Citation Nr: 1324121 Decision Date: 07/29/13 Archive Date: 08/07/13 DOCKET NO. 07-39 802 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Chicago, Illinois THE ISSUE Entitlement to service connection for residuals of frostbite to the bilateral upper and lower extremities. REPRESENTATION Appellant represented by: Illinois Department of Veterans Affairs ATTORNEY FOR THE BOARD Russell P. Veldenz, Counsel INTRODUCTION The Veteran served on active duty from September 1950 to September 1952. This matter is before the Board of Veterans' Appeals (Board) on appeal of a rating decision in April 2007 of a Department of Veterans Affairs (VA) Regional Office (RO) in Chicago, Illinois. In December 2010, the Board remanded the case for development. In May 2012, the Board adjudicated claims for service connection for a hearing loss disability and for tinnitus, but again remanded the frostbite claims for development. In March 2013, the Board again remanded the frostbite claims for 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, 271 (1998). Although the Veteran had requested a hearing before a Veteran's law judge, in March 2010, he withdrew that request. Please note 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). FINDING OF FACT Residuals of frostbite to the bilateral upper and lower extremities including as manifested by peripheral neuropathy and/or arthritis were not present to a compensable degree within one year from the date of separation from service; and the Veteran's current symptoms of pain and swelling of the extremities are unrelated to an injury or disease or event in service CONCLUSION OF LAW The criteria for service connection for residuals of frostbite to the bilateral upper and lower extremities have not been met. 38 U.S.C.A. §§ 1110, 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2012). REASONS AND BASES FOR FINDING AND CONCLUSION 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 the claims. Duty to Notify Under 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b), when VA receives a complete or substantially complete application for benefits, it will notify the claimant of the following: (1) any information and medical or lay evidence that is necessary to substantiate the claim, (2) what portion of the information and evidence VA will obtain, and (3) what portion of the information and evidence the claimant is to provide. Also, the VCAA notice requirements apply to all five elements of a service connection claim. The five elements are: 1) veteran status; 2) existence of a disability; 3) a connection between the Veteran's service and the disability; 4) degree of disability; and 5) effective date of the disability. Dingess v. Nicholson, 19 Vet. App. 473, 484-86 (2006). The VCAA notice, as required by 38 U.S.C.A. § 5103(a), must be provided to a claimant before the initial unfavorable adjudication by the RO. Pelegrini v. Principi, 18 Vet. App. 112, 119 (2004). The RO provided pre- adjudication VCAA notice by letter, dated in August 2006. The notice included the type of evidence needed to substantiate the underlying claims of service connection, namely, evidence of an injury or disease or event, causing an injury or disease, during service; evidence of current disability; and evidence of a relationship between the current disability and the injury or disease or event, causing an injury or disease, during service. The Veteran was notified that VA would obtain service treatment records, VA records, and records from other Federal agencies, and that he could submit other 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 notice included the provisions for the effective date of a claim and for the degree of disability assignable. As for content of the VCAA notice, the documents complied with the specificity requirements of Quartuccio v. Principi, 16 Vet. App. 183, 186-87 (2002) (identifying evidence to substantiate a claim and the relative duties of VA and the claimant to obtain evidence); of Charles v. Principi, 16 Vet. App. 370, 374 (2002) (identifying the document that satisfies VCAA notice); of Pelegrini v. Principi, 18 Vet. App. 112, 119-120 (2004) (38 C.F.R. § 3.159 notice); of Dingess v. Nicholson, 19 Vet. App. 473, 484-86 (2006) (notice of the elements of the claim); and of Vazquez-Flores v. Peake, 580 F.3d 1270 (Fed. Cir. 2009) (evidence demonstrating a worsening or increase in severity of a disability and the effect that worsening has on employment). Further VCAA notice is not required. Duty to Assist Under 38 U.S.C.A. § 5103A, VA must make reasonable efforts to assist the claimant in obtaining evidence necessary to substantiate the claim. The RO has obtained service treatment records, VA records, records from private medical caregivers, and afforded the Veteran a VA examination in January 2011 and an addendum dated in May 2013. The report of the VA examination included a review of the Veteran's medical history, including his service treatment records, an interview and an examination of the Veteran, as well as sufficient findings to rate disability. The examiner also provided opinions as to whether the Veteran's current symptomatology are related to service and provided a rationale for the opinions. The Board concludes that the VA examination is adequate. 38 C.F.R. § 4.2; see Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (holding that when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate). The Board notes that the Veteran's service records, both treatment and personnel, were apparently destroyed in a fire at the National Archives facility in St. Louis Missouri, and are unavailable. In August 2006, the RO requested that the National Personnel Records Center (NPRC) furnish the Veteran's complete service medical and dental records. However, a response was received from NPRC in February 2007 indicating the Veteran's records were presumed destroyed by fire and that there were no service medical records or surgeon general office (SGO) records available. A February 2007 VA memorandum also reflects that, following the completion of all procedures, the Veteran's service treatment records could not be obtained. Similarly, as to personnel records, the RO in December 2010 requested that the NPRC furnish the Veteran's complete service personnel file. However, responses were received from NPRC in December 2010 and February 2011 indicating the Veteran's records were presumed destroyed by fire and that there were no service personnel records available. A March 2012 VA memorandum also reflects that, following the completion of all procedures, the Veteran's service personnel records could not be obtained. In both instances, the Veteran was notified of the unavailability of his service records and the notification also provided alternative evidence that the Veteran could submit in support of his claim. Where "service . . . records are presumed destroyed . . . the BVA's [Board's] obligation to explain its findings and conclusions and to consider carefully the benefit-of-the-doubt is heightened." O'Hare v. Derwinski, 1 Vet. App. 365, 367 (1991). The case law does not, however, lower the legal standard for proving a claim for service connection, but rather increases the Board's obligation to evaluate and discuss in its decision all of the evidence that may be favorable to the claimant. See Russo v. Brown, 9 Vet. App. 46, 51 (1996). Further, there is no adverse presumption of service connection as a result of the loss of these records. Cromer v. Nicholson, 455 F.3d 1346 (Fed. Cir. 2006). There is, however, an expanded duty to assist the Veteran in obtaining evidence from alternate or collateral sources. Id. Based on the foregoing attempts, the Board finds that VA met its expanded duty to assist the Veteran regarding the missing records and in any event, the Veteran stated he never sought treatment in service so the Veteran is not prejudiced by their absence. As the Veteran has not identified any additional evidence pertinent to the claims and as there are no additional records to obtain, the Board concludes that no further assistance to the Veteran in developing the facts pertinent to the claims is required to comply with the duty to assist. Legal Principles Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C.A. § 1110, 38 C.F.R. § 3.303. Generally, to establish entitlement to compensation for a present disability, a Veteran must show: (1) a present disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. All three elements must be proved. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection means that the facts, shown by evidence, establish that a particular injury or disease resulting in disability was incurred coincident with service, or if preexisting such service, was aggravated by service. This may be accomplished by affirmatively showing inception or aggravation during service. 38 C.F.R. § 3.303(a). Service connection may be established by continuity of symptomatology after service under 38 C.F.R. § 3.303(b). The Federal Circuit recently held that continuity of symptomatology under § 3.303(b) applies only to chronic diseases listed in § 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). Peripheral neuropathy, as an organic disease of the nervous disease, and arthritis are listed as diseases under § 3.309 as a chronic disease. The showing of a chronic disease in service requires a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word "chronic." Continuity of symptomatology after discharge is required where the condition noted during service is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. 38 C.F.R. § 3.303(b). For a Veteran who served 90 days or more of active service after December 31, 1946, there is a presumption of service connection for either peripheral neuropathy or arthritis, if the disability is manifest to a compensable degree within one year of discharge from service. 38 U.S.C.A. § 1112; 38 C.F.R. §§ 3.307, 3.309. Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Evidentiary Standards VA must give due consideration to all pertinent lay and medical evidence in a case where a Veteran is seeking service connection. 38 U.S.C.A. § 1154(a). Competency is a legal concept in determining whether lay or medical evidence may be considered, in other words, whether the evidence is admissible as distinguished from credibility and weight, factual determinations going to the probative value of the evidence, that is, does the evidence tend to prove a fact, once the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997). Competency is a question of fact, which is to be addressed by the Board. Jandreau, v. Nicholson, 492 F.3d 1372, 1377 (2007). When the evidence is admissible, the Board must then determine whether the evidence is credible. "Credible evidence" is that which is plausible or capable of being believed. See Caluza v. Brown, 7 Vet. App. 478, 511 (1995), aff'd per curiam, 78 F. 3d 604 (Fed. Cir. 1996) (the determination of credibility is a finding of fact to be made by the Board in the first instance). If the evidence is credible, the Board, as fact finder, must determine the probative value or weight of the admissible evidence, that is, does the evidence tend to prove a material fact. Washington v. Nicholson, 19 Vet. App. 362, 369 (2005). If the evidence is not credible, the evidence has no probative value. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the Veteran. 38 U.S.C.A. § 5107(b). Facts Initially, as noted, the Veteran's service records, both treatment and personnel, were apparently destroyed in a fire at the National Archives facility in St. Louis Missouri, and are unavailable. In any event, the Veteran informed VA that he never went on sick call while in the military. He has submitted statements that he suffered frostbite to the hands and knees while on a training exercise in late 1950 or early 1951, but did not seek medical attention because he would have been placed on KP or denied weekend passes. VA has obtained the records of the Veteran's private physician, Dr. B.G.T. He has been the Veteran's physician since August, 1978. There is one history, undated, where the Veteran reported swelling of the hands and feet in the early morning and he had arthritis. He had no history of neuritis or neuralgia. He worked as a miner. There is nothing in the history that indicated the Veteran had suffered a cold injury or frostbite. In December 1978, the Veteran complained of swelling in his hands and feet that started one week earlier. In February 1979, the Veteran was admitted to a hospital for symptoms of a heart attack but an extensive history did not include reference to a prior cold injury such as frostbite. The Veteran had bursitis and arthritis in his spine with radiculopathy into his extremities. A neurological and musculoskeletal examination were normal. In May 1990, the Veteran complained of his feet being cold. The note stated the Veteran had a blocked artery probably secondary to a circulation problem in the legs and the diagnosis was peripheral vascular insufficiency. A vascular consult that month attributed the Veteran's leg pain as secondary to the arthritic condition of the knee. An X-ray of the left hand in September 1990 demonstrated minimal degenerative changes in the intraphalgeal joints. In February 1992, the Veteran had an electromyelogram (EMG) with results suggestive of chronic right brachial plexopathy and a mild left carpal tunnel syndrome. For the chronic right brachial plexopathy, a compressive etiology was suspected with involvement of the posterior and lateral cords. In March 1992, the Veteran was diagnosed with left lower extremity paresthesia after complaining of symptoms of a burning sensation on his foot with standing or walking. The symptoms started three weeks earlier. Medication was suspected as the cause for the symptom. In August 1992, the Veteran's skin was very sensitive and it felt like his feet were on fire. An admission history that same month (for heart symptoms) also revealed the skin was normal except for one scar that resulted from a burn when the Veteran was seven. In November 1992, the Veteran complained of burning on the top of his feet radiating into the ankles, the right was worse than the left. The diagnosis was claudication causing the foot pain. In December 1993, the Veteran complained of decreased sensation in the dorsum of his right hand and numbness in the right arm. It was noted he had cervical spine surgery. The radial nerve was tender in the mid humerus area and the Veteran's right biceps muscle was smaller than the left. The impression was radial nerve radiculopathy. In January 1994, the Veteran complained both arms were weak but the right arm was apparently worse and his right hand was numb as if there was no blood flow. It was not the entire hand, but predominately in the dorsum of the right hand. There was no temperature change but there was some sensory impairment. He had trouble carrying objects. In the history, there is no mention of a cold injury. In August 1994, the Veteran complained of a right ring finger pain but now the left was starting to ache, which the Veteran stated was a different ache than arthritis. In November 1994, the Veteran complained both great toes were tender, but it appears he had a fungal infection and he had high uric acid leading to a diagnosis and treatment for gouty arthritis. In April 1996, Dr. B.G.T. injected corticosteroids in the Veteran's right plantar fasciitis. In August 1996, the Veteran complained of back and leg pain. The diagnosis was low back pain with sciatica. The history indicated the Veteran had a history of gout, a herniated disc, and prior back surgery in the lumbar area. In November 1996, the Veteran was diagnosed with peripheral neuritis. He also had a painful right fourth finger and all fingers on the right hand were swollen compared to the left. He was diagnosed with gout and increased uric acid. The Veteran also complained of his lower legs and feet burning with some swelling. The Veteran was evaluated by a vascular specialist who, besides noting various past coronary procedures, also noted that the Veteran had right lower extremity pain upon ambulation. The vascular specialist noted that the Veteran had low back surgery three years earlier with minor improvement and diagnosed sciatica. In December 1996, the Veteran reported paresthesia of the lower extremities for the past two months. It was a burning pain that progressively worsened. The diagnosis was peripheral neuropathy of an unknown etiology. The upper extremities were normal. He also had a rash on the top of his left foot that burned. In June 1997 the Veteran complained of pain in the left knee and the legs and feet. The note indicated he has arthritis in the knee. The leg pains occurred when he got out of bed in the morning and medication helped. An X-ray in June 1997 demonstrated osteoarthritis of the first metatarsal joint and a calcaneal spur. In March 1999, the Veteran complained of the top of his feet and his ankles had a burning sensation. The diagnosis was peripheral neuropathy. In October 2000, the Veteran was noted to have a history of arthritis and multiple degenerative changes. When the Veteran stood, he had burning in his feet probably secondary to spinal stenosis. In December 2000, the Veteran was diagnosed with degenerative disc disease of the lumbar spine with spinal stenosis and facet arthropathy. In May 2004, the Veteran was admitted to the hospital for right flank pain but reported joint pain with a history of gout. A history noted other medical events such as coronary artery bypass surgery and back surgery, but there was no history of a cold injury such as frostbite. The Veteran denied any cold or heat intolerance. In August 2005, the Veteran complained of pain in the hands and legs. The hand pain made it difficult to drive. The diagnosis was osteoarthritis. The first treatment at VA appears to have occurred in April 2006 when the Veteran stated he had bilateral burning pain in the hands and feet. The Veteran filed his clam for service connection for residuals of a frostbite injury in June 2006. In August 2006, the Veteran was diagnosed with degenerative disc disease of the lower back with radiculopathy. In September 2006, Dr. B.G.T. noted complaints of feet and hand pain with a diagnosis of rheumatoid arthritis. In October 2006 Dr. B.G.T.'s notes included a diagnosis of active rheumatoid arthritis. This diagnosis was also noted at VAMC and the Veteran reported multiple joint pains. An October 2006 VA physical therapy consult report shows that the Veteran complained of multiple joint pains to include his hands. He was also noted to have recently been diagnosed with rheumatoid arthritis. An October 2006 VA x-ray report shows degenerative changes in both of the Veteran's hands. The Veteran gave a history of a frostbite injury in 1950 and the note also indicated the Veteran had filed a claim for service connection. In January 2007, the Veteran told his medical providers at VA that he did not have any injury to the feet themselves, only the toes were frozen in service. This was in response to any X-ray finding in the left foot that suggested a recent fracture deformity. In February 2007, the Veteran reported cold weather causes pain and his feet stayed cold all the time. The diagnosis was osteoarthritis without mention of a cold injury. He also complained that month to Dr. B.G.T. that his legs and feet burn so bad that he could not sleep. He was diagnosed with restless leg syndrome and peripheral neuropathy. In May 2007, Dr. B.G.T. wrote a letter stating the Veteran had complained of symptoms related to a frostbite of the hands and feet that occurred during basic training. The Veteran still has numbness and tenderness to the right hand. The left was not as bad. The feet stay tender and sore with numbness. The hands and feet were hypersensative to cold. Dr. B.G.T. then stated "[a]pparently the frostbite caused a reflex sympathetic dystrophy-like condition to develop and persist over the years." The Veteran also developed secondary frostbite arthritis to the hands and feet, but he also had rheumatoid arthritis. In March 2008, the Veteran underwent a cardiac evaluation which included a comprehensive history and physical examination. No cold injury or frostbite was mentioned in the history and the Veteran denied intolerance to heat and cold. The Veteran also did not report any numbness and tingling or weakness. The examination as to the skin was normal. In May 2008, VA notes indicated the Veteran had chronic pain all over but he had lots of pain in the hands and feet due to a history of frostbite. He described the pain as 8/10 with pain and tingling in both hands, swelling, and stiffness. There were no focal neurological deficits. The diagnosis was rheumatoid arthritis and history of frostbite to both feet. In a letter dated in October 2008, Dr. B.G.T. opined that the Veteran's complaints of numbness and swelling of his feet, first documented in December 1978, and hands over the years, and his subsequent development of osteoarthritis, were as likely as not the result of frostbite which occurred between September 1950 and September 1952. Dr. B.G.T. did not state when the Veteran first told him about the in- service frostbite injury, except to say it was recent. He also attributed other complaints, signs, and symptoms to the history of a frostbite injury in service. For instance, in discussing a medical record dated August 1978, the physician stated that complaints of left shoulder pain with a sensation of numbness and pain in the left medial aspect of his arms and fingers "could be the first indication of some frost bite arthritis-neuropathy in my chart, especially since X-rays of his cervical spine were negative." Dr. B.G.T. also mentioned, in discussing a December 20, 1978, treatment record that the Veteran at that time complained of swelling of the feet and hands. He added that this "could definitely" be related to old frostbite injuries he suffered while in the Army. He conceded the Veteran did not mention a prior frostbite injury. The physician further mentioned that "I definitely feel that this condition could have existed long enough to date from the military time - especially it could have begun between September 1950 and September 1952." In Dr. B.G.T.'s opinion, the Veteran's complaints of pain, numbness, and swelling of the hands and feet and the development of osteoarthritis as likely as not resulted from the frostbite injury reported to him by the Veteran. The private physician noted the Veteran's history of back injuries, surgeries, and the resulting residuals are not related to the frostbite injuries. The physician stated that he has treated the Veteran mainly for his cardiac conditions but noted occasional treatment for shoulder, neck, and arm pain. The Veteran has rheumatoid arthritis, which the physician attributed to be a complication of the Veteran's frostbite. After reviewing his records, Dr. B.G.T. concluded the multiple complaints of foot and hand pain, swelling, numbness, and weakness could be related to the Veteran's recent report of a frostbite injury in service. In May 2008, a hand X-ray revealed moderate arthritis primarily in the interphangeal joints and the first carpal bone. There also was a triangulofibrocartilage complex calcification associated with hydroxapatite dispositional disease. A hand written addition to the X-ray report suggested the findings were secondary to vascular disease, renal failure, or osteoarthritis. In November 2008, the Veteran's history included rheumatoid arthritis, peripheral neuropathy, artery disease, gout, fibromyalgia, and many other diagnoses and medical events but there was no mention of a prior cold or frostbite injury. The Veteran had chronic low back pain and it was noted the Veteran had been in a motor vehicle accident decades earlier that resulted in back pain, shoulder pain, and pain in most joints. The Veteran denied weakness, swelling, or significant tenderness to the peripheral joints. The Veteran was evaluated for neck and pain in February 2009 and it included a comprehensive history and examination. The Veteran reported a burning sensation on the top of his feet and diffuse pain down his legs. There was no mention of a prior cold injury or frostbite. The diagnosis was multilevel cervical spondylosis, and lumbar stenosis with neurogenic claudication. The Veteran was provided a VA examination in January 2011. The Veteran reported he experienced frostbitten hands and feet while on a 5-day bivouac during basic training when stationed at Fort Leonard Wood, Missouri in January 1951. His exposure to the cold reportedly occurred when he slept in pup tents and while he performed his training activities in the frozen ground conditions. He noted extensive white skin flaking to the bilateral feet on day five of the training. He reported that he did not seek medical attention during active duty for the residuals. He was able to perform his full duties during military service and he did not report the disability at the time of his separation examination. He alleged that he had constant burning on the tops of the feet which he rated as five out of ten and which had persisted until the present. The Veteran did not refer to any injury or symptoms to the hands during the complete course of the exam. Since service, the Veteran reported a gradual worsening of the constant top surface of the feet progressively rated from 7/10 in 1954 and rated 10/10 in the 1960's to the present. It was treated in the 1960's with topical applications to the feet which were not helpful. He reported an onset of intermittent skin rashes to the tops and bottoms of the feet, and superficial skin infection on a persistent intermittent weekly basis to the feet beginning in the 1970's. He reported Dr. B. G. T. has found the Veteran has good peripheral circulation and the Veteran states he does not have symptoms of circulatory deficit or arthritis to the feet although the examiner noted a medical diagnosis of peripheral vascular disease affecting the legs and arms that began in 1979 in association with hyperlipidemia and atherosclerosis conditions. The Veteran stated he underwent ultrasound studies and nerve conduction studies but no significant peripheral blockages were noted. He cannot recall the results of the nerve conduction study. Medications for the burning discomfort and the joint/spine pain have been minimally helpful. He has been diagnosed with rheumatoid arthritis in the late 1990's and osteoarthritis/spinal stenosis conditions since the 1970's with 3 spine surgeries that he also reported as minimally effective. He stated the arthritic discomfort has largely involved the hips/knees and the spine. The Veteran states that his feet are not affected by either of the circulatory or arthritic conditions. Currently, the Veteran complained of pain to the dorsum of the feet, cold sensation to the feet and there is intermittent dusky discoloration to the feet "when dependent' but no change with exposure to the cold. He also reported thinning skin in the feet. The Veteran stated sensation to the feet was intact. Upon examination, the Veteran was noted to take slow, stiff, antalgic, small steps gait with a walker. His skin was pale and pink without edema. The skin temperature was warm. There was mild dryness on the soles of his feet with very light scattered flaking. There was no flaking on the tops of the feet. There were no rashes. Capillary refill was 2-3 seconds. His skin had a soft and smooth texture and despite the Veteran's report, the examiner did not find any thickening or thinning to the skin on the feet. There were no ulcerations. There was some decreased hair growth but hair was present mid-foot and on the toes. There were no signs of infections or scars. The Veteran had normal reflexes in both the upper and lower extremities. Objective sensory changes included a scattered mild to moderate loss of light touch sensation to the feet dorsums and soles as well as the hands with decreased sharp/dull discrimination. The finding included weakness, atrophy and decreased strength to the thighs, bilateral lower legs, and bilateral ankles/feet. The Veteran had intact and full peripheral pulses and there was no evidence of Raynaud's phenomenon or any evidence of vascular insufficiency. X-rays of the right ankle showed diffuse arthritic changes and a large plantar and slightly smaller posterior calcaneal spur. There was possible bone demineralization. The left ankle had severe degenerative arthritic changes noted on the articular surfaces of the left first MTP joint. There also was a suspicion of a recent fracture deformity and soft tissue calcifications, which may have represented periosteal new bone formation. Nerve conduction studies were conducted and the results were interpreted as not correlating with cold injury. It demonstrated electrodiagnostic evidence of a mixed sensorimotor peripheral neuropathy affecting bilateral lower extremities with evidence of chronic denervation of foot intrinsic muscles. Arterial and venous studies did not reveal any abnormalities. The diagnoses offered by the examiner were: (a) burning paresthesias to the feet dorsums of mixed sensorimotor etiology with chronic denervation of the intrinsic foot muscles which do not correlate with cold injury etiology; (b) peripheral vascular disease without current medical evidence or clinical findings of acute or chronic effects; (c) personal history of recurrent skin redness/flaking, and superficial skin infections to the feet with no current clinical findings or medical evidence of such; and, (d) rheumatoid arthritis/osteoarthritis with no specific effects or deficits related to the reported areas. The examiner opined that there were no residuals of frostbite at the time of the examination. The examiner also found there was no evidence of medical treatment for any claimed symptoms/problems until 1978 which was too remote from military service to be considered related to or the result of military service. The examiner also stated there is no conclusive medical evidence there are direct service related residuals of such an injury in the form of paresthesias, circulatory deficit or arthritic complications specifically to the hands or feet which are the claimed areas of injury although there is evidence of osteo and rheumatoid arthritis affecting other focal and global areas of the body. In an addendum dated in May 2013, the examiner acknowledged that the Veteran is compenant to report his signs and symptoms which the Veteran related to cold injury exposure during military service. The examiner still concluded that it is less likely than not that the Veteran's claimed chronic residuals of cold injuries to the upper and lower extremities are related to any events or conditions of military service. While the Veteran gives a subjective history of symptoms that are theoretically related to cold exposure injury, the examiner noted there was no diagnostic or clinical medical evidence of injury or residuals that can be objectively related to a cold exposure injury. Besides the lack of medical evidence of such exposure or injury during service, there is no medical evidence of treatment for symptoms or problems with the extremities until 1978 which significantly post-dates military service and is too remote to be considered service connected. Analysis As noted above, evidence from the NPRC indicates that this Veteran's records are fire-related, that is, apparently destroyed in the fire at the National Archives and Records Administration facility in St. Louis, Missouri and thus, there are no service treatment records or separation examination available for review. When service treatment records are lost or missing, VA has a heightened duty to assist in developing the claim, as well as to consider the applicability of the benefit of the doubt rule and to explain its decision. O'Hare v. Derwinski, 1 Vet. App. 365, 367 (1991). The Board has already found that the VA met its duty to assist in developing the claim by exhausting all reasonable efforts to obtain the records concerning medical treatment in service. Further efforts to search for records which likely no longer exist would be futile. VA advised the Veteran that he could submit alternative evidence. He has submitted statements, but has not submitted any additional records of medical treatment in service. In any event, it is unlikely that there ever were any detailed records of in-service treatment for a frostbite injury, as the Veteran has stated as part of his claim and to the VA examiner in January 2011 that he never sought medical attention for his hands and feet due to frostbite or a cold injury nor did he mention such an injury or symptoms at his separation examination. Therefore, the only evidence regarding the occurrence of a cold injury during service is the Veteran's statements. There is no evidence of diagnosis or treatment of a cold injury (frostbite) in service. The question still remains whether the Veteran has residuals of frostbite and if so, are they due to service. Service connection may be established by either continuity of symptomatology after service under 38 C.F.R. § 3.303(b) or by initial diagnosis of the medical condition after service under 38 C.F.R. § 3.303(d). As a lay person, the Veteran is competent to describe symptoms, which he is able to perceive through the use of his senses. 38 C.F.R. § 3.159 (Competent lay evidence means any evidence not requiring that the proponent have specialized education, training, or experience; lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person.); see Layno v. Brown, 6 Vet. App. 465, 469-71 (1994) (lay testimony is competent as to symptoms of an injury or illness, which are within the realm of one's personal knowledge, personal knowledge is that which comes to the witness through the use of the senses). Further, the Veteran's statements and testimony are admissible and are to be considered as evidence of continuity. Rucker v. Brown, 10 Vet. App. 67, 74 (1997) (Competency is a legal concept in determining whether lay evidence may be considered, in other words, whether the evidence is admissible). The Board thus finds that the Veteran is competent to describe his symptoms in service and thereafter. Here, however, while the Veteran is competent to describe symptoms during service, and over the course of 50 or more years since service, he is not a doctor competent to diagnosis his condition in service and over the course of 50 plus years. When there is evidence of continuity of symptomatology, it does not necessarily follow that there is a relationship between a current diagnosis, for example, peripheral neuropathy or arthritis, and the continuity of symptomatology as stated by the Veteran. Medical evidence is required to demonstrate such a diagnosis and a relationship to service unless such the diagnosis and the relationship to service is one to which a lay person's observation is competent. See Savage v. Gober, 10 Vet. App. 488, 497 (1997) (medical evidence is required to demonstrate continuity of symptomatology and any present disability unless such a relationship is one to which a lay person's observation is competent). Although the Veteran is competent to describe some peripheral neuropathy and some arthritis symptoms, unless either diagnosis is a condition that is capable of lay observation, the determination as to the presence or diagnosis of such a disability is medical in nature and competent medical evidence is required to substantiate the claim. Barr v. Nicholson, 21 Vet. App. 303, 308 (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). Neither peripheral neuropathy nor arthritis (whether it is rheumatoid arthritis or osteoarthritis) are conditions found to be capable of lay observation. See Jandreau, 492 F.3d at 1377 (explaining in a footnote, sometimes a layperson will be competent to identify the condition where the condition is simple, for example a broken leg, and sometimes not, for example, a form of cancer); see also Barr, 21 Vet. App at 309 (varicose veins were subject to non-expert diagnosis due to the readily observable defining characteristics of the condition). The diagnosis of peripheral neuropathy and arthritis depends upon interpretation of symptoms, and clinical and diagnostic tests, such as X-rays and laboratory tests, which requires medical knowledge. No factual foundation has been established that the Veteran is otherwise qualified through specialized education, training, or experience to offer a medical diagnosis. Therefore, the Veteran's assertion or opinion that he has residuals of frost bite, peripheral neuropathy or arthritis, and the relationship of the conditions to service is does not constitute competent medical evidence such as a diagnosis by a medical professional. The Veteran's discussion of his symptoms over the years certainly is important, however, the Veteran's opinion as to the cause of his symptoms cannot outweigh the opinion of a medical professional. The Veteran, as a lay person, is competent not only to identify a simple medical condition, but also a contemporaneous medical diagnosis, or symptoms that later support a diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The Veteran has stated his physician, presumably Dr. B.G.T., has told the Veteran that he has one of the worse cold injury cases the doctor had seen in his care, that statement does not connect any current disability to service. The Board finds that this statement, standing alone, is too generalized to be assigned much probative weight. Significantly, the private physician did not make such a comment in either his letters or office notes although he has offered opinions in letters to VA and they are discussed below. The Board has also determined that the Veteran is not credible in his statements that he suffered a cold injury and has had severe symptoms ever since. In determining whether statements submitted by a Veteran are credible, the Board may consider internal consistency, facial plausibility, and consistency with other evidence, and statements made during treatment. Caluza v. Brown, 7 Vet. App. 498, 511 (1995). The Board finds that reduced probative value should be placed on the Veteran's allegations of the presence of residuals of frostbite from the time of discharge to the present based on the length of time between the Veteran's discharge and the time when the Veteran first informed anyone that he had or had had residuals of frostbite which began during active duty. The Board recognizes that there is no in- service treatment records, but the Veteran states he has had pain and swelling in his hands and feet ever since service, with pain reaching 7/10 and he did seek some treatment. The evidence of record, documents the first treatment for the hands and feet in 1978, nearly 30 years after service. The Board recognizes lay evidence does not lack credibility merely because it is unaccompanied by contemporaneous medical evidence. See Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006) (lack of contemporaneous medical records does not serve as an "absolute bar" to the service connection claim). Instead, the evidence of continuity fails not because of the lack of medical documentation; rather the assertions of continuity are not credible and less probative than the negative evidence, which interrupts continuity. Buchanan v. Nicholson, 451 F. 3d 1331, 1336 (Fed. Cir. 2006); see also Harvey v. Brown, 6 Vet. App. 390, 394 (1994) (Board decision properly assigned more probative value to a private hospital record that included lay history that was made for treatment purposes than to subsequent statements made for compensation purposes); Kahana v. Shinseki, 24 Vet. App. 428, 440 (2011) (Lance, J., concurring) (the silence in a medical record can be weighed against lay testimony if the alleged injury, disease, or related symptoms would ordinarily have been recorded in the medical record being evaluated by the fact finder). However, the Board notes that the Veteran, while describing potential symptoms as early as 1978, did not start reporting a history of a frostbite injury in service until 2006 or later, after he filed his claim for service connection. For instance, in 1979, the Veteran underwent a comprehensive physical examination and history, even though it was for symptoms of a heart attack, but many other medical incidents and diagnoses were recorded, while a prior frostbite injury was not listed. In May 1990, he reported his feet were cold, but did not report a history of cold exposure causing injury to a vascular specialist evaluating his symptoms. He also did not report a frostbite injury in a second evaluation by a vascular specialist in November 1996. In May 2004, when hospitalized for right flank pain, he did not report a history of a cold injury and denied any cold intolerance. Even after he filed his claim, he was not consistent with his history of a frostbite injury. In March 2008, the Veteran underwent a cardiac evaluation with a comprehensive history and evaluation but did not mention a cold injury or frostbite injury and denied intolerance to the cold or numbness, tingling, or weakness. In November 2008, the Veteran's history included various diseases and medical events but there was no mention of a frostbite injury although there was a history of a motor vehicle accident causing back and shoulder pain and the Veteran denied symptoms to the peripheral joints. The Veteran also did not mention a frostbite injury when evaluated for neck and back pain in February 2009. The Court has held that contemporaneous evidence is more probative then the Veteran's statements submitted as part of his claim. Curry v. Brown, 7 Vet. App. 59 (1994) (noting that contemporaneous evidence has greater probative value than history as reported by the veteran). Further, the Board may take into consideration that the Veteran first gave a history of an in- service frostbite injury after he filed his claim. Pond v. West, 12 Vet. App. 341 (1999) (although the Board must take into consideration the Veteran's statements, it may consider whether self-interest may be a factor in making such statements); Cartwright v. Derwinski, 2 Vet. App. 24 (1991) (pecuniary interest in benefits may affect credibility of claimant's testimony). The Board recognizes that documentation of an injury is not required, Buchanan, supra, but rather, the Board has weighed the negative evidence of the treating medical records against the Veteran's statements that a cold injury to the hands and feet in service has caused him problems since separation to the present. The Veteran's post-service medical records are negative for complaints, symptoms, treatment, findings, or diagnoses for almost three decades following separation and there is no mention of a prior frostbite injury until over 50 years following separation. The Board finds this silence as to the allegation of the presence of residuals of frostbite constitutes competent probative evidence indicating that, for almost 50 years after discharge, the Veteran did not have or did not believe he had residuals of frostbite. For the same reason the Board finds the competent probative evidence of record weighs against a finding of continuity of frostbite symptomatology from the time of discharge to the present. The Board has determined that while the Veteran is competent to provide lay evidence concerning the onset of his residuals of frostbite, the Veteran is not as credible as the documented medical evidence and his prior silence that the onset of symptomatology occurred long after service. The Board has therefore assigned little weight to the Veteran's assertions of continuity of symptoms since service The Board finds that the only competent and credible medical evidence before the Board, as to the claim of service connection for residuals of a cold injury are the reports of the Veteran's private physician, Dr. B.G.T., and the VA examiner. Both are qualified by education, training, or experience to diagnose a medical condition and to offer an opinion on causation. With regard to medical opinions, the probative value or evidentiary weight to be attached to a medical opinion is within the Board's province as finder of fact. The guiding factors in evaluating the probative value of a medical opinion include whether the opinion applied valid medical analysis to the significant facts of the case in order to reach the conclusion submitted in the opinion. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-03 (2008). Dr. B.G.T.'s opinions are based upon the Veteran's history, which the physician admitted had been reported to him recently despite having treated the Veteran since 1978. As noted, the Board has found the Veteran is not credible regarding the occurrence of a frostbite injury in service and his opinions therefore are not based upon accurate facts. Swann v. Brown, 5 Vet. App. 229, 233 (1993) (the Board may reject a medical opinion because other facts present in the record contradict the facts provided by the veteran that formed the basis for the opinion); Bardwell v. Shinseki, 24 Vet. App. 36, 40 (2010) (holding that a layperson's assertions indicating exposure to gases or chemicals during service are not sufficient evidence alone to establish that such an event actually occurred during service). See also Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (holding that the Board may reject a medical opinion that is based on facts provided by the veteran that have previously been found to be inaccurate). The opinion of Dr. B.G.T. indicates that the Veteran's symptoms are frostbite disorders that "could be" related to his period of active service. The Board notes that service connection generally requires more than a "remote possibility" or "pure speculation" about a connection to service; rather, the connection to an event, injury, or disease in service should be at least as likely as a connection between the claimed disorder and some other cause or factor occurring outside of service. 38 C.F.R. § 3.102 (noting that "reasonable doubt" is a substantial doubt and one within the range of probability as distinguished from pure speculation or remote possibility); see also Bloom v. West, 12 Vet. App. 185, 187 (1999). Medical opinions that are speculative, general, or inconclusive in nature do not provide a sufficient basis upon which to support a claim. See e.g. McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006) (finding doctor's opinion that "it is possible" and "it is within the realm of medical possibility" too speculative to establish medical nexus); Goss v. Brown, 9 Vet. App. 109, 114 (1996) (using the words "could not rule out" was too speculative to establish medical nexus); Warren v. Brown, 6 Vet. App. 4, 6 (1993) (medical opinion expressed only in terms such as "could have been" is not sufficient to reopen a claim of service connection); Obert v. Brown, 5 Vet. App. 30, 33 (1993) (physician's statement that the Veteran may have been having some symptoms of his multiple sclerosis for many years prior to the date of diagnosis also implied "may or may not" and was deemed speculative). The Board concludes that the opinion of Dt. B.G.T. linking the Veteran's claimed frostbite residuals to service is essentially too speculative, general, and inconclusive in nature to provide a sufficient basis upon which to support the Veteran's claim. The Board finds that the more credible medical evidence as to the claim of service connection for residuals of a frostbite injury is the opinion of the VA examiner. The Board recognizes that, in January 2011, the reported rationale for why the claimed symptoms were not linked to active duty was that there was no medical evidence of frost bite or other cold injuries during military service and no reference to any such complaints/problems on the separation physical. The examiner clarified the opinion in May 2013 by noting that while the Veteran gives a subjective history of symptoms that are theoretically related to cold exposure injury, the examiner noted there was no diagnostic or clinical exam medical evidence of injury or residuals that can be objectively related to a cold exposure injury. Besides the lack of medical evidence of such exposure or injury during service, there is no medical evidence of treatment for symptoms or problems with the extremities until 1978 which significantly post-dates military service and is too remote to be considered service connected. Thus, the examiner was not relying exclusively or even predominately upon the lack of service documentation but upon the objective medical evidence such as multijoint arthritis and EMG/NCS results inconsistent with a cold injury and upon the length of time between service and the first instance of symptoms that might be related as a cold injury residual. The Board finds the unfavorable medical opinion of the January 2011 VA examiner is well reasoned, detailed, and provides a rationale that is consistent with other evidence of record, and included reviews of the claims file and the Veteran's symptoms. The examiner noted, for instance, what treatment was provided and when and the lack of findings or complaints until 1978. The examiner also took into account all of the medical evidence of record. He set forth an accurate historical history with medical details taken from the Veteran's claims file, which renders it especially probative. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000) (factors for assessing the probative value of a medical opinion are the physician's access to the claims file and the thoroughness and detail of the opinion). As the VA examiner applied medical analysis to the significant facts of the case to reach the conclusion expressed in the opinion, the Board also finds the evidence competent and credible and highly probative on the material issues of fact, pertaining to the issue of residuals of a cold injury that could be related to service. The VA examiner has provided the most probative evidence and the Board assigns it the most weight as the examiner's report specifically addresses the question of a diagnosis and notes that the symptoms and the findings do not show the existence of a neurological or arthritic condition that can be said to have resulted from a cold injury or frostbite. In sum, the Board finds that the opinion of the VA examiner as the most persuasive evidence of record and this weighs against the Veteran's claim. Accordingly, the weight of the medical evidence is against an association or link between any current disabilities and service, including the incident during training where the Veteran asserts he suffered frostbite injuries to the hands and feet. The preponderance of the competent probative evidence is against the claim of service connection on the applicable theories of service connection, and the benefit of-the-doubt standard of proof does not apply. 38 U.S.C.A. § 5107(b). ORDER Entitlement to service connection for residuals of frostbite to the bilateral upper and lower extremities is denied. ____________________________________________ G. A. WASIK Acting Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs