinion on aggravation is not competent evidence and cannot be considered as evidence favorable to the claim. Even if any weight was afforded to the Veteran's lay opinion, the Board gives greater probative value to the medical opinion of a skilled clinical professional, such as the examiner from the December 2012 VA examination, than to the contentions of the Veteran. In light of the above, while the Veteran's low back symptomatology may have increased in severity during active service, the Board finds that the evidence of record clearly and unmistakably shows that his low back disorder, which existed prior to service, was not chronically worsened during service. It is pertinent to note that temporary or intermittent flare-ups during service of a preexisting injury or disease are not sufficient to constitute "aggravation in service" unless the underlying condition, as contrasted to the symptoms, is worsened. Hunt v. Derwinski, 1 Vet. App. 292, 297 (1991); see also Verdon v. Brown, 8 Vet. App. 529, 538 (1996). The Board observes that it is not necessary to address the issue of aggravation under the provisions of 38 U.S.C.A. § 1153 and 38 C.F.R. § 3.306(b). This statue and regulation do not apply to this case because the Board has determined under 38 U.S.C.A. § 1111 that the evidence clearly and unmistakably demonstrates that the Veteran's pre-existing low back disorder was not aggravated by active service. See VAOPGCPREC 3-2003. For the reasons discussed above, the Board finds that the Veteran's low back disorder clearly and unmistakably pre-existed active service and clearly and unmistakably was not aggravated during active service. Thus, the preponderance of the evidence is against the claim and the doctrine of reasonable doubt is not for application. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Accordingly, service connection for a low back disorder is not warranted. ORDER Entitlement to service connection for a right elbow disorder is denied. Entitlement to service connection for a low back disorder is denied. ____________________________________________ JENNIFER HWA Acting Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs