Citation Nr: 1324233 Decision Date: 07/30/13 Archive Date: 08/07/13 DOCKET NO. 07-10 289 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Paul, Minnesota THE ISSUE Entitlement to service connection for a thoracolumbar spine disability. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD L. Zobrist, Associate Counsel INTRODUCTION The appellant is a Veteran who served on active duty from September 1956 to September 1960. This matter is before the Board of Veterans' Appeals (Board) on appeal from a July 2006 rating decision of the St. Paul, Minnesota, Department of Veterans Affairs (VA) Regional Office (RO). In May 2007, the Veteran testified at a Decision Review Officer (DRO) hearing; a transcript of this proceeding is associated with the claims file. This appeal has previously been before the Board. In December 2010 and January 2013, this case was remanded by the Board for additional development. The Board finds that the Agency of Original Jurisdiction (AOJ) substantially complied with the remand directives and that no further action in this regard is warranted. See Dyment v. West, 13 Vet. App. 141, 146-47 (1999) (remand not required under Stegall v. West, 11 Vet. App. 268 (1998), where there was substantial compliance with the Board's remand instructions). The issue of entitlement to service connection for a cervical spine disorder has been raised by the record (see, e.g., 2003, 2005, and 2006 treatment records (noting diagnoses of cervical spine subluxation and cervical spine strain/sprain); May 2007 DRO hearing transcript, page 12 (1956 neck/shoulder injury); and letter from Dr. N. S., dated in July 2007 (reporting more than one incident in service)), but has not been developed or adjudicated by the AOJ. Therefore, the Board does not have jurisdiction over it, and it is referred to the AOJ for appropriate action. FINDING OF FACT The preponderance of the evidence is against a finding that the Veteran's current thoracolumbar spine disability is causally related to, or aggravated by, an event, injury, or disease in service. CONCLUSION OF LAW Service connection for a thoracolumbar spine disability is not warranted. 38 U.S.C.A. §§ 1131, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2012). REASONS AND BASES FOR FINDING AND CONCLUSION Veterans Claims Assistance Act of 2000 (VCAA) As provided for by the Veterans Claims Assistance Act of 2000 (VCAA), the United States Department of Veterans Affairs (VA) has a duty to notify and assist claimants in substantiating a claim 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 and 3.326(a) (2012). Duty to Notify Upon receipt of a complete application, VA must notify the claimant of the information and evidence not of record that is necessary to substantiate a claim, which information and evidence VA will obtain, and which information and evidence the claimant is expected to provide. 38 U.S.C.A. § 5103(a). The notice requirements apply to all five elements of a service connection claim: 1) veteran status; 2) existence of a disability; 3) a connection between the veteran's service and the disability; 4) degree of disability; and 5) effective date of the disability. Dingess v. Nicholson, 19 Vet. App. 473 (2006). The notice must be provided to a claimant before the initial unfavorable adjudication by the RO. Pelegrini v. Principi, 18 Vet. App. 112 (2004). The notice requirements may be satisfied if any errors in the timing or content of such notice are not prejudicial to the claimant. Mayfield v. Nicholson, 19 Vet. App. 103 (2005), rev'd on other grounds, 444 F.3d 1328 (Fed. Cir. 2006). The RO provided the appellant with proper notice by letter dated in June 2006. This notice complied with the specificity requirements of Dingess, identifying the five elements of a service connection claim, and Quartuccio v. Principi, 16 Vet. App. 183 (2002), identifying the evidence necessary to substantiate a claim and the relative duties of VA and the claimant to obtain evidence. The Veteran has received all essential notice, has had a meaningful opportunity to participate in the development of his claim, and is not prejudiced by any technical notice deficiency along the way. See Conway v. Principi, 353 F.3d 1369 (Fed. Cir. 2004). In any event, the Veteran has not demonstrated any prejudice with regard to the content of the notice. See Shinseki v. Sanders, 129 S.Ct. 1696 (2009) (reversing prior case law imposing a presumption of prejudice on any notice deficiency, and clarifying that the burden of showing that an error is harmful, or prejudicial, normally falls upon the party attacking the agency's determination); see also Mayfield v. Nicholson, 444 F.3d 1328, 1333-34 (Fed. Cir. 2006). Duty to Assist Furthermore, the Board finds that there has been compliance with the assistance provisions set forth in the law and regulations. VA has obtained available service treatment records (STRs) and pertinent postservice medical records. The Veteran gave testimony at a Decision Review Officer (DRO) hearing in May 2007. In December 2010, the Board remanded this issue to the RO via the Appeal Management Center (AMC) for additional development. Specifically, the Board directed that the RO attempt to secure additional private treatment records regarding chiropractic treatment received since October 1961 from Dr. N. S. In January 2011, the Veteran provided 16 pages of records from Dr. N. S. and, in November 2012, the Veteran's representative indicated that there was "no additional evidence or argument to submit." As such, the Board finds that there has been substantial compliance with the December 2010 Board remand and that no additional assistance in this regard is required. See Dyment and Stegall, both supra. VA afforded the Veteran his first VA examination in August 2007. The VA examiner physically examined the Veteran and opined that there was no current back pathology, and the Veteran's claim was again denied by the RO. In January 2013, the Board found that the August 2007 was not adequate as to nexus and again remanded this issue to the RO via the AMC. Specifically, the Board directed that the RO afford the Veteran a new VA examination and readjudicate the issue on appeal. The Veteran received a second VA examination in March 2013. The examiner considered the relevant history of the Veteran's thoracolumbar spine disability, performed a physical examination, and provided a rationale to support the conclusions reached. See Stefl v. Nicholson, 21 Vet. App. 12, 123-24 (2007). The Board finds that the March 2013 examination is adequate for adjudication purposes. See Barr v. Nicholson, 21 Vet. App. 303 (2007) (VA must provide an examination that is adequate for rating purposes). As such, the Board finds that there has been substantial compliance with the January 2013 Board remand. See Dyment and Stegall, both supra. The Board finds that no additional assistance in this regard is required. The Board notes that some of the Veteran's service treatment records (STRs) from active military service cannot be obtained and are assumed to be either lost or destroyed. In this regard, the National Personnel Records Center stated that the Veteran's STRs were fire-related. The Board is mindful that, in a case such as this, where some or all of the Veteran's service records are unavailable, VA has a heightened obligation to assist the Veteran in the development of his claim. O'Hare v. Derwinski, 1 Vet. App. 365, 367 (1991); Pruitt v. Derwinski, 2 Vet. App. 83, 85 (1992). However, the Board further notes that neither the Veteran nor his representative have asserted that the Veteran suffered any back injuries or received any medical treatment in service other than what is discussed below. Thus, the Board finds that further development of the record with respect to the Veteran's STRs is not required. All known and available records have been obtained and associated with the Veteran's claims file, and the Veteran and his representative have not contended otherwise. In April 2013, the Veteran indicated that he had no other information or evidence to submit for Board consideration. Thus, the Board finds that the record as it stands includes adequate competent evidence to allow the Board to decide this matter and that no further development of the evidentiary record is necessary. VA has complied with the notice and assistance requirements, and the Veteran is not prejudiced by a decision on the claim at this time. Analysis The Board notes that it has reviewed all of the evidence in the Veteran's claims file and in "Virtual VA" (VA's electronic data storage system), with an emphasis on the evidence relevant to the matter on appeal. Although the Board has an obligation to provide reasons and bases supporting its decision, there is no need to discuss, in detail, every piece of evidence of record. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (VA must review the entire record, but does not have to discuss each piece of evidence). Hence, the Board will summarize the relevant evidence as appropriate and the Board's analysis will focus specifically on what the evidence shows, or fails to show, as to the claim. This appeal involves a claim of entitlement to service connection for a thoracolumbar spine disability. Applicable law provides that service connection will be granted if it is shown that the veteran suffers from disability resulting from an injury suffered or disease contracted in line of duty, or for aggravation of a preexisting injury or disease in line of duty, in the active military, naval, or air service. 38 U.S.C.A. § 1131; 38 C.F.R. § 3.303. That an injury occurred in service alone is not enough; there must be chronic disability resulting from that injury. 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). Under 38 C.F.R. § 3.303(b), with an enumerated "chronic disease" (such as arthritis) shown in service (or within the presumptive period under § 3.307), subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. See also Groves v. Peake, 524 F.3d 1306, 1309 (2008). This rule does not mean that any manifestation of joint pain, any abnormality of heart action or heart sounds, any urinary findings of casts, or any cough, in service will permit service connection of arthritis, disease of the heart, nephritis, or pulmonary disease, first shown as a clear cut clinical entity, at some later date. For the showing of chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word "Chronic." When the disease identity is established (leprosy, tuberculosis, multiple sclerosis, etc.), there is no requirement of evidentiary showing of continuity of symptomatology. 38 C.F.R. § 3.303(b). 38 C.F.R. § 3.303(b) also provides another route by which a Veteran can establish service connection for an enumerated chronic disease such as arthritis - by way of continuity of symptomatology. Continuity of symptomatology after discharge is required only where the condition noted during service (or in the presumptive period) is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned, i.e., "when the fact of chronicity in service is not adequately supported." When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support a claim for disability compensation for the chronic disease. Proven continuity of symptomatology establishes the link, or nexus, between the current disease and serves as the evidentiary tool to confirm the existence of the chronic disease while in service or a presumptive period during which existence in service is presumed. 38 C.F.R. § 3.303(b). See also Walker v. Shinseki, 708 F.3d 1331, 1338-39 (Fed. Cir. 2013). For continuity of symptomatology, the Board cannot determine that lay evidence lacks credibility solely because it is unaccompanied by contemporaneous medical evidence. Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006). Symptoms, not treatment, are the essence of any evidence of continuity of symptomatology. See Cartright v. Derwinski, 2 Vet. App. 24, 26 (1991). The Board may, however, consider a lack of contemporaneous medical evidence as one factor, among others, in determining the credibility of lay evidence. Buchanan, 451 F.3d at 1337. Certain chronic disabilities, such as arthritis, are presumed to have been incurred in service if manifest to a compensable degree within one year of discharge from service. 38 U.S.C.A. §§ 1101, 1133; 38 C.F.R. §§ 3.307, 3.309. 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); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Board determinations with respect to the weight and credibility of evidence are factual determinations going to the probative value of the evidence. Layno v. Brown, 6 Vet. App. 465, 469 (1994). Competency of evidence differs from weight and credibility. Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while 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, 74 (1997); Layno, supra. A veteran is competent to describe symptoms that he experienced in service or at any time after service when the symptoms he perceived, that is, experienced, were directly through the 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); Layno, 6 Vet. App. at 469-71 (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; lay testimony is competent only so long as it is within the knowledge and personal observations of the witness, but lay testimony is not competent to prove a particular injury or illness); see Barr, 21 Vet. App. at 308 (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). The absence of contemporaneous medical evidence is a factor in determining credibility of lay evidence, but 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); Barr, 21 Vet. App. at 310 ("[T]he Board may not reject as not credible any uncorroborated statements merely because the contemporaneous medical evidence is silent as to complaints or treatment for the relevant condition or symptoms."). In determining whether statements submitted by a veteran are credible, the Board may consider internal consistency, facial plausibility, consistency with other evidence, and statements made during treatment. Caluza v. Brown, 7 Vet. App. 498 (1995). Lay evidence may establish a diagnosis of a simple medical condition, 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). Also, a veteran as a lay person is competent to offer an opinion on a simple medical condition. Davidson v. Shinseki, 581 F. 3d 1313, 1316 (Fed. Cir. 2009) (citing Jandreau). VA must consider the competency of the lay evidence and cannot outright reject such evidence on the basis that such evidence can never establish a medical diagnosis or nexus; however, this does not mean that lay evidence is necessarily always sufficient to identify a medical diagnosis, but rather only that it is sufficient in those cases where the lay person is competent and does not otherwise require specialized medical training and expertise to do so, i.e., the Board must determine whether the claimed disability is a type of disability for which a layperson is competent to provide etiology or nexus evidence. See Davidson, 581 F. 3d at 1316 (recognizing that, under 38 U.S.C.A. § 1154(a), lay evidence can be competent and sufficient to establish a diagnosis of a condition when a lay person is competent to identify the medical condition; he is reporting a contemporaneous medical diagnosis; or lay testimony describing symptoms at the time supports a later diagnosis by a medical professional). The Veteran's entrance examination and medical history report were negative for any back condition, and the Veteran is presumed to have entered service in sound condition. In his initial claim, and during his May 2007 DRO hearing, the Veteran averred that he first injured his back in 1956, while in mechanic school. He stated that the injury happened when he was carrying a 100-pound sack of potatoes up a flight of stairs and the sack slipped off his shoulders, causing a shoulder and neck injury with pain radiating into his lower back. He further stated that he did not seek medical treatment for this injury because he did not want to "wash out" of mechanic school. (See DRO hearing transcript, page 13). The Veteran asserted that he suffered further injury in 1958, when he injured his lower back while replacing generators. His STRs confirm that the Veteran sought medical care in January 1958 for a backache of several months' duration. The pain was described as a dull ache on the Veteran's left side, just over the sacroiliac area. He was given a complete orthopedic exam, which was negative. X-rays were likewise negative. The Veteran again sought treatment in February 1958, and X-rays were again negative. The Veteran was put on light duty for one week, and the treatment provider stated: "I doubt serious back trouble." In March 1958, the Veteran again sought treatment for back pain. Spine films were noted to be negative. The Veteran stated that the only treatment he received when seeking treatment for his back pain was over-the-counter (OTC) pain medication. There are no other STRs in the record that address symptoms of, or treatment for, back pain. The Veteran has not claimed that he suffered any other back injury before discharge from service or that there are STRs related to back symptomatology that are not in the record. Therefore, the Board concludes that, although the Veteran's STRs are fire-related, there are no STRs related to back pain or injury that are missing from the record before us. On separation from service, in August 1960, the Veteran's spine was clinically evaluated as normal and he denied "all other significant medical or surgical history." The Veteran did not note any back pain on his separation medical history report. The Board acknowledges that, during the May 2007 DRO hearing, the Veteran stated that his back did bother him when he was discharged from service and that his back pain symptoms had continued consistently from his 1956 injury throughout service. The Veteran is competent to give evidence about observable symptoms such as back pain. Layno v. Brown, 6 Vet. App. at 465. Furthermore, as noted above, lay evidence concerning continuity of symptoms after service, if credible, is ultimately competent, regardless of the lack of contemporaneous medical evidence. See Buchanan, supra. Contemporaneous STRs are, however, probative evidence to be considered in making this important determination and tend to refute the notion that the Veteran had back pain following his March 1958 treatment. 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). The Board finds that, if the Veteran had on-going back pain at the time of his separation from service, two-and-a-half years after his 1958 treatment for back pain, it would be reasonable for him to have reported such; he did not. To the contrary, the record reflects that the Veteran stated that he was in good health and denied any significant medical events in service. Thus, the Board finds reasons to place reduced probative value on the Veteran's 2007 DRO testimony asserting a continuity of symptomatology since service. Not only may the Veteran's memory be faulty with the passage of time, but self-interest may play a role in the more recent statements. See Pond v. West, 12 Vet. App. 24, 25 (1991). Conversely, the Board also finds that the Veteran's September 1960 separation examination and medical history report are probative evidence demonstrating that the Veteran did not have back pain or other back symptomatology upon separation from service. The Board acknowledges that, following service, the Veteran has received intermittent chiropractic treatment for back pain. Billing and appointment records reflect that the Veteran received treatment from several different chiropractors in 1961, 1966, 1974, 1976-78, 1980-84, 1986-89, 1995, 1998-2000, and 2002-07. The Veteran also asserts that he received treatment in 1960, but that he was unable to obtain any records related to that treatment; the nature of that treatment and the area of the spine affected are not known. (The Board notes that there are additional records of back pain attributed, by medical professionals, to cardiac events. Also, there are chiropractic treatment records from 1961-2007 related to cervical spine treatments; that issue has been referred to the AOJ for adjudication and is not presently before the Board.) The Veteran asserts that these records demonstrate "nearly continuous treatment from 1961 to the present time." There are, however, gaps of up to seven years between treatments. While "symptoms, not treatment, are the essence of any evidence of continuity of symptomatology," Savage v. Gober, 10 Vet. App. 488, 496 (1997), the Board finds it reasonable that, if the Veteran suffered from a continuity of symptomatology such that he was required to seek treatment up to 43 times in one calendar year (1976), he would not have gaps of several years between treatments; he does. Furthermore, on several occasions, while seeking medical treatment for serious, unrelated conditions, the Veteran expressly denied any back symptomatology. In March 1992, during physical examination, the Veteran reported that his back did not hurt at that time. In February 2005, after evaluation after reporting a painful lump in his right groin, the Veteran was described as, prior to the previous evening, being "in his usual good health." In a pre-operative evaluation a few days later, the Veteran reported a past medical history of coronary artery disease, hypertension, hypercholesterolemia, a history of frequent premature ventricular contractions, some instances of multifocal atrial tachycardia, and a history of pancreatitis connected to gallbladder stones; no back condition or symptomatology was reported. In fact, the Veteran expressly denied "bone or joint discomfort or low back pain" and stated that "[h]e is still able to have a moderate to heavy amount of physical exertion." In October 2005, on evaluation for chest pain, the Veteran denied any "significant problems". The Board finds it reasonable that, if the Veteran was experiencing a continuity of back pain symptomatology, he would have reported such when seeking medical diagnoses or preparing for surgery; he did not. In addition, on March 2013 VA examination, the Veteran "denied any acute injuries to his back after separation from active duty status." This assertion is inconsistent with the evidence of record, which, as noted below, describes several incidents of back injury throughout the Veteran's career as a mechanic. In a May 2007 nexus opinion, Dr. N. S. states that the Veteran first came to see him in 1961 for immobilizing back pain and muscle spasms that occured after trying to lift a wheel and experiencing a "severe catch" in the lower back. In November 1987, the Veteran reported that he hurt his left lower back while working under a truck. In March 1992, the Veteran reported that he had been run over by a tractor several years prior. In June 1995, the Veteran reported hurting his right shoulder and neck while working on cars. In September 1995, the Veteran reported that he hurt his back when leaning over a car to change its thermostat. In October 1995, the Veteran reported that he strained his back "working underneath a car removing an automatic transmission." In February 1996, the Veteran reported back pain after collapsing while getting out of his truck. In February 1998, the Veteran reported pain and stiffness after kicking loose a towing chain. In October 1999, the Veteran twisted his back rolling up the window in his pickup. In April 2001, the Veteran was in a motor vehicle accident, during which his vehicle "was struck from behind by a fast moving Dodge pickup," causing the Veteran to "slam [] up against the left side of the car." In February 2006, the Veteran received treatment for his lumbar spine after "working on vehicle". The Veteran is competent to report back injury incidents that he personally experienced. See Layno, 6 Vet. App. at 369-71. However, the Board finds that the Veteran's statements between 1961 and 2006, asserting that he experienced other back injuries and was, as a result, seeking treatment for back pain, are more credible than the Veteran's later March 2013 statement made during a VA examination for compensation purposes. See Buchanan, 451 F. 3d at 1336-37 (the Board can consider the time between and weigh the Veteran's conflicting statements); Cartright v. Derwinski, 2 Vet. App.24, 25 (1991) (finding that, while the Board may not ignore a Veteran's testimony simply because he or she is an interested party and stands to gain monetary benefits, personal interest may affect the credibility of the evidence); see also Caluza, 7 Vet. App. at 510-511 (credibility can be generally evaluated by a showing of interest, bias, or inconsistent statements, and the demeanor of the witness, facial plausibility of the testimony, and the consistency of the testimony). Next, the record contains several "buddy statements" written in August 2006 and provided to VA on behalf of the Veteran. As noted above, lay evidence may be competent if it is provided by a person who has knowledge, through their own senses, of facts or circumstances that are not medical in nature and are capable of lay observation. See 38 C.F.R. § 3.159; see also Barr, 21 Vet. App. at 308, and Layno, 6 Vet. App. at 469-71. Dr. T. L. states that he has maintained a veterinary practice in the town where the Veteran lives since 1966, that the Veteran has been Dr. T. L.'s auto mechanic for the past 35 years, and that the Veteran has taken extra time to finish work due to back pain. While Dr. T. L. is competent to report his observations of the Veteran's symptoms, he does not indicate that he knew the Veteran prior to 1966 and is, thus, not competent to speak to the Veteran's condition prior to that time. Furthermore, it is not disputed that the Veteran has intermittent episodes of back pain following separation from active duty service. Thus, this letter is not competent evidence supporting the Veteran's claim. The letters from Ms. M. S., Mr. T. S., Ms. M. O., and Mr. L. O. report that the Veteran has had back pain since his military service. However, none of the letter writers indicates that his or her testimony is based on their own observations of the Veteran and his condition. In addition, as noted above, is not disputed that the Veteran has intermittent episodes of back pain following separation from active duty service. Furthermore, to the extent that these lay statements relate the Veteran's disability to his active duty service, the letter writers have not indicated that they have the medical training and expertise to opine competently as to a nexus between the Veteran's military service and his current back disabilities. Thus, these letters are not competent lay evidence supporting the Veteran's claim. Mr. C. O. states that he has been aware of the Veteran's condition since the Veteran separated from service and states that the Veteran's back has bothered him "all these years". Likewise, Mr. R. H. also asserts that he has known the Veteran "since he got out of service" and that he remembers that the Veteran had back problems that interfered with work. Mr. M. F. states that he remembers the Veteran having back problems in the 1960s. All three report their personal observations, and the Board finds that they are competent to do so. However, as noted above, it is not disputed that the Veteran has had back pain subsequent to military service, for which he has sought treatment on an intermittent basis. The question is whether said back pain is related to the Veteran's military service, and neither Mr. C. O. nor Mr. R. H. have indicated that they are competent to render etiological opinions as to the origin of the Veteran's current back disabilities. Furthermore, to the extent that Mr. C. O.'s letter may indicate an observed continuity of symptomatology, the Board finds that the probative value of a generalized statement that the Veteran's back has bothered him "all these years" is significantly outweighed by the Veteran's own statements, while undergoing preparation for surgery and while seeking a diagnosis of a possible cardiac condition, that his back symptomatology has not been continuous since his discharge from service. Thus, the Board finds that these letters are not competent, probative evidence in support of the Veteran's claim. For the above reasons, the Board finds that the Veteran has not provided credible testimony to support his assertion that his back pain has been continuous since his active duty service, and the preponderance of the evidence is against a grant of service connection based on continuity of symptomatology. Furthermore, to the extent that the Veteran asserts that his current back disability is related to his in-service injuries, the Board finds that a spine disorder is not the type of disability for which a layperson is competent to provide etiology or nexus evidence, and the Veteran has not shown that he possesses the medical training and expertise necessary to opine as to the medical etiology of his current disability. See Barr, 21 Vet. App. at 309. This is especially true in the Veteran's case, due to the physical labor required throughout his extensive career as a mechanic, as well as the multiple incidents of additional incidents related to the Veteran's postservice employment. Finally, the Veteran was afforded a VA examination in March 2013. The 2013 examiner reviewed the Veteran's claims file and extensively reviewed and summarized the Veteran's postservice medical records, noting specific chiropractic treatments and diagnoses, as well as references to the Veteran's back contained in medical records related to treatment for other conditions. The 2013 examiner also recorded, in detail, the Veteran's subjective complaints, including the variations of symptom severity, duration, and impact on functioning. The examiner noted that the Veteran reported his baseline pain level at 5/10 and was able to sit without pain for over two hours and get up out of a chair, even repeatedly, without any increase to his back pain. The Veteran reported being able to rake leaves and retrieve objects from the floor without additional pain, but stated that his pain increases sometimes when he shovels snow or reaches up over his head to grasp or retrieve an item. The examiner noted that, after standing in one position for 20 minutes, the Veteran feels weak and his back begins to ache. The Veteran also reported that his back would tire after walking a half mile, but that he had no back pain increase in doing so. The examiner also considered the Veteran's reports of functional impairments and flare-ups related to his back pain, including the effects of repeat episodes of heavy lifting required by the Veteran's occupation and the need for chiropractic treatments after such episodes. The 2013 examiner also conducted an in-person physical examination, to include thoracic and lumbar spine X-rays. Range of motion tests indicated painful and reduced range of motion in forward flexion (limitation to 75 degrees with pain), extension (limitation to 15 degrees with pain), right lateral flexion (limitation to 20 degrees with pain, left lateral flexion (limitation to 25 degrees with pain), and right and left lateral rotation (limitation to 15 degrees with pain). The Veteran's range of motion did not decrease further after repetition. The examiner opined that this range of motion was normal for this Veteran, due to the aging process. The 2013 examiner confirmed that arthritis had been documented through imaging studies of the thoracolumbar spine. March 2013 thoracic spine findings were unremarkable, with normal height and alignment of the thoracic vertebral bodies, disc height maintained, and no significant degenerative changes. (Findings related to the lower cervical spine are not relevant to this analysis.) February 2013 lumbar spine findings revealed disc space narrowing at all levels except for L4-L5, hypertrophic spurring in the mid-levels, and slight retrolisthesis L4 and L5. There was no evidence of fracture, and sacroiliac joints were negative. The diagnosis was degenerative disc disease (DDD), unchanged since prior radiological study. Thoracic spine findings from April 2009 showed intact alignment, no compression fractures, and early DDD and were otherwise unremarkable. April 2009 lumbar spine findings revealed disc space narrowing throughout with marginal spurring most evident at L2-L3 and L3-L4. Mild degenerative changes were noted at L4-L5 and L5-S1. Despite acknowledging the Veteran's complaints of continuous symptomatology since service, including back pain and stiffness, and considering the Veteran's report of in-service injury as credible, the 2013 examiner nonetheless opined that the Veteran's current back disabilities are "less likely than not . . . related to active duty service." The 2013 examiner noted that the first documented postservice treatment "was most likely related to an intervening interceding injury to the back after separation from active duty service related to lifting a wheel." The examiner further noted that "[t]he record of chiropractic manipulations dating from 10/61 up into 2003 did not include diagnoses or a history of the condition being treated." The examiner compared the current X-ray results of the thoracic spine, which were negative for any significant clinical findings, with those reported in 2009, which showed minimal DDD of the lower thoracic spine. Ultimately, considering the absence of any spine pathology before or during service, treatment shortly after service for severe, sustained back pain following an intervening injury, "evidence of ongoing cervical, thoracic and lumbosacral back pain intermittently thereafter . . . [and] no evidence on current physical examination of ligamentous instability or radiculopathy of the thoracolumbar spine," the examiner concluded that the current clinical findings of DDD and degenerative joint disease (DJD) were "less likely than not (less than 50/50% probability) related to active duty status." The Board acknowledges that the 2013 examiner initially noted that the Veteran had not previously been diagnosed with a thoracolumbar spine condition. However, the Board notes that the 2013 examiner's thorough review of postservice medical records includes recognition of diagnoses provided by treating physicians starting in May 2003 and that the examiner summarizes recent radiological evidence demonstrating mild joint space narrowing, spurring, and DDD. Thus, the Board finds that the 2013 examiner did consider the diagnoses contained in the Veteran's available medical records. Furthermore, the 2013 examiner provided current diagnoses of mild DDD in the Veteran's lower thoracic spine and multilevel DDD and DJD in the lumbosacral spine. The Board finds that this examination is adequate with respect to its consideration of current and prior diagnoses of the spine. See Acevedo v. Shinseki, 25 Vet. App. 286, 294 (2012) (medical reports must be read as a whole and in the context of the evidence of record). The Board finds that the 2013 VA examination, taken as a whole, is more than adequate, and extremely probative, as it encompassed a full review (including citation to specific documents) of the claims file and postservice medical records (noting the intermittent nature of postservice chiropractic treatments), thoroughly documented and considered the Veteran's statements and the "buddy statements" included in the record, is supported by sufficient detail, and provides a complete rationale for the opinion stated, which is supported by the evidence of the record. In contrast, the only contravening medical nexus evidence of record consists of two 2007 letters from Dr. N. S. In May 2007, Dr. N. S. stated that it was the Veteran's "contention that these injuries began when he was in the service [and] have increased in severity through the years" and confirmed that the Veteran first came to see him "for a low back problem that came on after trying to lift a wheel." In July 2007, Dr. N. S. stated that the Veteran had reported "several bouts of problems when he was working in maintenance profession while in the Air Force . . . that necessitated him [to] have to 'lay off' work for a few days to recover" and for which he was treated solely with OTC medications. Dr. N. S. opined that "[t]here is no question in my mind that he suffered an injury in the service," that subsequent episodes of back pain "were also based on the initial injury doing his maintenance work in the Air Force," and that said injury "is worsening with age." However, Dr. N. S. did not provide a rationale, nor did he review the STRs, and he fails to discuss the Veteran's years as a mechanic, a job that Dr. N. S. acknowledges requires considerable physical exertion. In addition, Dr. N. S. did not discuss the numerous job-related, post-service injuries for which he treated the Veteran. Furthermore, Dr. N. S. appears to have relied on the Veteran's reported etiology of his back condition and, as noted above, the Veteran is not competent to report such etiology. Consequently, the Board finds that the nexus opinions from Dr. N. S. lack probative value. See Prejean v. West, 13 Vet. App. 444, 448 (2000) (noting that the probative value attributed to a medical opinion "takes into account such factors as its thoroughness and degree of detail, and whether there was review of the veteran's claims file"). Thus, the Board finds that the nexus opinions from Dr. N. S. are less probative than the 2013 VA nexus opinion. In summary, the record reflects that the Veteran was treated for a back injury while in service and that he has intermittently received treatment for back pain subsequent to service. However, the Veteran has made inconsistent statements as to whether his back pain has been continuous since service, even at times, while seeking advanced medical care for other conditions, denying any back pain. The Veteran has also been inconsistent in reporting whether he has experienced other, intervening back injuries following separation from service. Consequently, the Board finds that, while the Veteran is competent to report his lay observations, to include back pain, his lay testimony is not credible as to a continuity of symptomatology since service. The other lay evidence of record does not indicate that those providing said evidence are competent to opine as to the etiology of the Veteran's current back disability. Furthermore, several "buddy statements" were not based on personal observation of the Veteran and his back condition. Thus, Board finds that the other lay evidence of record is not competent evidence in support of the Veteran's claim. Likewise, the probative medical evidence of record does not support the Veteran's claim. As noted above, the Board finds that the nexus opinions from Dr. N. S. are less probative because they do not evince that he reviewed the Veteran's STRs, they do not provide any rationale supporting the nexus opinions, and they do not discuss the influence of intervening injuries, such as the back pain resulting from attempting to lift a wheel, described by Dr. N. S. as "severe" and "immobilizing". In contrast, the March 2013 VA examiner thoroughly reviewed the Veteran's STRs and his postservice medical records, noted the intermittent nature of medical treatment received, conducted a detailed physical examination (to include indicated tests and studies), provided diagnoses as to Veteran's current back disability, and provided a detailed rationale supported by the evidence of record. The Board finds that the March 2013 VA examination is highly probative evidence against the Veteran's claim. In light of the foregoing, the preponderance of the evidence is against the claim, and, therefore, the benefit-of-the-doubt doctrine does not apply. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102. ORDER Entitlement to service connection for a thoracolumbar spine disorder is denied. ____________________________________________ M. C. GRAHAM Acting Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs