Citation Nr: 1322499 Decision Date: 07/15/13 Archive Date: 07/24/13 DOCKET NO. 03-24 808 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Cleveland, Ohio THE ISSUE Entitlement to service connection for residuals of pneumonia. (The issue of entitlement to an initial rating higher than 10 percent for hypochondriasis to include cold intolerance will be the subject of a separate decision.) REPRESENTATION Veteran represented by: Barbara J. Cook, Attorney at Law WITNESS AT HEARING ON APPEAL The Veteran ATTORNEY FOR THE BOARD Debbie A. Breitbeil, Counsel INTRODUCTION The Veteran, who is the appellant, served on active duty from January 1949 to June 1952. This matter comes to the Board of Veterans' Appeals (Board) on appeal of rating decision in June 2005of a Department of Veterans Affairs (VA) Regional Office (RO). In August 2006, the Veteran appeared at the RO and testified at a hearing conducted by the undersigned Veterans Law Judge. A transcript of the hearing is of record. In a March 2008 decision, the Board denied service connection for residuals of pneumonia. The Veteran appealed the Board's decision to the U.S. Court of Appeals for Veterans Claims (Court), and in a January 2010 Memorandum Decision the Court vacated that portion of the Board's decision relevant to the issue of service connection for residuals of pneumonia and remanded the case to the Board for further development. In December 2011, the Board remanded the case to the RO for further development. As the requested development has been completed, no further action is necessary to comply with the Board's remand directives. Stegall v. West, 11 Vet. App. 268 (1998). 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). FINDINGS OF FACT 1. There is no competent medical evidence of current residuals of pneumonia. 2. Pneumonia and residuals thereof were not present during active duty; and the competent evidence shows that there are no residuals of pneumonia that are related to an injury, disease, or event of service origin. CONCLUSION OF LAW Residuals of pneumonia were not incurred in or aggravated during military service. 38 U.S.C.A. §§ 1110, 1131, 5107 (West 2002); 38 C.F.R. § 3.303 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSION I. 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. 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. The VCAA notice requirements apply to all five elements of a service connection claim: (1) veteran status; (2) existence of a disability; (3) a connection between the veteran's service and the disability; (4) degree of disability; and (5) effective date of the disability. Dingess v. Nicholson, 19 Vet. App. 473 (2006). VCAA notice must be provided to a claimant before the initial unfavorable adjudication by the RO. Pelegrini v. Principi, 18 Vet. App. 112 (2004). The RO provided pre- and post-adjudication VCAA notice by letters dated in August 2001, August 2003, March 2006, and October 2006. The Veteran was notified of the evidence needed to substantiate a claim of service connection for residuals of pneumonia; that VA would obtain service records, VA records and records of other Federal agencies; and that he could submit records not in the custody of a Federal agency, such as private medical records or with his authorization VA would obtain any non-Federal records on his behalf. The March 2006 and October 2006 notice included the elements of a service connection claim regarding the effective date of an award and the degree of disability. Furthermore, under 38 U.S.C.A. § 5103A, VA must also make reasonable efforts to assist the claimant in obtaining evidence necessary to substantiate a claim. The Veteran testified at a hearing before the undersigned Veterans Law Judge in August 2006. In Bryant v. Shinseki, 23 Vet. App. 488 (2010), the United States Court of Appeals for Veterans Claims (Court) held that 38 C.F.R. § 3.103(c)(2) requires that the Veterans Law Judge who conducts a hearing fulfill two duties to comply with the above the 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 Board hearing in August 2006, the Veterans Law Judge indicated that the hearing would focus on the issue of entitlement to service connection for residuals of pneumonia (among other issues no longer on appeal), and discussed the elements of the claim that was lacking to substantiate the claim. The Veteran was assisted at the hearing by an accredited representative from Disabled American Veterans, who no longer serves as his representative. The representative and the Veterans Law Judge asked questions to ascertain the nature and etiology of the claimed pneumonia and its residuals. There was no pertinent evidence identified by the Veteran or his representative that might have been overlooked and that might substantiate the claim. The hearing focused on the elements necessary to substantiate the claim, and the Veteran, through his testimony, demonstrated that he had actual knowledge of the elements necessary to substantiate his claim for service connection for residuals of pneumonia. Neither the representative nor the Veteran has suggested any deficiency in the conduct of the hearing. Therefore, the Board finds that, consistent with Bryant, the Veterans Law Judge complied with the duties set forth in 38 C.F.R. § 3.103(c)(2). The RO has also obtained the Veteran's service treatment records and pertinent post-service treatment records, including those from VA and those identified by the Veteran such as records from Mercy Hospital. The Veteran has submitted various private treatment records, such as those from Fernald Workers' Medical Monitoring Program. The Veteran has not identified any additional available evidence that remains outstanding. VA has provided the Veteran with an examination to assist him to substantiate his claim. 38 U.S.C.A. § 5103A(d). He was examined by VA in October 2006 and May 2012, to determine the nature and etiology of any current disease or residuals of previous respiratory illness. In light of the foregoing, VA's duty to assist is met. II. Legal Criteria Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 1131. Service connection means that the facts, shown by evidence, establish that a particular injury or disease resulting in disability was incurred in service. This may be accomplished by affirmatively showing inception 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 is required only where the condition noted during service is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. 38 C.F.R. § 3.303(b). Notwithstanding the above, service connection may also be granted for disability first diagnosed 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). Service connection may be established on a secondary basis for a disability shown to be proximately due to, or the result of, a service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either caused by or aggravated by a service-connected disability. Id.; Allen v. Brown, 7 Vet. App. 439 (1995) (en banc). III. Facts and Analysis Initially, the Board notes that it has reviewed all of the evidence in the Veteran's claims file (inclusive of records stored electronically in "Virtual VA"). Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, each item of evidence. See Gonzalez v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). Therefore, the Board will summarize the relevant evidence as appropriate, prior to applying the law. The Veteran claims entitlement to service connection for residuals of pneumonia. He asserts that his residuals are linked to the cold conditions of service when he served in Korea, from September 1950 to July 1951, and slept in tents with improper sleeping bags and clothes providing insufficient protection from the cold. He testified in 2006 that he was more susceptible to colds and pneumonia and that he had had pneumonia several times that required antibiotic treatment. The Veteran served on active duty from January 1949 to June 1952. His DD Form 214 shows that he in the Army with over two years of foreign and/or sea service. Medals include the Combat Infantry Badge and Korean Service Medal with five Bronze Service Stars. Service treatment records contain no complaints, treatment, or diagnosis of pneumonia or claimed residuals of pneumonia. At the time of his discharge, the report of separation physical examination dated in June 1952 shows that the Veteran's lungs and chest were clinically normal and that a chest X-ray taken that month was negative. After service, medical records consisting of VA and private medical records dated beginning in 1959, to include reports of VA examinations in October 2006 and May 2012, show no evidence of any upper respiratory symptoms prior to 1963. Private hospital treatment records dated in January and February 1963 show that the Veteran was treated at Mercy Hospital at that time for complaints of headache and stuffiness of the nose. His complaints reportedly began about two months previously, after an upper respiratory infection. A January 1963 report shows that the diagnosis at admission was possible pneumonia. A February 1963 discharge summary concludes with pertinent final diagnoses of acute upper respiratory infection; and acute sinusitis. VA hospital records indicate that the Veteran's first admission was in October 1970 in relation to cold injury complaints. He reported a history of hospitalization in 1963 twice for pneumonia. In a system review, his chest was negative, although on another record the Veteran indicated he coughed small amounts of yellow sputum every day and had noted a small amount of hemoptysis years ago (his history of "pneumonia" in 1963 was recorded). On physical examination, the chest and lungs were normal and a chest X-ray was negative. Private medical records, to include those associated with Fernald Workers' Medical Monitoring Program, indicate that the Veteran underwent periodic physical examination, evidently in connection with his employment. Reports do not reflect positive findings in regard to pneumonia or a chronic respiratory disability. For example, reports dated in August and September 1996 show that the Veteran's chest X-ray and pulmonary function test were normal and that a physical examination showed no findings of concern. Reports dated in September and October 1997 likewise reflected a negative chest X-ray and no clinical findings of concern relative to the respiratory system. Reports in 1998, 2000, 2001, and 2002, to include chest X-rays and pulmonary function tests, were consistent with the previous reports in that there were no respiratory findings of concern. At the time of an October 2006 VA examination, the Veteran described having been hospitalized and treated on an outpatient basis for pneumonias, which he attributed to his cold exposure history in service. He was currently on no treatment for any respiratory conditions and denied dyspnea on exertion, productive cough, sputum, hemoptysis, or anorexia. The examiner noted that the Veteran had never smoked. After an examination, the diagnoses included normal examination of the respiratory system with history of pneumonia in the past. The examiner elaborated that the Veteran did not suffer from pneumonia or have frequent recurrent pneumonia that would represent a pulmonary impairment. VA outpatient records do not show evidence of a chronic respiratory disability. A pulmonary function report of November 2006 was normal. In April 2007, the Veteran complained of a cough that had yellowish sputum, which seemed to worsen in the evening. On a subsequent record that same day, the Veteran reported a history of pneumonia in 1997. On physical examination, his lungs were clear to auscultation, and the assessment did not include a respiratory ailment. In July 2007, he complained of a chronic cough over the past two months, which was mostly non-productive. The assessment was chronic cough; the physician noted that one of the Veteran's medications was recently switched due to the cough and he could still be feeling the effects of the old medication that had cough as a side effect (or he could be having acid reflux). The physician also remarked that the Veteran's history and chest X-rays did not reflect infectious etiology. Records in March and April 2012 indicate that the Veteran was seen and treated for pneumonia; he was prescribed antibiotic treatment in March and in April a chest X-ray showed a stable chest with no cardiopulmonary findings At the time of a May 2012 VA respiratory examination, the examiner reviewed the Veteran's claims file (which included specifically noting certain findings from the service treatment records and post-service treatment records documenting treatment for respiratory conditions) and physically examined the Veteran in order to assess his current respiratory system to include any current disease or residuals of previous episodes. It was noted that the Veteran had been diagnosed with pneumonia but stated that there was nothing in the evidence of record to indicate acute or chronic symptoms of respiratory disease or dysfunction other than a single case of self-limited pneumonia successfully treated with antibiotics in March 2012. The examiner opined that the Veteran had no diagnosis or treatment for any chronic respiratory condition or dysfunction, and concluded that it was less likely than not that the Veteran has a respiratory condition or dysfunction that was caused by or the result of the claimed cold exposure in service, an episode of tonsillitis in 1949, or any other aspect of military service. The examiner explained in the rationale that the Veteran had had a few infections that were successfully treated with antibiotics, that they were thus self-limited in nature, that they had healed without residuals, and that the weight of the medical literature did not support a nexus between claimed cold exposure and the later development of chronic respiratory disease or residuals from acute infections. As the record now stands, there is no satisfactory proof that the Veteran has a current diagnosis of residuals of pneumonia. The VA examiners in October 2006 and May 2012 reviewed the Veteran's claims files and examined the Veteran. The examiners variously opined that the Veteran did not currently suffer from pneumonia, did not have frequent recurrent pneumonia that would represent a pulmonary impairment, and did not have a diagnosis or treatment for any chronic respiratory condition or dysfunction. The Veteran's reported treatment for pneumonia in 1963 was acknowledged by the examiners, and the Veteran's most recent treatment for pneumonia documented in March and April 2012 was reviewed by the VA examiner in May 2012. Nevertheless, the medical opinions reflected the belief that the infections were self-limited and had healed without residuals. In light of the foregoing, there is no current disability from pneumonia residuals. In the absence of proof of present disability, there is no valid claim of service connection for residuals of pneumonia. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). As for the Veteran's statements attributing residuals of pneumonia to service, particularly cold exposure therein, although he is competent to describe symptoms such as cough and sputum, pneumonia residuals, as claimed in this case, is not a condition under case law where lay observation has been found to be competent. Therefore, the determination as to whether pneumonia or residuals thereof were present during active service or are related to an injury or disease of service origin is medical in nature. That is, it is not capable of lay observation, and competent medical evidence is needed to substantiate the claim. See Savage v. Gober, 10 Vet. App. 488, 498 (1997) (on the question of whether the veteran has a chronic condition since service, the evidence must be medical unless it relates to a condition as to which, under case law, lay observation is competent); Barr v. Nicholson, 21 Vet. App. 303 (2007) (lay testimony is competent to establish the presence of observable symptomatology, where the determination is not medical in nature and is capable of lay observation). Under certain circumstances, lay evidence can be competent to establish a diagnosis of a simple medical condition, relate a contemporaneous medical diagnosis, or describe symptoms that later support a diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Also, the Veteran as a lay person is competent to offer an opinion on a simple medical condition. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009) (citing Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007)). As the presence or diagnosis of pneumonia and/or its residuals cannot be made by the Veteran as a lay person based on mere personal observation, which is perceived by visual observation or by any other of the senses, the disability is not a simple medical condition that the Veteran is competent to identify. Further, it is not argued or shown that the Veteran is otherwise qualified through specialized education, training, or experience to offer such a diagnosis. Where, as here, there is a question of the presence or a diagnosis of pneumonia and/or its residuals, not capable of lay observation by case law, and the disability is not a simple medication condition under Jandreau for the reason expressed, to the extent the Veteran's statements are offered as proof of the presence of pneumonia and/or its residuals in service or since service, the statements are not competent evidence, and the statements are excluded. That is, they are not admissible as evidence, and the statements are not to be considered as competent evidence favorable to claim. For these reasons, the preponderance of the evidence is against the claim that the Veteran has residuals of pneumonia related to an injury, disease, or event in service, and the benefit-of-the-doubt standard of proof does not apply. 38 U.S.C.A. § 5107(b). Notwithstanding the foregoing discussion regarding no finding of competent medical evidence of current residuals of pneumonia, even if it was accepted that the Veteran had pneumonia residuals, particularly in light of the fact that there is objective medical evidence showing treatment for pneumonia during the period of the appeal, the preponderance of the evidence is still against the Veteran's claim of service connection for residuals of pneumonia. This case presents different theories of service connection: affirmatively showing inception in service under 38 C.F.R. § 3.303(a); chronicity and continuity of symptomatology under 38 C.F.R. § 3.303(b); and first diagnosed after service under 38 C.F.R. § 3.303(d). The Board will address each of the theories in turn in the discussion that follows. Affirmatively Showing Inception in Service (38 C.F.R. § 3.303(a)) On the basis of the service treatment records alone, pneumonia and residuals thereof were not affirmatively shown to have been present in service. There was no complaint, treatment, or diagnosis of pneumonia or a respiratory disability during service or at the time of the Veteran's separation physical examination, before discharge from service. Thus, service connection under 38 U.S.C.A. §§ 1110, 1131 and 38 C.F.R. § 3.303(a) (affirmatively showing inception in service) is not established. As the preponderance of the evidence is against the claim on this theory of service connection, the benefit-of-the-doubt standard of proof does not apply. 38 U.S.C.A. § 5107(b). Chronicity and Continuity of Symptomatology (38 C.F.R. § 3.303(b)) The Veteran has testified that during service he was exposed to an extreme cold environment in Korea and that he has since been susceptible to and received treatment for colds and pneumonia. As the service treatment records lack the documentation of the combination of manifestations sufficient to identify pneumonia or its residuals, and as chronicity in service is not adequately supported by the service treatment records, in the absence of persistent symptoms of a respiratory disability, then continuity of symptomatology after service under 38 C.F.R. § 3.303(b) is required to support the claim. Since the filing of his VA disability compensation claim in 2001, the Veteran has complained that he has suffered cold symptoms and pneumonia related to cold exposure during service. In other words, it appears he is relating recurrent respiratory infections to service. Prior to the filing, however, the contemporaneous records do not show that he attributed respiratory symptoms to his cold exposure or to his period of service. After service, as previously described, there were no documented complaints, clinical findings, or diagnoses of pneumonia or a respiratory disability until many years after the Veteran's final separation from service in 1952. Private records from Mercy Hospital dated in 1963 indicated that the Veteran reported that his respiratory symptoms began about two months previously after an upper respiratory infection; neither the Veteran nor the medical providers at that time made a correlation between his complaints and his period of service. Moreover, the Veteran had an opportunity at that time to report a history of respiratory symptoms since service but he did not. While admitted to the VA hospital in October 1970, the Veteran reported that he had a productive cough every day and had a small amount of hemoptysis years ago, yet again when he had the opportunity the Veteran did not relate that his symptoms had been ongoing since service. Therefore, based on the foregoing, the medical evidence does not show that there is continuity of symptomatology after service to support the claim. The Veteran in statements in connection with his claim for VA benefits maintains that he has current residuals of pneumonia that were traceable to service. The Board, as fact finder, must determine the probative value or weight of the Veteran's statements in deciding whether there is continuity of symptomatology. After service, the evidence against continuity of symptomatology shows that the first symptoms pertaining to pneumonia or a respiratory disability were documented in 1963, more than 10 years after service. The absence of continuity of symptoms from service to 1963 is persuasive evidence against continuity of symptomatology. 38 C.F.R. § 3.303(b); Maxson v. West, 12 Vet. App. 453, 459 (1999), aff'd sub nom. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (It was proper to consider the Veteran's entire medical history, including a lengthy period of absence of complaints.). Further, as noted by the Veteran in the private records of 1963 and the VA hospital records of 1970, which were prior to the present claim, he did not attribute his symptoms to service or even report that his respiratory symptoms were of a longstanding nature. As the Veteran's early reports of respiratory problems were made for the purpose of treatment, his statements then are considered to be more credible than the statements of the Veteran made for the purpose of supporting his claim for disability benefits. For these reasons - inconsistent statements and self interest - the lay evidence of continuity lacks credibility. See Caluza v. Brown, 7 Vet. App. 498, 511 (1995) (In weighing credibility, VA may consider inconsistent statements, internal inconsistency, or self interest.); see Buchanan v. Nicholson, 451 F.3d 1331, 1336 (Fed. Cir. 2006) (The Board cannot determine that lay evidence lacks credibility merely because it is unaccompanied by contemporaneous medical evidence.). For the foregoing reasons, then, continuity of symptomatology has not been established, either by the clinical record or by the statements of the Veteran. That is, the preponderance of the evidence is against the claim of service connection for residuals of pneumonia based on continuity of symptomatology under 38 C.F.R. § 3.303(b). First Diagnosed After Service (38 C.F.R. § 3.303(d)) The Board now turns to the question of whether service connection for current residuals of pneumonia (i.e., assuming the presence of current residuals of pneumonia, which was diagnosed in March 2012) may be granted on the basis that the claimed disability was first diagnosed after service, considering all the evidence, including that pertinent to service under 38 C.F.R. § 3.303(d). In this case, there is no diagnosis of pneumonia or a respiratory disability until many years after service. Furthermore, there is no competent evidence in the record that links any current pneumonia or respiratory disability to an injury or disease or event in service. VA examiners in October 2006 and May 2012 have concluded that the Veteran did not have frequent recurrent pneumonia and that despite a few respiratory infections the Veteran was treated successfully with antibiotics and had no residuals. The May 2012 examiner further opined that the medical literature did not support the Veteran's claim of a connection between cold exposure in service and the subsequent development of chronic respiratory disability or residuals from acute infections. Further, the examiner did not find that the Veteran had a respiratory condition or dysfunction that was the result of any other aspect of service. In formulating the opinions, the VA examiners accounted for the significant facts in the record and provided rationale, referring to the documents in the file. There are no medical opinions to the contrary in the record. As for the Veteran's statements attributing claimed current pneumonia residuals to service, although he is competent to describe symptoms, the diagnosed pneumonia (as made in 2012) is not a condition under case law where lay observation has been found to be competent, as previously discussed in this decision. Therefore, the determination as to whether any current pneumonia residuals were present during active service or are related to an injury or disease of service origin is medical in nature (i.e., not capable of lay observation), and competent medical evidence is needed to substantiate the claim. See Savage v. Gober, 10 Vet. App. 488, 498 (1997) (on the question of whether the veteran has a chronic condition since service, the evidence must be medical unless it relates to a condition as to which, under case law , lay observation is competent); Barr v. Nicholson, 21 Vet. App. 303 (2007) (lay testimony is competent to establish the presence of observable symptomatology, where the determination is not medical in nature and is capable of lay observation). Under certain circumstances, lay evidence can be competent to establish a diagnosis of a simple medical condition, relate a contemporaneous medical diagnosis, or describe symptoms that later support a diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Also, the Veteran as a lay person is competent to offer an opinion on a simple medical condition. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009) (citing Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007)). As the presence or diagnosis of pneumonia and/or its residuals cannot be made by the Veteran as a lay person based on mere personal observation, which is perceived by visual observation or by any other of the senses, the disability is not a simple medical condition that the Veteran is competent to identify. Further, it is not argued or shown that the Veteran is otherwise qualified through specialized education, training, or experience to offer such a diagnosis. Where, as here, there is a question of the presence or a diagnosis of pneumonia and/or its residuals, which is not capable of lay observation by case law, and the disability is not a simple medication condition under Jandreau for the reason expressed, to the extent the Veteran's statements are offered as proof of the presence of pneumonia and/or its residuals in service or since service, the statements are not competent evidence, and the statements are excluded. That is, they are not admissible as evidence, and the statements are not to be considered as competent evidence favorable to claim. To the extent the Veteran has expressed the opinion that he has current pneumonia residuals that are related to service, the Veteran's opinion as a lay person is limited to inferences that are rationally based on his perception and does not require specialized knowledge, education, or training. As the Veteran as a lay person is not competent to declare either the presence or diagnosis of pneumonia or its residuals based on personal observation, any inference based on what is not personally observable cannot be competent lay evidence. Additionally, it is not argued or shown that he is otherwise qualified through specialized education, training, or experience to offer an opinion on the relationship between any current pneumonia residuals and an injury, disease, or event in service. Therefore, the Veteran's lay statements are not competent evidence and the statements are not to be considered as favorable evidence on the question of a possible association of a current disability of pneumonia residuals and service. As the Board does not find the Veteran competent to establish a diagnosis or to express an opinion on the origin or cause of pneumonia or pneumonia residuals, the Board need not reach the question of whether his statements are credible. And although the Veteran is competent to relate a contemporaneous medical diagnosis and symptoms that later support a diagnosis by a medical professional, the Veteran has not submitted any such evidence that establishes a diagnosis of pneumonia, pneumonia residuals, or a respiratory disability before 1963 or probative evidence that a medical professional related any pneumonia or pneumonia residuals to an injury, disease, or event in service. The Board has earlier discussed the VA examination opinions, finding that there was no current pneumonia or pneumonia residuals related to service including cold exposure therein. The VA opinions, which constitute competent medical evidence, were rendered by examiners qualified by education and training to offer a medical opinion. Such evidence opposes rather than supports the claim. As the preponderance of the evidence is against the claim based on a disability first diagnosed after service under 38 C.F.R. § 3.303(d), the benefit-of-the-doubt standard of proof does not apply. 38 U.S.C.A. § 5107(b). For the above reasons, service connection for residuals of pneumonia, considering the applicable theories of service connection, is not established. ORDER Service connection for residuals of pneumonia is denied. ____________________________________________ CHERYL L. MASON Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs