Citation Nr: 1323203 Decision Date: 07/19/13 Archive Date: 07/24/13 DOCKET NO. 04-31 739A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Cleveland, Ohio THE ISSUE Entitlement to service connection for a neck disability, to include as secondary to service-connected low back disability. REPRESENTATION Veteran represented by: The American Legion WITNESSES AT HEARING ON APPEAL The Veteran and his spouse ATTORNEY FOR THE BOARD Helena M. Walker, Counsel INTRODUCTION The Veteran served on active duty from March 1981 to May 1984. This case comes before the Board of Veterans' Appeals (Board) on appeal of a July 2003 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Cleveland, Ohio. The Veteran's case was most recently remanded by the Board in January 2013. This was done in response to an August 2012 remand from the Court of Appeals for Veteran's Claims (Court) after the parties submitted a Joint Motion for Remand (JMR) dated that same month. The requested action was taken, and the case has since been returned to the Board for adjudication. In addition to the paper claims files, the Veteran also has an electronic claims file in Virtual VA. The Board has reviewed both the paper and electronic claims files in rendering this decision. FINDING OF FACT The preponderance of the evidence is against finding that the Veteran's neck disability is etiological related to a disease, injury, or event in service, to include his service-connected back disability. CONCLUSION OF LAW The Veteran's neck disability is not due to or the result of any service-connected condition or any other incident of service. 38 U.S.C.A. §§ 1101, 1131, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.307, 3.309, 3.310 (2012). REASONS AND BASES FOR FINDING AND CONCLUSION The Board has thoroughly reviewed all the evidence in the Veteran's claims file. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, all the evidence submitted by or on behalf of the Veteran. 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). The analysis below focuses on the most salient and relevant evidence and on what this evidence shows, or fails to show, on the claim. The Veteran must not assume that the Board has overlooked pieces of evidence that are not explicitly discussed herein. See Timberlake v. Gober, 14 Vet. App. 122 (2000) (the law requires only that the Board address its reasons for rejecting evidence favorable to the Veteran). Veterans Claims Assistance Act of 2000 (VCAA) With respect to the Veteran's claim, the VA has met all statutory and regulatory notice and duty to assist provisions. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2012). Under the VCAA, when VA receives a complete or substantially complete application for benefits, it is required to notify the Veteran and his or her representative, if any, of any information and medical or lay evidence that is necessary to substantiate the claim. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b); Quartuccio v. Principi, 16 Vet. App. 183 (2002). In Pelegrini v. Principi, 18 Vet. App. 112, 120-21 (2004) (Pelegrini II), the United States Court of Appeals for Veterans Claims (Court) held that VA must inform the Veteran of any information and evidence not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; (3) that the Veteran is expected to provide; and (4) request that the Veteran provide any evidence in his or her possession that pertains to the claim. The requirement of requesting that the Veteran provide any evidence in his possession that pertains to the claim was eliminated by the Secretary during the course of this appeal. See 73 Fed. Reg. 23353 (final rule eliminating fourth element notice as required under Pelegrini II, effective May 30, 2008). Thus, any error related to this element is harmless. VCAA letter dated in December 2002, May 2004, March 2006, and March 2010 fully satisfied the duty to notify provisions. See 38 U.S.C.A. § 5103(a) (West 2002); 38 C.F.R. § 3.159(b)(1) (2012); Quartuccio, at 187. The Veteran was advised that it was ultimately his responsibility to give VA any evidence pertaining to the claim. The letters informed him that additional information or evidence was needed to support his claim, and asked him to send the information or evidence to VA. See Pelegrini II, at 120-121. The March 2006 letter also explained to the Veteran how disability ratings and effective dates are determined. See Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). The Board is aware that the Veteran was provided adequate VCAA after the rating decision on appeal, but if there is any notice deficiency is present in this case, the Board finds that any prejudice due to such error has been overcome in this case by the following: (1) based on the communications sent to the Veteran over the course of this appeal, the Veteran clearly has actual knowledge of the evidence the Veteran is required to submit in this case; and (2) based on the Veteran's contentions as well as the communications provided to the Veteran by VA, it is reasonable to expect that the Veteran understands what was needed to prevail. See Shinseki v. Sanders/Simmons, 129 S. Ct. 1696 (2009); Fenstermacher v. Phila. Nat'l Bank, 493 F.2d 333, 337 (3d Cir. 1974) ("[N]o error can be predicated on insufficiency of notice since its purpose had been served."). In order for the Court to be persuaded that no prejudice resulted from a notice error, "the record must demonstrate that, despite the error, the adjudication was nevertheless essentially fair." Dunlap v. Nicholson, 21 Vet. App. 112, 118 (2007). In this case, the Veteran has been continuously represented by an experienced national service organization and has submitted argument in support of his claim. These arguments have referenced the applicable law and regulations necessary for a grant of service connection. Thus, the Board finds that the Veteran has actual knowledge as to the information and evidence necessary for him to prevail on his claims and is not prejudiced by a decision in this case. As such, a remand for additional notice would serve no useful purpose and would in no way benefit the Veteran. Sabonis v. Brown, 6 Vet. App. 426, 430 (1994) (remands which would only result in unnecessarily imposing additional burdens on the VA with no benefit flowing to the Veteran are to be avoided). The Board also concludes VA's duty to assist has been satisfied. The Veteran's service treatment records (STRs) and VA medical records are in the file. Records from the Social Security Administration (SSA) also have been associated with the claims file. Private medical records identified by the Veteran have been obtained, to the extent possible. The Veteran has at no time otherwise referenced outstanding records that he wanted VA to obtain or that he felt was relevant to the claim. The duty to assist also includes providing a medical examination or obtaining a medical opinion when such is necessary to make a decision on the claim. 38 C.F.R. § 3.159(c)(4)(i) (2012). In this case, the Veteran was provided a VA examination in February 2013 with a separate opinion dated in May 2013. The February 2013 VA examination was found to be inadequate and the claims file was sent to another medical professional to provide a supplemental opinion. The May 2013 VA examiner considered the Veteran's complaints of an in-service neck injury, as well as the service treatment records, post-service treatment records, and reviewing previous physical examinations of the Veteran's neck. Based on the foregoing, the examiner concluded that the Veteran's neck disability was not due to or aggravated by an event, disease, or injury incurred during active service, nor was it secondary to a service-connected disability. The Board acknowledges the contentions of the Veteran's representative, who indicated that the May 2013 VA examiner did not possess the requisite licensure to provide her opinion. The representative included a purported document showing that the examiner was inactive to practice medicine. The document, however, listed another person's name, and not the name of the May 2013 examiner. In fact, the May 2013 examiner is a Medical Officer who resides in the Washington D.C. metro area. There is no indication that the May 2013 examiner is not competent to provide the requested opinion, and as will be discussed below, the February 2013 examiner based his opinion on an erroneous factual basis. As such, the representative's argument that the May 2013 examiner is not competent, fails. Therefore, as the May 2013 opinion was based on review of the claims file, including the Veteran's statements, and provided an extensive rationale for the opinion provided, the Board concludes that the opinion provided is adequate. Given the foregoing, the Board finds the evidence of record to be thorough, complete, and sufficient upon which to base a decision with respect to the Veteran's claim for service connection. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate). As such, the Board finds that the medical evidence of record is sufficient to adjudicate the Veteran's claim. Given the February 2013 VA examination, the May 2013 clarified opinion, and the subsequent readjudication of the claim, the Board finds that there has been substantial compliance with its January 2013 remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (a remand by the Board confers upon the claimant, as a matter of law, the right to compliance with the remand instructions, and imposes upon the VA a concomitant duty to ensure compliance with the terms of the remand); see also D'Aries v. Peake, 22 Vet. App. 97, 105 (2008); Dyment v. West, 13 Vet. App. 141, 146-47 (1999). As there is no indication that any failure on the part of VA to provide additional notice or assistance reasonably affects the outcome of this case, the Board finds that any such failure is harmless. See Mayfield v. Nicholson, 19 Vet. App. 103 (2005), rev'd on other grounds, Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006). Legal Criteria Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. § 1131; 38 C.F.R. § 3.303(a). Service connection requires competent evidence showing: (1) the existence of a present disability; (2) 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. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); see also Caluza v. Brown, 7 Vet. App. 498 (1995). When a chronic disease, to include arthritis, becomes manifest to a degree of 10 percent within one year of the Veteran's discharge from service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the Veteran's period of service. 38 U.S.C.A. § 1112 (West 2002); 38 C.F.R. §§ 3.307, 3.309 (2012). In this case, the Veteran was not diagnosed with arthritis of the neck for many years following service. As such, service connection on a presumptive basis is not warranted. See id. A recent decision of the U. S. Court of Appeals for the Federal Circuit (Federal Circuit Court), however, clarified that this notion of continuity of symptomatology since service under 38 C.F.R. § 3.303(b), which as mentioned is an alternative means of establishing the required nexus or linkage between current disability and service, only applies to conditions identified as chronic under 38 C.F.R. § 3.309(a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Service connection may also be established for any disability which is proximately due to or the result of a service-connected disease or injury. See 38 C.F.R. § 3.310 (2006). 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 (a) caused by or (b) aggravated by a service-connected disability. Id. The Board observes that the provisions of 38 C.F.R. § 3.310 were amended effective as of October 20, 2006, during the pendency of the instant appeal. See 71 Fed. Reg. 52744 -47 (Sept. 7, 2006). The amendment sets a standard by which a claim based on aggravation of a non-service-connected disability by service-connected one is judged. Although the VA has indicated that the purpose of the regulation was merely to apply the Court's ruling in Allen, it was made clear in the comments to the regulation that the changes were intended to place a burden on the Veteran to establish a pre-aggravation baseline level of disability for the non-service connected disability before an award of service connection based on aggravation may be made. This had not been the VA's practice and thus suggests that the recent change amounts to a substantive change in the regulation. For this reason and as the Veteran's claim was pending before the regulatory change was made, the Board will consider his claim under the prior version of 38 C.F.R. § 3.310 as it is more favorable to the Veteran. With disability compensation claims, VA adjudicators are directed to assess both medical and lay evidence. In certain circumstances lay evidence may be sufficient to establish a medical diagnosis or nexus. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009). In addressing lay evidence and determining its probative value, if any, attention is directed to both 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"). See Layno v. Brown, 6 Vet. App. 465, 469 (1994). In terms of competency, lay evidence has been found to be competent with regard to a disease with "unique and readily identifiable features" that is "capable of lay observation." See Barr v. Nicholson, 21 Vet. App. 303, 308-09 (2007) (concerning varicose veins); see also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (a dislocated shoulder); Charles v. Principi, 16 Vet. App. 370, 374 (2002) (tinnitus); Falzone v. Brown, 8 Vet. App. 398, 405 (1995) (flatfoot). That notwithstanding, a Veteran is not competent to provide evidence as to more complex medical questions and, specifically, is not competent to provide an opinion as to etiology in such cases. See Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (concerning rheumatic fever); see also Routen v. Brown, supra. 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. See Buchanan v. Nicholson, 451 F.3d 1331, 1335 (Fed. Cir. 2006); but see Maxson v. Gober, 230 F.3d 1330 (Fed. Cir. 2000) (evidence of a prolonged period without medical complaint after service can be considered along with other factors in the analysis of a service connection claim). Factual Background and Analysis The Veteran contends that a cervical spine disability is related to his service connected lumbar disability. Alternatively, he asserts that it is related to injuries to his head in service. A review of the service treatment records show that in June 1980 (prior to enlistment), the Veteran denied any problems with his neck or head. In a medical examination in June 1980, the Veteran did not have head or neck problems. His spine and head were clinically evaluated as normal. In November 1983, the Veteran reported that he had back pain after striking his back on a hatch in a tank. The pain was in the right buttock area and he was diagnosed with a muscle strain. Throughout service, the Veteran received periodic treatment for low back pain. On March 11, 1984, the Veteran had facial pain, ear ache and left facial swelling. He was diagnosed with probable mumps. He received continued treatment for mumps on March 21, 1984. He returned to duty in April 1984. In April 1984, the Veteran reported that he did not have frequent or severe headaches. He specifically reported that he did not have a head injury. He also reported that he had recurrent back pain. The Veteran's spine and head were clinically evaluated as normal. These records did not show any complaints of "blows to the head" or neck, or any other neck injury. In February 1994, the Veteran was seen for complaints of neck problems. The private physician indicated that the Veteran had decreased range of motion in his neck. He also noted that the Veteran's shunts for treatment of his nonservice-connected hydrocephalus were not palpable in the neck area. The Veteran is currently diagnosed as having degenerative changes in the cervical spine. A November 2001 x-ray of the Veteran's cervical spine revealed no fracture or dislocation. The vertebral segments were aligned normally. There were some changes of spondylosis involving the inferior end plate at C5 and the superior end plate at C6. Disc spaces appeared normal. A March 2003 x-ray of the Veteran's cervical spine revealed some narrowing of the intervertebral disc at the C4-C5 level which was more marked in comparison to the November 2001 examination. Spurs were noticed from the margins of C4-C5. The height of the vertebral bodies appeared unremarkable. The alignment appeared unremarkable. The vertebral soft tissue space was normal. The impression was some degenerative changes in the cervical spine, especially in the C4-C5 region. In a March 2003 VA Compensation and Pension Examination, the Veteran was diagnosed with degenerative joint disease of the cervical spine, especially at C4-C5, confirmed by x-ray. The Veteran indicated that he hurt his back in service, but did not allege any in-service injury to the neck. The examiner did not provide an opinion as to the etiology of the Veteran's neck disability. In September 2005 and August 2007 VA spine examinations, the Veteran did not report any chronic neck problems, nor did he contend that his service-connected low back disability caused any additional problems in his neck. In a March 2010 VA Compensation and Pension Examination, the VA examiner reviewed the claims file and medical records. The Veteran reported that he had two blows to the head in service and he began to experience upper neck pain. The Veteran reported that the pain had been constant and progressive since service. After physical examination and review of x-rays, the Veteran was diagnosed with cervical spine degenerative disc disease. The examiner opined that the Veteran's cervical spine degenerative disc disease was as likely as not caused by or related to injury in service. The rationale provided was that injury or trauma to the spine has been shown in medical literature to be an etiologic factor in the development of degenerative disease. In a June 2011 decision, the Board denied the claim. In the decision, the Board determined that the March 2010 opinion was based on an inaccurate factual premise and is not probative. The August 2012 JMR argued that the terms of the December 2009 Board remand had not been complied with. It stated that a remand was necessary in accordance to Stegall v. West, 11 Vet. App. 268 (1998) as the Board erred by failing to ensure that the development undertaken in the case complied with the terms in the Board's December 2009 remand. In January 2013, the Board remanded the claim for a new VA examination. The Veteran was afforded a new VA examination in February 2013, at which time his degenerative joint disease of the cervical spine was confirmed. The Veteran indicated that during service he had "2 blows" to the head, and then he started to develop upper neck pain. He told the examiner that the neck pain has been constant and progressive since that time. Following review of the claims file, and interview and physical examination of the Veteran, the examiner provided a nearly identical opinion as the March 2010 examiner. Again, the March 2010 opinion was found to be inadequate by the Board because it was based on an inaccurate factual background. The February 2013 examiner stated that the Veteran's neck disability was at least as likely as not incurred in or caused by the claimed in-service injury, event, or illness. In so concluding, the examiner indicated that trauma to the spine has been shown in medical literature to be a factor in development in degenerative disease, and the Veteran had injury to the head in service. Additionally, the examiner did not provide an opinion with respect to secondary service connection. The claims file was sent to a VA Medical Officer in May 2013 for a clarified opinion with respect the Veteran's neck disability. The examiner reviewed the Veteran's claims file, including the previous VA examination reports, and opined that his current neck disability is less likely than not incurred in, caused by, or aggravated by his time in the military. In reaching this conclusion, the examiner based her opinion in part, on the fact that although the Veteran reported other back problems during service, he never reported problems with his neck. Further, there were no treatment records related to any head or neck injury during service. In addition, she found that there is no nexus between the Veteran's service-connected back disability and his claimed neck disability. In so concluding, she looked specifically at the medical notes regarding treatment for his back disability, and they do not include any reference to head or neck complaints. She stated that although it would be speculation to say exactly, she opined that the Veteran's current neck disability is at least as like as not related to his normal and natural aging process. She opined that the neck problems are not aggravated beyond the normal aging process by anything related to service. The examiner further opined that the Veteran's current neck disability is not secondary to his service-connected back disability. She based this opinion on current literature showing no scientific-based evidence linking a neck disability to a low back disability, and anatomically speaking, the neck and low back are too far apart in distance to result in the back disability causing a neck disability. Additionally, she indicated that movement in the neck is a nonweight-bearing function, and that his neck and low back would at least as likely as not function independently and mutually exclusive of each other. It is clear from the record that the Veteran has a current neck disability. As noted above, the Veteran contends that this disability was either due to head injuries during service or proximately caused or aggravated by his service-connected low back disability. Based on the evidence of record, the Board concludes it was not. The Board finds the opinions expressed in the May 2013 VA Medical Officer's report to be credible and highly probative. The report was based on a careful review of the claims file, and review of previous VA examinations that included interviews of the Veteran as well as physical examinations. Further, a complete and through rationale is provided for the opinion rendered. As noted, the Veteran did not have significant neck complaints until the early-2000s, which was many years after the onset of significant low back problems, and many years after discharge from service. Additionally, she indicated that there were no complaints of neck problems following the documented in-service back injury. Further, she opined that the anatomical distance between the low back and neck would tend to show no nexus between the Veteran's service-connected back disability and his claimed neck disability. As such, she concluded that the Veteran's neck disability is less likely than not related to an event, injury, or disease while on active duty, and is less likely than not secondary to his service-connected back disability. These opinions are fully explained and consistent with the evidence of record. The medical professional's opinions clearly contemplated both causation and aggravation. The Board is aware of two, nearly identical VA opinions dated in March 2010 and February 2013. These examiners opined that the Veteran's current neck disability was at least as likely as not related to the Veteran's alleged in-service head injuries. The Board notes that there is no clinical evidence of record showing any treatment for head/neck injuries during service. For the reasons described more fully below, the Board considers the March 2010 and February 2013 VA examination reports to be based on an incorrect factual premise and, therefore, of no probative value here. See Reonal v. Brown, 5 Vet. App. 458 (1993); see also Kowalski v. Nicholson, 19 Vet. App. 171, 179 (2005) (holding that the Board may reject a medical opinion that is based on facts provided by the Veteran that have been found to be inaccurate or that are contradicted by other facts of record); see also Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (explaining that factors affecting the probative value of a medical opinion are whether the opinion is based on sufficient facts or data, is the product of reliable principles reliably applied to the facts, and the reasoning employed by the expert). The Board has considered the Veteran's contentions that he had two head injuries during service and that he has experienced ongoing neck problems since service. The Board, however, has "the authority to discount the weight and probity of evidence in the light of its own inherent characteristics and its relationship to other items of evidence." Madden v. Brown, 125 F.3d 1477, 1481 (Fed. Cir. 1997). In this case, the "inherent characteristics" of the Veteran's current statements as to a continuity of head injuries during service and neck problems from service are inconsistent with the objective medical record and his own more contemporaneous statements. In that regard, the Veteran was not shown to have any chronic neck disability at service discharge, nor did the Veteran complain of any neck problems until 1994, and then again in the early-2000s. Of even greater significance, the Veteran was seen numerous times following service for musculoskeletal complaints, including back complaints, and he did not bring up his neck problems. And as noted above, his first diagnosis of degenerative joint disease of the neck appears to have occurred during his March 2003 VA examination. As such, the Board finds that had the Veteran been experiencing ongoing neck problems since service, it would have been reasonable for him to make such an assertion to his treating professionals between service separation and the present. The Board finds that all these factors weigh heavily against finding that the Veteran's current assertions of continuity of symptomatology since service to be credible. The Board also has considered the case of Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006), wherein the Court held that the Board cannot determine that lay evidence lacks credibility merely because it is unaccompanied by contemporaneous medical evidence. However, this is not a case in which the record is merely silent regarding whether or not he experienced injury or complaints in service. Rather, this is a case in which the record shows no neck disability or complaints at separation from service, and no neck complaints until 1994. Additionally, he did not describe any neck problems to treating personnel during the times he was treated for his other musculoskeletal complaints soon after discharge from service. The Veteran had every opportunity to discuss these complaints to treating personnel, but did not do so. Thus, there is affirmative evidence, rather than merely a lack of contemporaneous evidence. In short, the Board gives greater credence and weight to the contemporaneous and near contemporaneous medical records and the Veteran's statements when seeking such treatment and than his recent assertions of continuity of symptomatology and in-service injuries to the neck, which were first made only after filing his claim for service connection. Therefore, the Board finds that the Veteran's allegations of an in-service neck/head injury and continuity of symptomatology are not credible. Furthermore, the Board has considered the Veteran's contentions that his current neck disability was caused by his service-connected low back disability. In this regard, the Board acknowledges that the Veteran is competent to give evidence about what he experienced; for example, he is competent to discuss the existence of neck pain. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005). However, in most cases, the Veteran is not competent to render an opinion as to the cause or etiology of any current disorder because he does not have the requisite medical knowledge or training. See Rucker v. Brown, 10 Vet. App. 67, 74 (1997) (stating that competency must be distinguished from weight and credibility, which are factual determinations going to the probative value of the evidence). In this instance, therefore, the Veteran, as a lay person, has not been shown to be capable of making medical conclusions, especially as to complex medical diagnoses such as a link between his current neck disability and his low back disability. As such, the Board ascribes far more weight to the conclusions of the medical professional who concluded that the Veteran's current neck disability was not caused or aggravated by his low back disability. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007) (explaining in footnote 4 that a veteran is competent to provide a diagnosis of a simple condition such as a broken leg, but not competent to provide evidence as to more complex medical questions). In short, the most probative medical evidence specifically rules out a relationship between the Veteran's current neck disability and his back disability. The Board places more weight on the opinion of the competent VA medical professional who provided the May 2013 opinions, based on review of the medical records and claims file and review of the Veteran's interviews and physical examinations, than on the Veteran's lay assertions that his current neck disability is related to his back disability. As such, no finding of service connection is warranted on a secondary basis. For the same reasons as discussed above, the Board finds that the Veteran's statements with respect to his in-service neck/head injury and continuity of neck symptoms lack credibility. In summary, the preponderance of the evidence demonstrates that the Veteran's degenerative joint disease of the cervical spine was not caused or aggravated by his military service or service-connected low back disability. In that regard, the Board finds the conclusions of the May 2013 VA opinion provider of significantly more probative value than those of the Veteran based on his non-credible claims of continuity of neck symptomatology from service, and more probative than the March 2010 and February 2013 opinions by VA examiners based upon an inaccurate factual basis. As such, the Board finds that the benefit of the doubt doctrine is not for application, and that the claim must be denied. See generally Gilbert v. Derwinski, 1 Vet. App. 49 (1990); Ortiz v. Principi, 274 F.3d 1361 (Fed Cir. 2001). ORDER Service connection for a neck disability is denied. ____________________________________________ MICHAEL LANE Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs