Citation Nr: 18142227 Decision Date: 10/15/18 Archive Date: 10/15/18 DOCKET NO. 13-11 225 DATE: October 15, 2018 ORDER Service connection for a pulmonary disorder is denied. Service connection for a nerve disorder of the upper and lower extremities, to include as secondary to service connected left foot fracture, is denied. FINDINGS OF FACT 1. A pulmonary disorder is not shown to be causally or etiologically related to any disease, injury, or incident in service and did not manifest to a compensable degree within one year of service discharge. 2. A nerve disorder of the upper and lower extremities is not shown to be causally or etiologically related to any disease, injury, or incident in service, did not manifest to a compensable degree within one year of service discharge and is not caused or aggravated by service connected left foot fracture. CONCLUSIONS OF LAW 1. The criteria for pulmonary disorder have not been met. 38 U.S.C. §§ 1131, 1112, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303(a), 3.307, 3.309 (2017). 2. The criteria for nerve disorder of the upper and lower extremities, to include as secondary to service connected left foot facture, has not been met. 38 U.S.C. §§ 1131, 1112, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303(a), 3.307, 3.309, 3.310 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had honorable active duty service with the United States Army from July 1958 to July 1960. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a March 2012 rating decision of the Muskogee, Oklahoma, Regional Office (RO). In June 2015, the Board remanded these matters for additional development. It returned in December 2016, at which point the Board denied both issues. Subsequently, the Veteran appealed the Board’s denial to the United States Court of Appeals for Veterans’ Claims (CAVC), which pursuant to a June 2017 Joint Motion for Partial Remand (JMPR), vacated the Board’s decision to the extent the Veteran’s claims were denied, and remanded the matter for further consideration. In September 2017, pursuant to the JMPR, the Board remanded this matter for additional development and it returns for further appellate review. This appeal has been advanced on the Board’s docket pursuant to 38 C.F.R. § 20.900(c) (2017). 38 U.S.C. § 7107(a)(2) (2012). The Board acknowledges the Veteran’s January 2015 statement indicating that he has to do all the ‘leg work’ with regard to his claim in order to gain a resolution. He claims in his September 2016 lay statement that he has been treated unfairly based on all the information that has been submitted, and asks for assistance on his claim. The Veterans Claims Assistance Act of 2000 (VCAA) and implementing regulations impose obligations on VA to provide claimants with notice and assistance. 38 U.S.C. §§ 5102, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2017). In the instant case, VA's duty to notify was satisfied by an March 2012 letter, sent prior to the issuance of the rating decision on appeal. See 38 U.S.C. §§ 5102, 5103, 5103A; 38 C.F.R. § 3.159; see also Scott v. McDonald, 789 F.3d 1375 (Fed. Cir. 2015); Pelegrini v. Principi, 18 Vet. App. 112(2004); Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). The VCAA also requires VA to make reasonable efforts to help a claimant obtain evidence necessary to substantiate his claim. 38 U.S.C. § 5103A; 38 C.F.R. §§ 3.159(c), (d). This "duty to assist" contemplates that VA will help a claimant obtain records relevant to his claim, whether or not the records are in Federal custody, and that VA will provide a medical examination or obtain an opinion when necessary to make a decision on the claim. 38 C.F.R. § 3.159(c)(4). The Veteran’s service treatment records, VA and private treatment records, and the Veteran’s statements are associated with the claims file. An addendum etiology opinion was obtained in March 2018, in connection with his service connection claims (lung condition and the upper and lower extremities), in accordance with the decision from CAVC. To that end, when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). As discussed in detail below, the VA examination and medical opinion and findings are adequate. This is determined as the March 2018 VA examination addresses all the questions pertinent to the Veteran’s case. The VA nexus opinion provided and considered all the pertinent evidence of record, the Veteran’s statements, and provided complete rationales for the opinions stated. Finally, the Board finds that there was substantial compliance with the Board’s September 2017 remand directives. A remand by the Board confers upon the claimant, as a matter of law, the right to compliance with the remand order. Stegall v. West, 11 Vet. App. 268 (1998). Nonetheless, it is only substantial compliance, rather than strict compliance, with the terms of a remand that is required. See D’Aries v. Peake, 22 Vet. App. 97, 105 (2008) (finding substantial compliance where an opinion was provided by a neurologist as opposed to an internal medicine specialist requested by the Board); Dyment v. Principi, 287 F.3d 1377 (2002). In December 2017, the Board remanded the instant claims in order to obtain an etiology opinion addendum that addressed the existence of lung biopsy data in the record and whether such a biopsy needed to be performed. The etiology opinion addendum was also to precisely identify the alternative etiologies of the pulmonary disorder and nerve disorders referenced in the February 2016 rationale and to discuss the possibility of a relationship between the Veteran’s claimed nerve disability and his service connected left foot disability. The March 2018 VA addendum opinion specifically addressed the existence of lung biopsy data in the record, whether a lung biopsy needed to be performed, identified the alternative etiologies for the claimed disorders and discussed the lack of relationship between the claimed nerve disability and the service connected left foot disability. Therefore, the Board finds that there has been substantial compliance with the September 2017 Board remand directives such that no further action is necessary in this regard. See Stegall, supra; D ‘Aries, supra. Furthermore, the Veteran and his representative have not identified, and the record does not otherwise indicate, any additional existing evidence that is necessary for a fair adjudication of the claims that has not been obtained. Hence, no further notice or assistance to the Veteran is required to fulfill VA’s duty to assist in the development of the claims. Smith v. Gober, 14 Vet. App. 227 (2000), aff’d 281 F.3d 1384 (Fed. Cir. 2002); Dela Cruz v. Principi, 15 Vet. App. 143 (2001). Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Direct service connection may not be granted without evidence of a current disability; in-service incurrence or aggravation of a disease or injury; and a nexus between the claimed in-service disease or injury and the present disease or injury. Id.; see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff'd, 78 F.3d 604 (Fed. Cir. 1996). Where a Veteran served for at least 90 days during a period of war or after December 31, 1946, and manifests certain chronic diseases, such as organic diseases of the nervous system, to a degree of 10 percent within one year, from the date of termination of such service, such disease shall be presumed to have been incurred or aggravated in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1112, 1137; 38 C.F.R. §§ 3.307, 3.309. Alternatively, when a disease at 38 C.F.R. § 3.309(a) is not shown to be chronic during service or the one year presumptive period, service connection may also be established by showing continuity of symptomatology after service. See 38 C.F.R. § 3.303(b). However, the use of continuity of symptoms to establish service connection is limited only to those diseases listed at 38 C.F.R. § 3.309(a) and does not apply to other disabilities which might be considered chronic from a medical standpoint. See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Service connection for disability based on exposure to ionizing radiation can be demonstrated by three different methods. See Rucker v. Brown, 10 Vet. App. 67, 71 (1997). First, there are certain types of cancer that are presumptively service-connected when they occur in “radiation-exposed Veterans.” 38 U.S.C. § 1112(c); 38 C.F.R. § 3.309(d). This category of “radiation-exposed Veterans” includes those Veterans who participated in a “radiation-risk activity.” “Radiation-risk activity” is defined to mean: onsite participation in a test involving the atmospheric detonation of a nuclear device; the occupation of Hiroshima or Nagasaki, Japan, by United States forces during the period beginning on August 6, 1945, and ending on July 1, 1946; internment as a prisoner of war in Japan that resulted in an opportunity for exposure to ionizing radiation comparable to that of Veterans who were in the occupation of forces of Hiroshima or Nagasaki during the period August 6, 1945, and ending on July 1, 1946; or certain service on the grounds of gaseous diffusion plants located in Paducah, Kentucky; Portsmouth, Ohio; and Oak Ridge, Tennessee; or, in certain circumstances, service on Amchitka Island, Alaska. 38 C.F.R. § 3.309 (d)(ii). Diseases presumptively service connected for radiation-exposed Veterans under the provisions of 38 U.S.C. § 1112(c) and 38 C.F.R. § 3.309(d) are: leukemia (other than chronic lymphocytic leukemia), cancer of the thyroid, cancer of the breast, cancer of the pharynx, cancer of the stomach, cancer of the small intestine, cancer of the pancreas, multiple myeloma, lymphomas (except Hodgkin’s disease), cancer of the bile ducts, cancer of the gall bladder, primary liver cancer (except if cirrhosis or hepatitis B is indicated), cancer of the salivary gland, cancer of the urinary tract, bronchiolo-alveolar carcinoma, cancer of the bone, cancer of the brain, cancer of the colon, cancer of the lung, and cancer of the ovary. 38 U.S.C. § 1112(c)(2); 38 C.F.R. § 3.309(d)(2). Second, “radiogenic diseases” may be service connected, provided that certain conditions are met, pursuant to 38 C.F.R. § 3.311. To consider a claim under section 3.311, the evidence must show the following: (1) the Veteran was exposed to ionizing radiation in service; (2) he subsequently developed a radiogenic disease; and (3) such disease first became manifest within a period specified by the regulation. 38 C.F.R. § 3.311(b). If any of the foregoing three requirements has not been met, service connection for a disease claimed as secondary to exposure to ionizing radiation cannot be granted under 38 C.F.R. § 3.311. 38 C.F.R. § 3.311(b)(1)(iii). For purposes of 38 C.F.R. § 3.311, the term “radiogenic disease” means a disease that may be induced by ionizing radiation. 38 C.F.R. § 3.311 (b)(2). The regulation states that the term radiogenic disease shall include: (i) All forms of leukemia except chronic lymphatic (lymphocytic) leukemia; (ii) Thyroid cancer; (iii) Breast cancer; (iv) Lung cancer; (v) Bone cancer; (vi) Liver cancer; (vii) Skin cancer; (viii) Esophageal cancer; (ix) Stomach cancer; (x) Colon cancer; (xi) Pancreatic cancer; (xii) Kidney cancer; (xiii) Urinary bladder cancer; (xiv) Salivary gland cancer; (xv) Multiple myeloma; (xvi) Posterior subcapsular cataracts; (xvii) Non-malignant thyroid nodular disease; (xviii) Ovarian cancer; (xix) Parathyroid adenoma; (xx) Tumors of the brain and central nervous system; (xxi) Cancer of the rectum; (xxii) Lymphomas other than Hodgkin’s disease; (xxiii) Prostate cancer; and (xxiv) Any other cancer. 38 C.F.R. § 3.311(b)(2). In order to prevail under a theory of secondary service connection, there must be: (1) evidence of a current disorder; (2) evidence of a service-connected disability; and, (3) medical nexus evidence establishing a connection between the service-connected disability and the current disorder. See Wallin v. West, 11 Vet. App. 509, 512 (1998). 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. Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). 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 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”). When assessing the probative value of a medical opinion, the access to the claims file and the thoroughness and detail of the opinion must be considered. The opinion is considered probative if it is definitive and supported by detailed rationale. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000). Claims file review, as it pertains to obtaining an overview of a claimant’s medical history, is not a requirement for medical opinions. A medical opinion that contains only data and conclusions has reduced probative weight. Further, a review of the claims file cannot compensate for lack of the reasoned analysis required in a medical opinion, which is where most of the probative value of a medical opinion comes from. “It is the factually accurate, fully articulated, sound reasoning for the conclusion, not the mere fact that the claims file was reviewed, that contributes probative value to a medical opinion.” See Nieves-Rodriguez, 22 Vet. App. at 304 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 claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski,1 Vet. App. 49, 53 (1990). 1. Entitlement to service connection for a pulmonary disorder. The Veteran asserts he has a lung disorder due to include exposure to mustard gas and radiation. He states that this exposure occurred in Fort McClellan, Alabama in 1953. A February 2016 VA respiratory conditions Disability Benefits Questionnaire (DBQ) report indicates that the Veteran has been diagnosed with pulmonary nodules. This confirms that the Veteran has a current disability. The Veteran’s service treatment records do not contain any complaint, treatment or diagnosis referable to a pulmonary disorder. In this regard, his April 1960 service discharge examination found his lungs and chest to be normal and the Veteran denied that he suffered from or that he ever suffered from shortness of breath or a chronic cough in an April 1960 Report of Medical History. As noted, the service records do not show that the Veteran participated in any radiation-risk activity as recognized by VA regulations. See 38 C.F.R. § 3.309(d)(3). However, in the December 2016 decision, the Board conceded that the Veteran was exposed to CWMs and radiation. This acknowledgment was based on the February 2016 VA examination report which states that the Veteran was possibly exposed to CWMs. The examiner stated that potential exposures occurring at Fort McClellan included “radioactive compounds (cesium-137 and cobalt-60).” The Board has first considered whether service connection is warranted on a presumptive basis. However, the clinical evidence of record fails to show that the Veteran manifested sarcoidosis to a degree of 10 percent within the one year following his discharge from service in July 1960. In this case, the first mention of a pulmonary condition in the clinical evidence was in his September 2006 private treatment records, which state that the Veteran had no known lung problems. In February 2011, the private treatment records reflect bilateral pulmonary nodules. Subsequent to the initial recognition of the Veteran’s condition, an August 2011 private treatment record indicated the severity of the pulmonary condition. In addition, the July 2012 VA treatment records, there was no ongoing diagnosis or treatment of a lung disease. Finally, the Veteran has not been diagnosed with sarcoidosis. As such, presumptive service connection is not warranted for sarcoidosis. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309. The preponderance of the evidence is against the Veteran’s claim for service connection for a pulmonary disorder. While the evidence of record shows that the Veteran has currently diagnosed pulmonary disorder, the probative evidence of record demonstrates that such is not related to his service. In an January 2016 VA examination report, the examiner opined that it is not at least as likely that a relationship exists between the Veteran’s diagnosed lung condition and service, with specific consideration of exposure to any CWMs, radiation or other chemicals in service. During the February 2016 VA examination, the examiner opined that any exposure to the chemicals have been shown to cause a variety of adverse health conditions, and there is no evidence of exposure occurring where the Veteran was based in Fort McClellan. In an addendum opinion, the March 2018 VA examiner opined that the Veteran’s lung condition did not develop in-service or within the first year after separation from active duty as the records do not indicate that any exposure to CWM, radiation or other chemicals in-service produced any acute conditions and therefore unlikely would result in a chronic long-term nerve disability. The examiner explained that a biopsy is not indicated because the nodules appear to be stable on serial radiological studies, that pulmonary function testing was normal and does not indicate any significant underlying or additional functional pulmonary disease process, that oxygen saturation was normal and there has not been treatment of the lung findings other than surveillance. The examiner further opined that it was not at least as likely as not that the Veteran’s lung disability was related to in-service exposure to CWM or radiation reasoning that the service treatment records do not indicate symptoms or treatment of an acute nerve gas exposure and the examiner detailed the manifestations of acute exposure. The examiner further reasoned that there is an alternative infectious etiology for the Veteran’s pulmonary condition rather than the claimed in-service exposure as an infectious condition present during service would be unlikely to have resulted in a normal chest X-ray at separation. These opinions had clear conclusions and supporting data, as well as a reasoned medical explanation connecting the two. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). No contrary probative medical opinion is of record. Furthermore, as for any direct assertions by the Veteran and/or his representative that the Veteran currently has the claimed pulmonary disorder as a result of his service, the Board points out that the matters of the diagnosis and etiology of the disabilities at issue is one within the province of trained professionals. See Jones v. Brown, 7 Vet. App. 134, 137-38 (1994). Although lay persons are competent to provide opinions on some medical issues (see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011)), the specific matter of the diagnosis and/or etiology of the Veteran’s claimed pulmonary disorder is a complex medical matter that falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377, n.4 (Fed. Cir. 2007) (providing that lay persons are not competent to diagnose cancer). As neither the Veteran and his representative are not shown to be other than laypersons without appropriate training and expertise, neither is competent to render a probative (i.e., persuasive) opinion the medical matter upon which this claim turns. See, e.g., Bostain v. West, 11 Vet. App. 124, 127 (1998). Hence, the lay assertions of current disability and/or medical nexus do not constitute competent evidence, and, thus, have no probative value. Therefore, the evidence weighs against a finding that the Veteran’s current disability was incurred in or is related to his active duty service. Accordingly, service connection must be denied. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not applicable. See 38 U.S.C. § 5107 (b); Gilbert, 1 Vet. App. at 53-56. 2. Entitlement to service connection for a nerve disorder of the upper and lower extremities. The Veteran contends that he currently suffers from a nerve disorder of the upper and lower extremities. He has consistently maintained that he was exposed to CWMs, to include mustard gas and radiation during service while stationed at Fort McClellan in 1953 and that this exposure is related to his current disability. A May 2013 private treatment record indicates a current disability of the lower extremities and an August 2010 private treatment record establishes a current nerve disorder in the upper extremities. The Veteran’s service treatment records are negative for complaints, treatments or diagnose related to a nerve disorder of the bilateral upper and/or lower extremities. An April 1960 service discharge examination found the Veteran’s upper and lower extremities to be normal and the Veteran denied that he had, or that he ever had, neuritis in an accompanying Report of Medical History. The Board has first considered whether service connection is warranted on a presumptive basis. According to the Veteran’s clinical records, the first mention of nerve disorder to the Veteran occurred in June 2010 where the electrodiagnostic study indicated moderate bilateral lower extremity multilevel radiculopathy and sever motor and sensory axonal polyneuropathy involving the bilateral lower extremity. According to the February 2016 VA examiner, this diagnosis did not occur within the first year after military separation. The May 2010 private treatment record indicates weakness of extremity, which is more pronounced in the left lower extremity and that this was likely secondary to neuropathy. As such, presumptive service connection is not warranted for a nerve disorder of the bilateral upper and lower extremities. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309. The preponderance of the evidence is against the Veteran’s claim for service connection for a nerve disorder of the bilateral upper and lower extremities on a direct basis. In a February 2016 VA peripheral nerves DBQ report, a VA examiner opined that a majority of the evidence supports that it is not at least as likely as not that a relationship exists between the Veteran’s diagnosed peripheral nerve/radiculopathy condition and exposure to any CWMs, radiation or other chemicals in service. The examiner reasoned that the service treatment records are silent for back or nerve issues, complaints, diagnoses or treatments, that the February 1960 separation examination indicates that no significant abnormalities or related abnormal physical examination findings were found and that such suggests that there were no chronic or ongoing nerve or back conditions. The examiner further reasoned that the service treatment records do not indicate symptoms or treatments of acute radiation syndrome, that exposure to nerve agents is highly toxic with inhalation or indigestion, that manifestations of exposure occur within minutes after exposure, that acute exposure of sulfur mustard agents can result in skin burns and blisters and that that there were multiple potential causes of peripheral neuropathy. The examiner further reasoned that there were alternative etiologies for the Veteran’s bilateral upper and bilateral lower extremity nerve condition, that those alternative etiologies are the most likely explanation for his nerve symptomology, that his records do not indicate that exposure to CWMs, radiation or other chemicals produced any acute conditions, and that it was therefore unlikely that such would result in a chronic long-term nerve disability. This opinion had clear conclusions and supporting data, as well as a reasoned medical explanation connecting the two. Nieves-Rodriguez v. Peake, supra; Stefl v. Nicholson, supra. This opinion is afforded probative weight. In contrast, a November 2017 opinion from Dr. S. O., a private neurologist, indicates that the Veteran’s diagnosis of moderate to severe mixed motor and sensory axonal polyneuropathy is attributable to toxic exposure to chemical agents including mustard gas and chlorine as the Veteran was exposed to multiple agents including mustard gas and chlorine in the 1950s when he was in the military chemical unit. However, no rationale was provided for this opinion. See Nieves-Rodriguez v. Peake, supra; Stefl v. Nicholson, supra. It is therefore afforded little, if any, probative weight. A November 2010 private treatment record from Dr. S. O. indicates that the Veteran had a history of mixed motor and sensory axonal polyneuropathy with chronic bilateral lower extremity lumbar radiculopathy. The physician also states that the Veteran’s symptoms are multifactorial to include lumbar radiculopathy and possible secondary to prior unexplained chemical agent environmental exposure. In June 2012, the same clinician stated that several studies indicated chronic severe left L5 and S1 radiculopathies with mild to moderate peripheral neuropathy possibly attributed toxic exposure chemical agents including mustard gas. However, the speculative terminology used by this physician does not provide a sufficient basis for an award of service connection for migraine headaches on a secondary basis. See Obert v. Brown, 5 Vet. App. 30, 33 (1993) (a medical opinion expressed in terms of “may” also implies “may or may not” and is too speculative to establish a causal relationship). See also Warren v. Brown, 6 Vet. App. 4, 6 (1993) (a doctor’s statement framed in terms such as “could have been” is not probative); Tirpak v. Derwinski, 2 Vet. App. 609, 611 (1992) (“may or may not” language by a physician is too speculative). These opinions therefore have little, if any, probative weight. A December 2012 opinion from Dr. S. C., a private physician, indicates that the Veteran has chronic weakness and neuropathy of both legs particularly in the left. The physician opined that the Veteran’s left foot drop and sensory impairment are directly related to his in-service traumatic left foot fracture, chemical exposures and radiation exposures. However, no rationale was provided for this opinion. See Nieves-Rodriguez v. Peake, supra; Stefl v. Nicholson, supra. A May 2013 opinion from this clinician indicates that the Veteran’s left leg nerve damage and persistent leg pain were the result of service connected injury while on active duty and was exacerbated by biologic agents/radiation during testing while on active duty. However, no rationale was provided for this opinion. Id. These opinions are therefore afforded little, if any, probative weight. The Board has next considered whether service connection is warranted on a secondary basis. A March 2018 VA physician opined that it was not at least as likely as not that the Veteran’s nerved disorder, neuropathy and radiculopathy are related to or aggravated beyond the normal progression by his service-connected left foot disorder and reasoned that the medical literature is void of peer reviewed evidence that the left foot would cause radiculopathy in one or both lower extremities or a peripheral neuropathy in all extremities. The physician reasoned that the most likely etiology of the peripheral neuropathy condition was related to the drug Pacerone and that the radiculopathy was related to the spine degenerative disc disease and degenerative joint disease. The physician further reasoned that degenerative lumbar spondylosis was a chronic condition that tends to progressively worsen over time with the natural aging process and/or due to repetitive injury and that the lack of surgery or interventional procedures for radicular disease and treatment with mainly oral pain medication would not support aggravation of the Veteran’s back condition with radiculopathy beyond its normal progression. This opinion had clear conclusions and supporting data, as well as a reasoned medical explanation connecting the two. Nieves-Rodriguez v. Peake, supra; Stefl v. Nicholson, supra. This opinion is afforded probative weight. Furthermore, as for any direct assertions by the Veteran and/or his representative that the Veteran currently has the claimed bilateral upper and lower extremity nerve disorder as a result of his service, the Board points out that the matters of the diagnosis and etiology of the disabilities at issue is one within the province of trained professionals. See Jones v. Brown, supra. Although lay persons are competent to provide opinions on some medical issues (see Kahana v. Shinseki, supra)), the specific matter of the diagnosis and/or etiology of the Veteran’s claimed pulmonary disorder is a complex medical matter that falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, supra. As neither the Veteran and his representative are not shown to be other than laypersons without appropriate training and expertise, neither is competent to render a probative (i.e., persuasive) opinion the medical matter upon which this claim turns. See, e.g., Bostain v. West, supra. Hence, the lay assertions of current disability and/or medical nexus do not constitute competent evidence, and, thus, have no probative value. Therefore, the evidence weighs against a finding that the Veteran’s current nerve disorder of the upper and lower extremities was incurred in or is related to his active duty service. Accordingly, service connection must be denied. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not applicable. See 38 U.S.C. § 5107(b); Gilbert, 1 Vet. App. at 53-56. KRISTY L. ZADORA Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD O. Owolabi, Law Clerk