Citation Nr: 1324129 Decision Date: 07/29/13 Archive Date: 08/07/13 DOCKET NO. 08-37 061 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Louis, Missouri THE ISSUES 1. Entitlement to service connection for residuals of a head injury. G! 2. Entitlement to service connection for post interior crest disorder (vertebrae). D no CD 3. Entitlement to service connection for residuals of an eye injury. R REPRESENTATION Appellant represented by: Missouri Veterans Commission ATTORNEY FOR THE BOARD T. Adams, Counsel INTRODUCTION The Veteran served on active duty from July 1994 to January 2003. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a November 2007 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Louis, Missouri, that, in pertinent part, granted service connection and assigned a 0 percent rating for residuals of fracture, 5th metacarpal, right hand, effective January 29, 2007, and denied service connection for residuals of a head injury, residuals of a neck injury, a bilateral knee disorder, a bilateral ankle disorder, bilateral hearing loss, and post interior crest disorder (vertebrae), residuals of an eye injury. In June 2010, the Board denied the Veteran's claims for service connection for bilateral hearing loss and an initial compensable disability rating for residuals of a fracture of the 5th right metacarpal, and remanded the claims for service connection for residuals of a head injury, residuals of a neck injury, a bilateral knee disorder, a bilateral ankle disorder, post interior crest disorder (vertebrae), and residuals of an eye injury for further evidentiary development. A review of the record reveals that service connection for bilateral ankle, bilateral knee, and neck disabilities was established in a January 2012 and October 2012 Decision Review Officer decisions Thus, as the benefits sought have been awarded in full, those issues are no longer before the Board. The Board has reviewed the Veteran's physical claims file, and his electronic file through the "Virtual VA" system, to ensure a complete review of the evidence in this case. FINDINGS OF FACT 1. The Veteran currently has concussion syndrome that is related to his active military service. 2. No disability diagnosed as post interior disorder crest has been present during the pendency of this claim. The Veteran is not currently shown to have a disability diagnosed as post interior crest disorder. No disability of the left or right leg has been present during the pendency of this claim CONCLUSIONS OF LAW 1. The criteria for service connection for residuals of a head injury have been met. 38 U.S.C.A. §§ 1131, 5107 (West 2002); 38 C.F.R. § 3.303, 3.304 (2012). 2. The criteria for service connection for post interior crest disorder (vertebrae) have not been met. 38 U.S.C.A. §§ 1131, 5107 (West 2002); 38 C.F.R. § 3.303 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Duty to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA) enhanced VA's duty to notify and assist claimants in substantiating their claims for VA 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). Upon receipt of a complete or substantially complete application for benefits, VA is required to notify the claimant and his representative of any information, and any 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). Proper notice from VA must inform the claimant of any information and evidence not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; and (3) that the claimant is expected to provide. 38 C.F.R. § 3.159(b)(1). This notice must be provided prior to an initial unfavorable decision on a claim by the RO. Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006); Pelegrini v. Principi, 18 Vet. App. 112 (2004). In addition, the holding in Dingess v. Nicholson, 19 Vet. App. 473 (2006) requires more extensive notice in claims for compensation, e.g., as to potential downstream issues such as disability rating and effective date. Regarding the Veteran's claim for service connection for residuals of a head injury, the VCAA is not applicable where further assistance would not aid the appellant in substantiating his claim. Wensch v. Principi, 15 Vet. App. 362 (2001); see 38 U.S.C.A. § 5103A(a)(2) (Secretary not required to provide assistance "if no reasonable possibility exists that such assistance would aid in substantiating the claim"). Indeed, given the favorable disposition of the claim for service connection for residuals of a head injury, the Board finds that all notification and development actions needed to fairly adjudicate the claim have been accomplished. Regarding the Veteran's claim for service connection for post interior crest disorder, prior to the initial denial of the present claim, the RO advised the Veteran of what the evidence must show to establish entitlement to service-connected compensation benefits in a notice letter sent in February 2007. The RO also explained what evidence VA would obtain and make reasonable efforts to obtain on the Veteran's behalf in support of his claim. The RO further described what evidence that the Veteran should provide in support of his claim. Moreover, the RO explained how VA determines the disability rating and effective date of a disability once service connection has been established, which satisfied Dingess notice requirements. Because the Veteran was provided with proper notice with respect to his claim by way of the February 2007 pre-adjudication notice letter, the Board concludes that VA's duty to notify has been met, and there is no outstanding duty to inform the Veteran that any additional information or evidence is needed. Moreover, the Veteran and his representative were provided with copies of the above rating decision, the SOC, and the SSOC, which include discussion of the facts of the claim, pertinent laws and regulations, notification of the bases for the decision, and a summary of the evidence considered to reach the decision. Regarding VA's statutory duty to assist in claims development, the record also reflects that VA has made reasonable efforts to obtain or to assist in obtaining all relevant records pertinent to the hearing claim. Pertinent medical evidence associated with the claims files consists of service and VA treatment records. Pursuant to the Board's June 2010 remand, the Veteran was afforded a VA examination and an opinion was obtained in May 2011. A review of that report of examination reveals that all subjective and objective findings necessary for evaluation of the Veteran's claim were observed and recorded. The examination appears complete and adequate. Barr v. Nicholson, 21 Vet. App. 303 (2007). Notably, the examiner determined that the Veteran does not currently have a diagnosis of post interior crest disorder. The adequacy of the subsequent nexus opinion is therefore moot. Therefore, the Board finds that the RO substantially complied with the remand instructions, and that no further RO action in this regard is warranted. Stegall v. West, 11 Vet. App. 268 (1998); Dyment v. West, 13 Vet. App. 141 (1999). Moreover, neither the Veteran nor his representative throughout the course of this appeal has made the RO or the Board aware of any other evidence relevant to his appeal that needs to be obtained. Based on the foregoing, the Board finds that all relevant facts have been properly and sufficiently developed in this appeal and no further development is required to comply with the duty to assist the Veteran in developing the facts pertinent to the claim adjudicated herein. Therefore, in view of the foregoing, the Board will proceed with appellate review. II. Service Connection It is the Board's responsibility to evaluate the entire record on appeal. See 38 U.S.C.A. § 7104(a). The Board has thoroughly reviewed all the evidence in the record. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, all of the evidence submitted by the Veteran or on his behalf. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (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 of record 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. 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). 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 Court of Appeals for Veterans Claims 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, "It 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. Service connection may be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred or aggravated in active military service. 38 U.S.C.A. §§ 1110, 1131 (West 2002); 38 C.F.R. § 3.303(a) (2012). In general, service connection requires competent and credible evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the current disability. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Under 38 C.F.R. § 3.303(b), an alternative method of establishing the second and third elements is through a demonstration of continuity of symptomatology. Barr v. Nicholson, 21 Vet. App. 303 (2007); see also Clyburn v. West, 12 Vet. App. 296, 302 (1999). Continuity of symptomatology may be established if a claimant can demonstrate (1) that a condition was "noted" during service; (2) evidence of post-service continuity of the same symptomatology; and (3) medical or, in certain circumstances, lay evidence of a nexus between the present disability and the post-service symptomatology. Hickson v. West, 12 Vet. App. 247, 253 (lay evidence of in-service incurrence is sufficient in some circumstances for purposes of establishing service connection); 38 C.F.R. § 3.303(b). However, application of 38 C.F.R. § 3.303(b) is only triggered if the disability in question is one that is listed as a chronic disability under 38 C.F.R. §§ 3.307, 3.309(a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Certain chronic diseases, including organic diseases of the nervous system, may be presumed to have been incurred in or aggravated by service if manifest to a compensable degree within one year of discharge from service. See 38 U.S.C.A. §§ 1101, 1112, (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.307, 3.309 (2012). Service connection may 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) (2012). 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, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Lay persons can also provide an eye-witness account of an individual's visible symptoms. See Davidson v. Shinseki, 581 F.3d 1313 (2009) (noting that a layperson may comment on lay-observable symptoms). Competency of evidence differs from weight and credibility. The former is a legal concept determining whether testimony may be heard and considered by the trier of fact, while the latter is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted into the record. See Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) ("although interest may affect the credibility of testimony, it does not affect competency to testify"). 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, 1137 (Fed. Cir. 2006). Factors for consideration in assessing credibility include a showing of interest, bias, inconsistent statements, consistency with other evidence, and a lack of contemporaneous medical evidence, although that alone may not bar a claim for service connection. Buchanan, 451 F.3d at 1336-37; Caluza v. Brown, 7 Vet. App. 498, 511 (1995), aff'd, 78 F.3d 604 (Fed. Cir. 1996), superseded in irrelevant part by statute, Veterans Claims Assistance Act of 2000, Pub. L. No. 106-475, 114 Stat. 2096 (Nov. 9, 2000). In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. See Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994). A. Residuals of a head injury The Veteran was also evaluated for a claimed head injury, to include a computed tomography (CT) scan, in 2002. The Veteran contends that he has residuals of a head injury related to an in-service parachute jump. His Form DD-214 indicates a military occupational specialty of infantryman and receipt of a Parachutist Badge. The Veteran's STRs include a July 2002 report which states that he had constant pressure on head. A July 2002 radiologic examination report states that he presented with a history of memory loss, slurred speech, and light headedness for one month and indicated that he numerous jumps. The impression was normal non-contrast CT of the head. November 2002 separation examination which indicates normal clinical evaluations of the Veteran's head, face, neck and scalp and neurologic and normal eye. RMH complained of an eye disorder. Complained of dizziness or fainting spells, frequent or severe headache and head injury, memory loss or amnesia; a period of unconsciousness or concussion; loss of memory or amnesia or neurological symptoms. Noted by doctor who said that these were symptoms of anxiety. Noted by doctor that he had a right eye scratched cornea. Noted that there were no current ongoing medical problems by physician. A post-separation examination in November 2002 also indicates normal head face neck and scalp, neurologic, and eye examinations. On October 1999 SFAS examination, he had a normal eyes examination and an associated RMH shows that he denied any eye trouble. A July 1998 report of medical examination shows normal eyes. October 1998 report of medical history shows he denied any eye trouble. A December 1997 eyes and ophthalmoscopic examinations were normal (normal on all exams). December 1997 RMH denied eye trouble. July 1996 report of medical examaintio normal eyes, ophthalmologic and ocular motility exams. RMH denied eye trouble. CLAIMED HEAD IN 8/02 AND EYE IN 1995. Private treatment records include a May 2005 report at which time the Veteran presented a history of a head injury in 2003 during a parachute accident. VA treatment records include a February 2009 report in which a VA clinical psychologist indicated that the Veteran demonstrated a typical pattern of scores associated with blast injuries including lower immediate memory and delayed memory and attentional scores. Above average scores for visuospatial and constructional ability were thought to represent his true ability prior to multiple blast injuries. In addition, there were some preservations noted on the test which were usually indicative of TBI. An April 2009 neurosurgery report noted a previous medical history of a TBI. On VA TBI examination in March 2011, the Veteran presented with a history of a claimed TBI which he claimed occurred during a parachute jump at Fort Bragg in 2002. He stated that he experienced a "bad landing" and was rendered unconscious for approximately ten minutes. He stated that he was seen 2 days later with complaint of dizziness and difficulty concentrating. The examiner observed that a July 2002 examination reflects complaints of head pressure, slurred speech, headache, memory loss, and light-headedness. However, a CT scan of the head was negative for any abnormality and no diagnosis of TBI has been made to date. On examination, the Veteran complained of daily headaches, sleep disturbance with nightly insomnia, mild to moderate fatigue, moderate memory impairment, and other cognitive problems including decreased attention, difficulty concentrating and with executive functions such as planning, organizing, and problem solving. He also complained of blurred vision secondary to an eye injury which occurred during service. He complained of hypersensitivity to light during headaches and of neurobehavioral symptoms including irritability. Objectively, it was noted that he had some blurred vision, but motor function was unremarkable, muscle tone and reflexes were normal, sensory function was normal. No paresthesia was noted. There was no evidence of cognitive impairment or objective evidence of memory loss. However, the Veteran was complained of moderate memory loss with difficulty recalling recent conversations, names of the acquaintances, and executive functions. Overall, he described his memory loss as mild to moderate. The examiner diagnosed concussion syndrome. The examiner opined that the evidence supports the conclusion that the Veteran suffered a head injury during service even though there is no record of this specific injury. However, the Veteran's symptoms listed in July 2002 are consistent with a head injury such as a concussion. The examiner also stated that there is no way to determine whether the Veteran was in fact unconscious for ten minutes as stated, but there is no reason to doubt his veracity. DISCOUNT OTHER OPINION BASED ON DID NOT EXAM THE VETERAN AND RESULTS ARE INCONSISTENT WITH THE OTHER EVIDENCE OF RECORD. Pursuant to the Board's June 2010 remand, the Veteran was afforded a VA TBI Disability Benefits Questionnaire examination in January 2013 which noted a TBI diagnosis in 2002. The examiner observed that in 2002 the Veteran jumped from a C-17 and bumped his head. The examiner questioned whether or not he was unconscious, but was fine after he landed and stated that no treatment was rendered. (Nieves-Rodriquez- infactual basis). On examination, there were no complaints of impairment of memory, attention, concentration or executive functions. Judgment was normal and social interaction was routinely appropriate. He was oriented to person, time, place, and situation. Motor activity and visual spatial orientation was normal. There were no subjective symptoms noted and no behavioral effects. He was able to communicate by spoken and written language. Consciousness was normal. He had no subjective symptoms or any mental, physical, or neurological conditions or residuals attributable to a TBI. Neuropsychological testing was revealed normal results. The examiner opined that there is no documentation of treatment for TBI although he claimed a Medical Board from military for TBI. The examiner also noted that a TBI DBQ was completed in 2002, but that all of the Veteran's complaints were subjective. ****** In March 2013, VA noted that the January 2013 report states the ACE process was used, but that since this case involves a Board remand, that process cannot be used and that the Veteran must be examined in-person. Noted that he had been examined on 2 prior occasions for residuals of a TBI and has been diagnosed with a TBI, but that the initial examination was conducted in March 2011 by an FNP. However, due to rating and evaluation procedural changes the DBQ format must be used in evaluating this disability. another examiantios was scheduled and conducted in April 2012. They indicated that the March 2011 opinion was adequate and asked that a specialist confirm those findings. But in April 2012 the same FNP who provided the March 2011 exam also did the April 2012 exam, so both were considered inaccurate. Noted that the April 2012 and January 2013 exam results contradict each other and that an in-person exam by an appropriate specialist was still needed to resolve the conflict. However, none has been provided. An addendum was obtained in April 2013, but it appears that the Veteran still has not been provided an examination (direct the examiner to resolve the conflicting findings in the April 2012 and January 2013 and ask for examiner's other than the NP and the MD. J.G. Noted that the April 2012 report noteded three or more subjective symptoms and one or more neurobehavioral effects that occasionally interefered with the workplace interaction and social interaction or both and noted residual headaches. FIND TBI REMAND (think done for MS) In April 2013, VA requested clarification of the January 2013 report of examination and findings therein; and asked if the Veteran had a current diagnosis of TBI citing to the 2002 TBI diagnosis. In an April 2013 addendum, the examiner opined that there is no TBI. VA must consider all favorable lay evidence of record. 38 U.S.C.A. § 5107(b); Caluza v. Brown, 7 Vet. App. 498 (1995). Accordingly, in addition to the medical evidence above the Board has considered the lay evidence submitted by the Veteran in the form of his correspondence to VA. In this regard, the Board also accepts that the Veteran is competent to report complaints of residuals of a head injury to include memory loss, headaches, sleep disturbance, and concentration problems during and after his service. Furthermore, lay assertions may serve to support a claim for service connection by supporting the occurrence of lay-observable events or the presence of disability or symptoms of disability subject to lay observation. 38 U.S.C.A. § 1153(a); 38 C.F.R. § 3.303(a); Jandreau v. Nicholson, 492 F.3d. 1372 (2007); see Buchanan v. Nicholson, 451 F. 3d 1331 (Fed. Cir. 2006). 1222278 The Board assigns low probative weight to the December 2009 VA opinion. The examiner found that the Veteran's migraine headaches likely preexisted service and were not aggravated while in service. He explained that this conclusion was purely based upon the Veteran's statements in the medical records that indicated that he had headaches with episodes of loss of consciousness and dizziness at the age of 14. However, during the examination and in other lay statements in the claims file, the Veteran clarified that these episodes only occurred while boxing. It does not appear that the examiner considered the Veteran's lay statements regarding the actual onset of his headache disability, which the Veteran has alleged to be after his in-service head injury. Dalton v. Nicholson, 21 Vet. App. 23, 39 (2007) (a medical examination that fails to take into account relevant lay assertions is of little probative value). B. Post interior crest disorder (vertebrae) The Veteran contends that he has post-interior crest disorder that is related to his service. The Veteran's STRs and post-service treatment records are negative for any diagnosis of post-interior crest disorder. On a Report of Medical Assessment, completed as part of his discharge physical examination in November 2002, the Veteran reported that he intended to seek VA disability for his neck. VA treatment records include a February 2009 primary care note the Veteran stated that when he was in Fort Bragg, he had a parachute jump in 2002 and he said he landed poorly after which he felt pain in his neck. The assessment was per patient account, in 2002 he had a parachute jump and he landed poorly. Since then, he said he has pain in the posterior part of the neck that radiates up to his ear. He was seeing a chiropractor for this, and according to the patient which he related to me that he could have broken C2 an old fracture, although the chiropractor is not sure. However, an examination was essentially unremarkable with no difficulty of motion of the neck. He has good range of motion and no pain on manipulation. An April 2009 neurosurgery report which states that the Veteran complained of pain in posterior neck radiating to neck. He stated that when he was in Afghanistan he popped his neck and fell, was unconscious, then had difficulty with balance. The impression was DJD, degenerative disk disease, but no target for surgery on neck. A February 2011 primary care report which reflects a long history of neck pain with abnormal MRI indicating a bulging disc at several levels. The assessment was chronic neck pain with a herniated disc in the cervical spine. Pursuant to the Board's June 2010 remand, on VA spine examination in May 2011, the examiner diagnosed bulging discs C6-7, C7-T1, disc herniation C6-C7 with effacement, and mechanical low back strain. The examiner indicated that there is no such condition called "post interior crest vertebrae disorder." He stated that the Veteran is service-connected for lumbar stain and was claiming a cervical spine condition. Both of these conditions could potentially involve the vertebrae. The Veteran also claimed a bilateral knee condition. The tibia which makes up lower portion of the knee joint does have a portion called the anterior crest which commences at he tibial turberosity of the knee and ends below at the anterior margin of the medial malleolus (the ankle). The lay person may call it the shin bone. With the Veteran claiming both bilateral knee and bilateral ankle conditions, it is more likely as not that the portion of the body involved in the Veteran's "interior crest disorder" is the leg and does not involve the vertebrae at all. After reviewing every page of the Veteran's available service records and the pertinent medical literature, the examiner was unable to find any diagnosis of "interior crest disorder." Therefore, it is not likely that the Veteran in fact has a condition by that name. In short, due to the unfortunate lack of medical records, the claims folder simply does not confirm medical evidence of current diagnoses related to an in-service head injury, to include encephalitis. On review of the evidence above, the Board notes that the Veteran has complained of neck pain, but pain alone, without a diagnosed or identifiable underlying malady or condition, does not constitute a disability for which service connection can be granted. Sanchez-Benitez v. Principi, 259 F.3d 1356 (Fed. Cir. 2001). TO THE EXTENT THAT __- IS RELATED TO HIS BILATERAL KNEE DISABILITY, THE BOARD OBSERVES THAT... "Congress specifically limits entitlement to service-connected disease or injury where such cases have resulted in a disability ... in the absence of a proof of present disability there can be no claim." Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The Court has held that the requirement for service connection that a current disability be present is satisfied when a claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim even though the disability resolves prior to the Secretary's adjudication of the claim. See McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). In this case, there is no medical evidence showing that any diagnoses related to an in-service head injury, to include encephalitis, have been present at any time during the pendency of the claims and the report of a current records review shows the VA examiner could not diagnose or otherwise quantify any specific residuals with his in-service head injury; he has accordingly not shown a current disorder for which service connection can be granted. VA must consider all favorable lay evidence of record. 38 U.S.C.A. § 5107(b) ; Caluza v. Brown, 7 Vet. App. 498 (1995). Accordingly, in addition to the medical evidence above the Board has considered the lay evidence submitted by the Veteran in the form of his correspondence to VA. A layperson is competent to testify in regard to the onset and continuity of symptomatology. Heuer v. Brown, 7 Vet. App. 379, 384 (1995); Falzone v. Brown, 8 Vet. App. 398, 403 (1995); Caldwell v. Derwinski, 1 Vet. App. 466 (1991). Lay evidence can, in some circumstances, also be competent to establish a medical diagnosis. See Davidson, supra. In this regard, the Board recognizes that there is no bright line rule that laypersons are not competent to offer diagnoses or etiology opinions. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009) (rejecting the view that competent medical evidence is necessarily required when the determinative issue is medical diagnosis or etiology). Evidence, however, must be competent evidence in order to be weighed by the Board. Whether a layperson is competent to provide an opinion as to the etiology of a condition depends on the facts of the particular case. In Davidson, the U.S. Court of Appeals for the Federal Circuit (Federal Circuit) drew support from Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007) for support for its holding. Id. In a footnote in Jandreau, the Federal Circuit addressed whether a layperson could provide evidence regarding a diagnosis of a condition and explained that "[s]ometimes the layperson will be competent to identify the condition where the condition is simple, for example a broken leg, and sometimes not, for example, a form of cancer." Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Although the Veteran seeks to offer etiology opinions rather than provide diagnoses, the reasoning expressed in Jandreau is applicable. The Board finds that the question of whether the Veteran currently has current diagnoses related to an in-service head injury, to include encephalitis, due to an in-service head injury is too complex to be addressed by a layperson. While the Veteran is certainly competent to testify to symptoms he observed during and since his service, such as neck pain, he is not competent to offer an opinion as to the cause of this disability. This connection or etiology is not amenable to observation alone. Rather it is common knowledge that such relationships are the subject of extensive research by scientific and medical professionals. Hence, the Veteran's opinion of the etiology of any current disabilities is not competent evidence and is entitled to low probative weight. For the foregoing reasons, the claims for service connection for residuals of a head injury and encephalitis must be denied. The Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claims, that doctrine is not applicable. See 38 U.S.C.A. § 5107(b) ; 38 C.F.R. § 3.102 ; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). 2010 Remand Finally, the Veteran submitted a formal claim for compensation benefits in February 2007. He completed a VA Form 21-526, Veteran's Application for Compensation or Pension. One of the issues listed, and developed in this case, was entitlement to service connection for "post interior crest disorder (vertebraes)[sic]." He listed treatment for this disorder during service in 2001. A review of the STRs does not reflect any entries that identify the disorder. Moreover, the Board is uncertain as to the nature of the claimed disorder. The Veteran is currently service-connected for mechanical low back strain and has a pending claim for a neck injury. Thus, it is not clear whether this issue involves the same areas of the spine. It is presumed the disorder involves the spine given the use of the word "vertebraes." On remand, the Veteran should be asked to clarify the exact nature of this issue in order to: 1) ensure it is a separate issue from his already service-connected mechanical low back strain and claimed neck injury; and 2) to allow for a proper and full development and adjudication. In that regard, the Veteran initially submitted a letter from S. F. McAdams, D.C., in February 2007. The RO requested that he provide a release form for VA to obtain records from Dr. McAdams. The Veteran did not respond to that request and did not provide any treatment records in support of his claim. The Veteran reported continued chiropractic care when seen in a VA clinic in February 2009. If the Veteran wishes such evidence to be considered in the adjudication of his claim, he must either provide the records or authorize the agency of original jurisdiction (AOJ) to obtain them on his behalf. Residuals of an eye injury The Veteran also suffered a scratched cornea in the right eye when he was hit by hot brass in August 1996. On a Report of Medical Assessment, completed as part of his discharge physical examination in November 2002, the Veteran reported that he intended to seek VA disability for his right eye. A July 1996 acute medical care note indicates that he complained of right eye burn of one day getting hit withhot brass. Said injury was better than yesterday and denied blurriness. There was redness and discoloration round pupil. No paon on palpation orbital sockerr. Full range of motion of the eye, but scratch on cornea. The assessment was scrathed cornea and he was provided a patch. VA treatment records include an April 2012 report which states that there was no residual damage to R eye following a July 1996 corneal abrasion. The Veteran was afforded a VA eye examination in March 2011 indicated a history residuals of an eye disosrder. He complained of increased light sensitivity and occasional visual blur od vs os since event involving blunt trauma from small arms shell to od in late 1994. No visual symptoms noted now for OS. Eyes feel fine today. The assessment was essentially emmetropia OU. DBQ eye examination in April 2012 at which time the examiner indicated that the Veteran was diagnosed with corneal abrasion of the right eye in July 1996. The examiner diagnosed resolved corneal abrasion of the right eye without sequelae. On VA __ examination in May 2011, it was noted that the Veteran's visual spacial orientation was normal. On VA DBQ examination in April 2012, he was diagnosed with corneal abrasion of the right eye in July 1996. Pupils were round and reactive to light. Examination revealed a normal right cornea. There was no evidence of scarring or disfigurement attributable to any eye condition. The examiner remarked that corneal abrasion of the right eye resolved without sequelae. ORDER ____________________________________________ Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs