Citation Nr: 1324074 Decision Date: 07/29/13 Archive Date: 08/07/13 DOCKET NO. 09-27 638 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Houston, Texas THE ISSUE Entitlement to service connection for a lumbar spine (low back) disorder. REPRESENTATION Appellant represented by: Texas Veterans Commission ATTORNEY FOR THE BOARD T. M. Gillett, Counsel INTRODUCTION The Veteran had active military service from June 1980 to July 1981. This appeal to the Board of Veterans' Appeals (Board/BVA) is from a May 2008 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In a September 2012 decision, the Board denied other claims the Veteran also had appealed - for service connection for a cervical spine (neck) disorder, for a bilateral shoulder and arm disorder manifested by pain, and determined he did not meet the basis eligibility requirements for non-service-connected pension benefits. Therefore, those claims are no longer at issue. However, the Board instead remanded this remaining claim for service connection for a low back disorder to the RO via the Appeals Management Center (AMC) to have the Veteran provide further details concerning his purported low back injury in service, including especially insofar as the circumstances of that injury and any treatment he may have received in the aftermath of it, and, assuming he provided sufficient information regarding this, to then have him undergo a VA compensation examination for a medical nexus opinion concerning the likelihood that any current low back disability is the result of that alleged injury in service. On remand, the AMC sent him a letter later in September 2012 and another in November 2012 asking that he provide additional details concerning his purported low back injury in service. He did not respond to those requests, however. The AMC also had him undergo a VA compensation examination in February 2013 for the requested medical nexus opinion regarding the etiology of his low back disorder and alleged relationship with an injury during his military service. But after considering the opinion obtained, which was unfavorable, the AMC issued a Supplemental Statement of the Case (SSOC) later in February 2013 continuing to deny the claim. So this claim is again before the Board for further appellate consideration. FINDING OF FACT The Veteran's currently diagnosed low back disorder, specifically, degenerative disc disease (DDD), has been determined by competent and credible medical opinion to be unrelated to his service or any incident of his service, including especially the alleged trauma when he says he fell from a telephone pole. CONCLUSION OF LAW His current low back disorder is not the result of disease or injury incurred in or aggravated by his active military service and may not be presumed to have been incurred during his service. 38 U.S.C.A. §§ 1101, 1112, 1113, 1131, 1137, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2012). REASONS AND BASES FOR FINDING AND CONCLUSION I. The Duties to Notify and Assist VA has duties to notify and assist a Veteran in substantiating a claim for benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2012). To this end, upon receipt of a complete or substantially complete application, VA was required to inform this Veteran of any information and medical or lay evidence not then of record: (1) that was necessary to substantiate this claim; (2) that VA would obtain and assist him in obtaining; and (3) that he was expected to provide. 38 C.F.R. § 3.159(b)(1); see also Quartuccio v. Principi, 16 Vet. App. 183, 187 (2002); Charles v. Principi, 16 Vet. App. 370, 373-74 (2002). Ideally, VCAA notice should be provided prior to an initial unfavorable decision on a claim by the RO. Pelegrini v. Principi, 18 Vet. App. 112 (2004) (Pelegrini II). If, however, for whatever reason it was not, or the notice provided was inadequate or incomplete, this timing error can be effectively "cured" by providing any necessary VCAA notice and then readjudicating the claim - including in a statement of the case (SOC) or supplemental SOC (SSOC) - such that the intended purpose of the notice is not frustrated and the Veteran is given an opportunity to participate effectively in the adjudication of the claim. See Mayfield v. Nicholson, 499 F.3d 1317, 1323 (Fed. Cir. 2007) (Mayfield IV); Prickett v. Nicholson, 20 Vet. App. 370, 376 (2006). Here, the RO sent a letter to the Veteran in January 2008, prior to initially adjudicating this claim in May 2008, therefore in the preferred sequence. The letter apprised him of the type of evidence and information needed to substantiate this claim on its underlying merits and of his and VA's respective responsibilities in obtaining this supporting evidence. The letter also provided information concerning how a "downstream" disability rating and effective date are determined in the eventuality a condition is found to be service connected. See Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006), aff'd, Hartman v. Nicholson, 483 F.3d 1311 (Fed. Cir. 2007). The Veteran therefore has received all required notice concerning his claim. VA also fulfilled its duty to assist him with this claim by obtaining all potentially relevant evidence, which is obtainable, and therefore, appellate review of this claim may proceed without prejudicing him. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159; see also Bernard v. Brown, 4 Vet. App. 384 (1993). To this end, the RO obtained his available service treatment records (STRs), as well as his procurable VA outpatient and private treatment records. Indeed, one of the specific reasons for remanding this claim in September 2012 was to try and obtain additional information and evidence concerning his alleged low back injury in service (a reported fall from a telephone pole), both insofar as the exact nature of the injury and regarding any evaluation or treatment he may have received in the aftermath of that accident. But as already alluded to, he did not provide any additional details concerning the incident in service, although sent letters in September and November 2012 asking that he provide additional details concerning that purported trauma. The duty to assist him with his claim is not a "one-way street", so he cannot stand passively by when he has putative evidence essential to his claim. See Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). As for other evidence worth noting, the file contains a copy of a May 2006 decision by an Administrative Law Judge of the Social Security Administration (SSA) granting the Veteran's claim for disability insurance benefits. The file, however, does not show that VA has contacted SSA to obtain any additional SSA records, to specifically include any treatment records utilized in making that May 2006 determination. In some instances, VA has a duty to obtain such records. Quartuccio v. Principi, 16 Vet. App. 183, 187-88 (2002); Voerth v. West, 13 Vet. App. 117, 121 (1999); Baker v. West, 11 Vet. App. 163, 169 (1998); Murincsak v. Derwinski, 2 Vet. App. 363, 370-72 (1992); Lind v. Principi, 3 Vet. App. 493, 494 (1992). But in Golz v. Shinseki, 590 F.3d 1317 (Fed. Cir. 2009), the U. S. Court of Appeals for the Federal Circuit (Federal Circuit Court) clarified that VA's duty to assist was limited to obtaining relevant SSA records. The Federal Circuit Court rejected the argument in Golz that SSA records are always relevant and that VA always is required to obtain them. Relevant records were defined under 38 U.S.C. § 5103A as those relating to the injury for which the claimant is seeking VA benefits and have a reasonable possibility of helping to substantiate the claim. Golz, 590 F.3d at 1321. The Federal Circuit Court also pointed out that, "[n]ot all medical records for a Veteran will have a reasonable possibility of aiding in the substantiation of a VA disability claim." Id. The Federal Circuit Court thus concluded in Golz, "[t]here must be specific reason to believe these records may give rise to pertinent information to conclude that they are relevant." Id., at 1323. Here, in the May 2006 SSA decision the Administrative Law Judge indicated he was basing the decision entirely on the listed treatment records, indicating treatment for cervical spine and shoulder disabilities. In the entire decision, the SSA examiner did not make any reference to the Veteran's claimed low back disorder or indicate that he had had reviewed any evidence regarding the low back disorder. Therefore, as that May 2006 SSA decision apparently was based entirely on evidence concerning other disabilities, the Board finds no specific reason to believe that the procurement of the records utilized by the Administrative Law Judge in making his determination would give rise to pertinent information regarding the Veteran's present claim before the Board. This is especially true considering the Board already has considered and denied, in September 2012, his additional claims of entitlement to service connection for cervical spine and shoulder disabilities. Therefore, the outstanding SSA records concerning these already denied claims lack relevancy to this remaining claim for a lumbar spine (low back) disability. Thus, a remand for their procurement would serve no useful or meaningful purpose and only instead result in unnecessarily imposing additional burdens on VA with no potential benefit flowing to the Veteran. See Soyini v. Derwinski, 1 Vet. App. 540, 546 (1991); Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). Further concerning the duty to assist, a VA medical examination as mentioned was provided on remand concerning this claim in February 2013. The February 2013 VA medical examination report provides sufficient medical evidence for deciding this claim as it addresses the salient questions of whether the Veteran has a low back disorder and whether this disorder is related or attributable to his service or dates back to his service. See Barr v. Nicholson, 21 Vet. App. 303, 311-12 (2007) (holding that once VA undertakes the effort to provide an examination for an opinion, it must ensure the examination and opinion are adequate). So, in summary, the Board finds that it is difficult to discern what additional guidance VA could have provided the Veteran regarding what further evidence he should submit to substantiate his claim. See Livesay v. Principi, 15 Vet. App. 165, 178 (2001) (en banc) (observing that "the VCAA is a reason to remand many, many claims, but it is not an excuse to remand all claims."); Reyes v. Brown, 7 Vet. App. 113, 116 (1994); Soyini, 1 Vet. App. at 546 (both observing circumstances when a remand would not serve any useful or meaningful purpose or result in any significant benefit to the Veteran). In deciding this claim, the Board has reviewed all of the relevant evidence in the Veteran's claims file, both his physical claims file and electronic ("Virtual VA") claims file, also referred to as his e-folder. Although the Board has an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that the evidence submitted by him or obtained on his behalf be discussed in exhaustive detail, so the Board need not specifically address each and every piece of evidence. Rather, the Board's analysis below will focus specifically on what evidence is needed to substantiate the claim and what the evidence in the claims file shows, or fails to show, with respect to the claim. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) and Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000). It is the Board's responsibility to evaluate the entire record on appeal. See 38 U.S.C.A. § 7104(a). When there is an approximate balance in the evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102. In Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990), the United States Court of Appeals for Veterans Claims (Court/CAVC) held that an appellant need only demonstrate that there is an "approximate balance of positive and negative evidence" in order to prevail. The Court has also stated, "[i]t is clear that to deny a claim on its merits, the evidence must preponderate against the claim." Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert, 1 Vet. App. at 53. II. Pertinent Statutes, Regulations, and Case Law Governing Claims for Service Connection Service connection is granted for disability resulting from disease or injury incurred in or aggravated by active military service in the line of duty. 38 U.S.C.A. §§ 1131, 1153; 38 C.F.R. §§ 3.303, 3.304, 3.306. Stated somewhat differently, establishing entitlement to direct service connection requires: (1) competent and credible evidence confirming the Veteran has the claimed disability or, at the very least, showing he has at some point since the filing of his claim; (2) competent and credible evidence of in-service incurrence or aggravation of a relevant disease or an injury; and (3) competent and credible evidence of a causal relationship, nexus, or linkage between the current disability and the disease or injury incurred or aggravated during service. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004), citing Hansen v. Principi, 16 Vet. App. 110, 111 (2002). When, for example, a condition may be diagnosed by its unique and readily identifiable features, the presence of the disorder is not a determination "medical in nature" and is capable of lay observation. In such cases, the Board is within its province to weigh that testimony and make a credibility determination as to whether that evidence supports a finding of service incurrence and continuity of symptomatology sufficient to establish service connection. See Barr, 21 Vet. App. at 310. So medical evidence is not always or categorically required when the determinative issue involves either medical diagnosis or etiology, but rather such issue may, depending on the facts of the particular case, be established by competent and credible lay evidence under 38 U.S.C.A. § 1154(a) (West 2002 & Supp. 2012). See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). Lay evidence can be competent and sufficient to establish a diagnosis of a condition when: (1) a layperson is competent to identify the medical condition, (e.g., a broken leg, separated shoulder, pes planus (flat feet), varicose veins, tinnitus (ringing in the ears), etc.), (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. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The Federal Circuit Court held in Colantonio v. Shinseki, 606 F.3d 1378 (Fed. Cir. 2010) and in Waters v. Shinseki, 601 F.3d 1274, 1278 (2010), that it is error to suggest that lay evidence can never be sufficient to satisfy the requirement of 38 U.S.C.A. § 5103A(d)(2)(B) that there be a nexus between military service and a claimed condition. But as also observed by the Federal Circuit Court, lay evidence must "demonstrate some competence." See King v. Shinseki (Fed. Cir. 2012) (citing 38 U.S.C.A. § 5107(b) and 38 C.F.R. § 3.307(b)) (internal quotation marks omitted). Competent lay evidence means any evidence not requiring that the proponent have specialized education, training, or experience. See 38 C.F.R. § 3.159(a)(2); Layno v. Brown, 6 Vet. App. 465, 469 (1994) (holding that lay testimony is not competent to prove that which would require specialized knowledge, training, or medical expertise). Lay evidence is competent if it is provided by a person who has first-hand knowledge of facts or circumstances, or conveys matters that can be observed and described by a lay person. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005) (holding that appellant was competent to testify as to factual matters of which he had first-hand knowledge, such as experiencing pain in his right hip and thigh in service, reporting to sick call, being placed on limited duty, and undergoing physical therapy). However, lay testimony is not competent with respect to determinations that are "medical in nature" or require medical knowledge due to their complexity. See Barr, 21 Vet. App. at 309. For example, the Court held that a claimant was not competent to determine whether he had rheumatic fever, which was a more medically complex condition. See Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007). Jandreau similarly held that a Veteran was incompetent to diagnose a form of cancer or comment on the disease's etiology. See also Colantonio v. Shinseki, 606 F.3d 1378, 1382 (Fed. Cir. 2010) (recognizing that in some cases lay testimony "falls short" in proving an issue that requires expert medical knowledge); Waters v. Shinseki, 601 F.3d 1274, 1278 (Fed. Cir. 2010) (concluding that a Veteran's lay belief that his schizophrenia had aggravated his diabetes and hypertension was not of sufficient weight to trigger VA's duty to seek a medical opinion on the issue). Competent medical evidence, as opposed to lay evidence, is evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions. 38 C.F.R. § 3.159(a)(1). Competent medical evidence may include statements conveying sound medical principles found in medical treatises. Id. It would also include statements contained in authoritative writings such as medical and scientific articles and research reports or analyses. Id. Whether medical versus lay evidence can establish this required cause-and-effect correlation between the Veteran's claimed disability and his military service, including by way of a service-connected disability, depends entirely on the nature and specific type of disability that he is claiming. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). So in some instances mere lay evidence will suffice, whereas in others it will not, requiring instead supporting medical evidence. Competency of evidence also differs from its ultimate weight and credibility. Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, whereas credibility is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67 (1997); Layno v. Brown, 6 Vet. App. 465 (1994) (distinguishing between competency ("a legal concept determining whether testimony may be heard and considered") and credibility ("a factual determination going to the probative value of the evidence to be made after the evidence has been admitted")); Cartwright v. Derwinski, 2 Vet. App. 24 (1991) (although interest may affect the credibility of testimony, it does not affect competency to testify). A Veteran is competent to report symptoms because this requires only personal knowledge, not medical expertise, as it comes to him through his senses. See Layno, 6 Vet. App. 465. But even if evidence is determined to be competent, the Board has the additional duty to assess the credibility and ultimate probative weight given to the evidence. Wensch v. Principi, 15 Vet. App. 362, 367 (2001); Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). In weighing credibility, VA may consider interest, bias, inconsistent statements, bad character, internal inconsistency, facial plausibility, self interest, consistency with other evidence of record, malingering, desire for monetary gain, and demeanor of the witness. Caluza v. Brown, 7 Vet. App. 498 (1995). The Board may weigh the absence of contemporaneous medical evidence against the lay evidence in determining credibility, but the Board cannot determine that lay evidence lacks credibility merely because it is unaccompanied by contemporaneous medical evidence. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). The final determination as to whether these requirements for service connection are met is based on an analysis of all the relevant evidence of record, medical and lay, and the evaluation of its competency and credibility to determine its ultimate probative value in relation to other evidence. See Baldwin v. West, 13 Vet. App. 1, 8 (1999). Reasonable doubt concerning any issue material to the determination is resolved in the Veteran's favor. 38 C.F.R. § 3.102. III. Analysis The Veteran attributes his current low back disability to specific injury or injuries during his military service. But having reviewed the evidence of record, that is, both the lay and medical evidence, including the medical opinion obtained on remand, the Board finds that the preponderance of this evidence weighs against this claim, so it must be denied. Reviewing the evidence of record, the Veteran's service treatment records (STRs) contain no notation indicating treatment or diagnosis of a low back injury or any complaints of associated symptoms during his service. The only lay evidence suggesting any low back injury or low back disorder symptoms during his service consists of his and his representative's statements, including those the Veteran made to the February 2013 VA compensation examiner. In these statements, including in those recounted in the February 2013 VA medical examination report, the Veteran maintained that he had experienced relatively minor low back pain after falling to the floor during service after lacerating his left knee. So his mention of this type of injury in service was different to his prior allegation of having instead fallen from a telephone pole. In any event, so regardless of the specific circumstances of his injury or injuries, there is not the required attribution of his current low back disability to any trauma of any sort during his service. See Watson v. Brown, 4 Vet. App. 309, 314 (1993) ("A determination of service connection requires a finding of the existence of a current disability and a determination of a relationship between that disability and an injury or a disease incurred in service."). STRs dating from October through November 1980 indicate multiple instances of treatment in service for a laceration of the left thigh. Yet, these records contain no additional mention of complaint, treatment or diagnosis of a low back disorder or associated symptoms, including of the minor low back pain now alleged to have been experienced while in service. Although the Board must consider his lay statements and testimony regarding the claimed history of this condition, it may consider whether his self-interest may be a factor in making such statements. Pond v. West, 12 Vet. App. 341 (1999); Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991). The Board finds it significant that he did not complain of any low back symptoms or condition while receiving that treatment for his left thigh laceration, despite this opportunity, especially since he is now alleging to have injured his low back at the same time he injured his left thigh. Had both his left thigh and low back in fact been injured, it seems only reasonable to have expectation that he would have complained about both, but he clearly did not. See Struck v. Brown, 9 Vet. App. 145 (1996) (discussing how contemporaneous medical findings may be given more probative weight than contrary evidence offered years later, long after the fact); Harvey v. Brown, 6 Vet. App. 390, 394 (1994) (upholding a Board decision assigning more probative value to a contemporaneous medical record report of cause of a fall than subsequent lay statements asserting different etiology); Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997) (upholding Board decision giving higher probative value to a contemporaneous letter the Veteran wrote during treatment than to his subsequent assertion years later). Moreover, lay statements found in medical records when medical treatment was being rendered may be afforded greater probative value; statements made to physicians for purposes of diagnosis and treatment are exceptionally trustworthy because the declarant has a strong motive to tell the truth in order to receive proper care. Rucker v. Brown, 10 Vet. App. 67, 73 (1997). Consider as well that, although he reported experiencing minor low back pain immediately following the fall, he did not make any statement indicating that he had experienced any recurrent or chronic low back pain for the entire remainder of his service following that incident. The file does not contain a service discharge examination report addressing whether he had any low back problem or abnormality at the time of his separation from service. But, again, there are earlier dated records concerning his service, and none of them makes any reference to symptoms or impairment specifically referable to his low back or lumbar spine. While according to the holdings in Buchanan and Kahana it is true the Board cannot draw a negative inference from this lack of any documentation in the STRs, this is permissible when the STRs are complete or substantially complete, at least in relevant part, and the injury in question is not alleged to have occurred in combat. See Bardwell v. Shinseki, 24 Vet. App. 36 (2010) (For non-combat Veterans providing non-medical related lay testimony regarding an event during service, Buchanan is distinguishable; the lack of documentation in service records must be weighed against the Veteran's statements). Keep in mind the Veteran served on active duty in the military from June 1980 to July 1981, so during peacetime rather than wartime. And, indeed, this is precisely the reason the Board previously in September 2012 denied his claim for non-service-connected pension benefits because, at minimum, they require wartime service. Furthermore, the record contains no notation regarding any post-service low back disorder symptomatology until June 2004, when the Veteran reported experiencing low back pain to a private examiner. The record contains no lay evidence indicating the Veteran had experienced any post-service low back disorder symptomatology prior to June 2004, so during the many intervening years. During the February 2013 VA compensation examination on remand, he stated that he had experienced minor low back pain during service rather immediately after falling to the floor because of the left knee/thigh laceration. He later told the February 2013 VA examiner that he currently experiences low back pain daily. Yet, he did not make any statements indicating that he had experienced such pain previously at any time after that single incident in service, after his discharge from service, or at least at any time prior to June 2004 when is the first objective indication he complained about it. In this circumstance, the Board may consider the absence of any indication of a relevant medical complaint until so relatively long after service as one factor, just not the only or sole factor, in determining whether a disease or an injury in service resulted in chronic or persistent residual disability. See Maxson v. West, 12 Vet. App. 453, 459 (1999), aff'd sub nom. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). See, too, Mense v. Derwinski, 1 Vet. App. 354 (1991) (holding that VA did not err in denying service connection when the Veteran had failed to provide evidence demonstrating continuity of symptomatology and had failed to account for the lengthy time period following service during which there was no clinical documentation of the claimed disorder). Negative evidence, meaning evidence actually weighing against a claim, cannot be equated with the absence of substantive evidence. Forshey v. Principi, 284 F.3d 1335, 1358 (Fed. Cir. 2002) (en banc). But nonetheless, ultimately, the Board must consider all of the evidence relevant to the claim, including the availability of medical records, the nature and course of the disease or disability, the amount of time that has elapsed since military service, and any other pertinent facts. Cf. Dambach v. Gober, 223 F.3d 1376, 1380-81 (Fed. Cir. 2000). Thus, when appropriate, the Board may consider the absence of evidence when engaging in a fact-finding role. See Jordan v. Principi, 17 Vet. App. 261 (2003) (Steinberg, J., writing separately) (noting that the absence of evidence may be considered as one factor in rebutting the aggravation part of the section 1111 presumption of soundness). To further assist in determining whether there is any relationship or correlation between the disability now affecting the Veteran's low back and any injury he may have sustained during his military service, the Board remanded his claim in September 2012 for the medical nexus opinion that later was obtained in February 2013 during the VA compensation examination. In the September 2012 remand requesting the provision of this examination and obtaining of this necessary medical opinion, the Board pointed out that, in an April 2012 statement on the Veteran's behalf, the Veteran's representative had reported that the Veteran had incurred his current low back disorder after falling off a telephone pole during his service. Yet, in the February 2013 VA medical examination report, the Veteran denied ever falling off of a telephone pole. Instead, he said that he had experienced a single injury to his low back during his service, when he fell to the floor after experiencing a left knee laceration, resulting in minor back pain. He acknowledged however not requesting any treatment for his consequent pain until about 2005, when he was referred to pain management by a clinic in Victoria, Texas. There necessarily, then, would not be any STRs showing complaints or treatment referable to his low back inasmuch as he, himself, has readily conceded not receiving any such evaluation or treatment during his service. He nonetheless reported experiencing daily low back discomfort ever since in the way of chronic pain, so continuity of symptomatology under 38 C.F.R. § 3.303(b). But concerning this, the Federal Circuit Court has clarified that this notion of continuity of symptomatology since service, as an alternative means of etiologically linking current disability to service, only applies to the conditions specifically identified as "chronic" under 38 C.F.R. § 3.309(a). See Walker v. Shinseki, 708 F.3d 1331, 1333 (Fed. Cir. 2013). And while it is true that degenerative joint disease (DJD), i.e., arthritis, is a condition this VA regulation considers chronic, the same cannot be said of degenerative disc disease (DDD). But even aside from that, this notion of continuity of symptomatology also only applies to situations when a condition has been "noted" during service, which, as already discussed, did not occur in this particular instance. Still further, the February 2013 VA examiner noted that thoracolumbar spine range of motion findings indicated a 10-degree loss of extension, but no other limitations and no objective evidence of painful motion throughout testing. He did not observe any tenderness of the thoracolumbar spine, spasms, or muscle atrophy. He added that the X-rays of record and the most recent MRI report indicated a normal thoracic spine and bilateral facet atrophy causing mild bilateral neuroforaminal narrowing at L4-S1 without stenosis of the lumbar spine. He consequently diagnosed DDD of the lumbar spine. But after his interview and physical examination of the Veteran, also review of the relevant evidence in the file, he determined the Veteran's low back disorder was less likely than not related to his service or any incident of service, so including the trauma specifically alleged. In discussing the medical basis or rationale of his opinion, this VA examiner noted the Veteran's reported injury in service, that being the purported fall to the floor resulting in a laceration of his knee. So there was the required acknowledgement of this possible injury in service. Dalton v. Nicholson, 21 Vet. App. 23 (2007) (holding that an examination was inadequate where the examiner did not comment on the Veteran's report of in-service injury and instead relied entirely on the absence of evidence in the STRs to provide a negative opinion). This VA examiner observed the STRs contained many indicating treatment for the laceration, itself, but none containing any mention of contemporaneous complaint or treatment for low back pain. He additionally thought it significant that the treatment records on file, even dated since service, were unremarkable regarding any treatment for low back disorder symptomatology until approximately 2005, many decades after the Veteran's service. This VA examiner observed there was no history of documented continuing complaints or treatment to suggest a chronic disabling back condition dating back to the Veteran's service. The VA examiner further noted that the Veteran's radiographic reports (apparently referring to the X-rays and MRI) and physical examination showing DDD were compatible with his age and senescence. The VA examiner found that the evidence did not indicate a traumatic injury of the low back, such as to have caused the current disability. He therefore disassociated this disability from the Veteran's military service. As the February 2013 VA medical examination report was written after an interview of the Veteran, an objective clinical examination, a review of his claims file, and contained specific findings concerning the nature and etiology of his low back disorder, the Board finds this opinion has a lot of probative weight, especially seeing as though it is unrefuted. See Prejean v. West, 13 Vet. App. 444, 448 (2000) (indicating the Board may determine the probative value of medical opinions based on their detail, the persuasiveness of their opinions, and the physicians' access to a Veteran's medical records). The February 2013 VA compensation examiner also provided the required explanatory rationale, which is where most of the probative value of a medical opinion is derived. Neives-Rodriguez v. Peake, 22 Vet. App. 295 (2008). For these reasons and bases, the preponderance of the evidence is against the Veteran's claim of entitlement to service connection for a low back disorder. His claim resultantly must be denied. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102; Alemany, 9 Vet. App. at 518. ORDER The claim for service connection for a low back disorder is denied. ____________________________________________ KEITH W. ALLEN Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs