Citation Nr: 18144201 Decision Date: 10/24/18 Archive Date: 10/23/18 DOCKET NO. 16-18 977A DATE: October 24, 2018 ORDER Entitlement to service connection for lumbar back disability is denied. Entitlement to service connection for residuals, broken nose is denied. Entitlement to service connection for irritable bowel syndrome is denied. Entitlement to service connection for migraine headaches is denied. Entitlement to an increased rating in excess of 10 percent for bilateral pes planus is withdrawn. Entitlement to an increased rating in excess of 10 percent for bilateral hearing loss is withdrawn. Entitlement to an increased rating in excess of 10 percent for tinnitus is withdrawn. FINDINGS OF FACT 1. A lumbar back disability was not manifest during active service, and is not shown to be causally or etiologically related to an in-service event, injury, or disease. 2. A disability involving residuals of a broken nose was not manifest during active service, a current disability involving residuals of a broken nose is not shown, and a disability involving residuals of a broken nose is not shown to be causally or etiologically related to an in-service event, injury, or disease. 3. An irritable bowel syndrome disability was not manifest during active service, and is not shown to be causally or etiologically related to an in-service event, injury, or disease; nor can such disability be presumed. 4. A migraine headache disability was not manifest during active service, and is not shown to be causally or etiologically related to an in-service event, injury, or disease. 5. In written correspondence to VA dated December 15, 2015, the Veteran and his representative withdrew the issue of entitlement to an increased rating in excess of 10 percent for a bilateral pes planus disability. 6. In written correspondence to VA dated December 15, 2015, the Veteran and his representative withdrew the issue of entitlement to an increased rating in excess of 10 percent for a bilateral hearing loss disability. 7. In written correspondence to VA dated December 15, 2015, the Veteran and his representative withdrew the issue of entitlement to an increased rating in excess of 10 percent for a tinnitus disability. CONCLUSIONS OF LAW 1. The criteria for service connection for a lumbar back disability have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131 (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2017). 2. The criteria for service connection for a disability for residuals of a broken nose have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131 (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2017). 3. The criteria for service connection for an irritable bowel syndrome disability have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131 (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.317 (2017). 4. The criteria for service connection for a migraine headaches disability have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131 (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2017). 5. The criteria for withdrawal of the appeal of the issue of entitlement to an increased rating in excess of 10 percent for a bilateral pes planus disability have been met. 38 U.S.C. § 7105(b)(2), (d)(5) (2012); 38 C.F.R. § 20.204 (2017). 6. The criteria for withdrawal of the appeal of the issue of entitlement to an increased rating in excess of 10 percent for a bilateral hearing loss disability have been met. 38 U.S.C. § 7105(b)(2), (d)(5) (2012); 38 C.F.R. § 20.204 (2017). 7. The criteria for withdrawal of the appeal of the issue of entitlement to an increased rating in excess of 10 percent for a tinnitus disability have been met. 38 U.S.C. § 7105(b)(2), (d)(5) (2012); 38 C.F.R. § 20.204 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from May 2008 to March 2012. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from two different March 2014 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in Pittsburgh, Pennsylvania. Veterans Claims Assistance Act of 2000 (VCAA) 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). The Veteran in this case has not referred to any deficiencies in either the duties to notify or assist; therefore, the Board may proceed to the merits of the claim. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015, cert. denied, U.S.C. Oct.3, 2016) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board….to search the record and address procedural arguments when the [appellant] fails to raise them before the Board”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to an appellant’s failure to raise a duty to assist argument before the Board). The Board has reviewed all of the evidence in the Veteran’s claims file. Although the Board has an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that the evidence submitted by the Veteran or obtained on his behalf be discussed in detail. Rather, the Board’s analysis below will focus specifically on what evidence is needed to substantiate the claim and what the evidence in the claims file shows, or fails to show, with respect to the claim. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) and Timberlake v. Gober, 14 Vet. App. 122, 128-130 (2000). In sum, the Board is satisfied that the originating agency properly processed the Veteran’s claim after providing the required notice and that any procedural errors in the development and consideration of the claims by the originating agency were insignificant and non-prejudicial to the Veteran. See Bernard v. Brown, 4 Vet. App. 384 (1993). Service Connection for Lumbar Back, Residuals of a Broken Nose, Irritable Bowel Syndrome, and Migraine Headache Disabilities Legal Criteria for Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). To establish entitlement to service-connected compensation benefits, a Veteran must show: “(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service-the so-called “nexus” requirement.” Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Service connection may also be granted for disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303(d). Finally, for veterans who served in the Southwest Asia theater of operations during the Persian Gulf War, service connection may also be established for chronic disability that cannot be attributed to a known clinical diagnosis (undiagnosed illness) or for a medically unexplained multisymptom illness (e.g., chronic fatigue syndrome, fibromyalgia, or irritable bowel syndrome). See 38 C.F.R. § 3.317. VA is required to give due consideration to all pertinent medical and lay evidence in evaluating a claim for disability benefits. 38 U.S.C. § 1154(a). 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, 1377 (Fed. Cir. 2007). Lay evidence cannot be determined to be not credible merely because it is unaccompanied by contemporaneous medical evidence. Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006). However, the lack of contemporaneous medical evidence can be considered and weighed against a Veteran’s lay statements. Id. Further, a negative inference may be drawn from the absence of complaints or treatment for an extended period. Maxson v. West, 12 Vet. App. 453, 459 (1999), aff’d sub nom. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). Proof of a current disability is a threshold to establishing service-connection for any claimed disability. In the absence of proof of a present disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). To be a present as a current disability, there must be evidence of the condition at some time during the appeals period. Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998). After the evidence is assembled, it is the Board’s responsibility to evaluate the entire record. See 38 U.S.C. § 7104(a) (2012). When there is an approximate balance of evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each issue shall be given to the claimant. See 38 U.S.C. § 5107 (2012); 38 C.F.R. §§ 3.102, 4.3 (2017). In Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990), the United States Court of Appeals for Veterans Claims (Court) stated that “a veteran need only demonstrate that there is an ‘approximate balance of positive and negative evidence’ in order to prevail.” To deny a claim on its merits, the preponderance of the evidence must be against the claim. See Alemany v. Brown, 9 Vet App. 518, 519 (1996), citing Gilbert, 1 Vet. App. at 54. Evidence and Analysis – Lumbar Back Disability The Veteran asserts that he has a lumbar back strain with pain resulting from his active duty service. He did not identify a specific incident or injury, but rather the stresses on his back resulting from his service as an infantryman and a mortarman in his approximately four years of active service, to include periodic back spasms. The Veteran received a VA examination for his claimed low back condition in February 2016. The Veteran reported back pain and periodic spasms to his examiner, and that he receives physical therapy for his back. The Veteran noted the pain was worse when bending over and that sometimes at work he wears a back brace in his occupation as a heating/air conditioning technician. The examiner noted the Veteran’s description of his back pain as “kind of like a sharp pain” but also noted the Veteran reported the low back condition did not limit his ability to work. Imaging of the lumbosacral spine was accomplished as part of this examination and revealed a straight lumbar spine, with no evidence of a fracture or subluxation. No lytic or blastic lesions were visible, and there was no spondylolysis or spondylolisthesis. There was no disc space narrowing observed, though the endplates of the lumbar vertebral bodies were somewhat depressed surrounding the disc spaces. No abnormality of the sacroiliac joints was visible. No abnormal range of motion was noted in either flexion or extension. No evidence of degenerative disc disease was noted via imaging accomplished during this examination. The examiner did note localized tenderness across the lower back bilaterally. Muscle strength was 5 on a scale of 5 and reflexes were noted as normal. This VA examiner provided a negative nexus opinion for service connection, saying the Veteran’s diagnosed lumbosacral spine strain was less likely than not (less than 50 percent probability) incurred in or caused by the Veteran’s claimed in-service injury, events, or illness. The examiner’s rationale was that the Veteran’s claimed low back strain was diagnosed per the Veteran’s report of subjective symptoms without any objective findings on examination or x-ray imaging. The examiner did note the Veteran’s combat service as an infantryman and a mortarman but also that the service treatment records were completely silent for any complaints or treatments of any problems related to the lower back, to include the Veteran’s last report of his own medical history in February 2012, a month prior to his separation from active service. The Board finds the VA examination report and opinion to be of great probative value. Indeed, the examiner considered the Veteran’s contention, the claims file, and clinical medical evidence before providing a negative opinion. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (the probative value of a medical opinion is derived from a factually accurate, fully articulated, and soundly reasoned opinion). A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). The examiner’s negative opinion was supported by a sufficiently clear and well-reasoned medical rationale and was consistent with the verifiable facts regarding the Veteran’s contentions. See Bloom v. West, 12 Vet. App. 185, 187 (1999); Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998); see also Claiborne v. Nicholson, 19 Vet. App. 181, 186 (2005). The Veteran has reported in lay statements his account of his active service leading to his back strain and his subsequent post-service physical therapy. However, the Board notes that the Veteran’s service treatment records, to include reports of medical history, are silent for any treatment or complaint of any low back condition or distress during active service. The Board acknowledges that the Veteran is competent to testify as to his beliefs that his disabilities are related to service. Barr v. Nicholson, 21 Vet. App. 303, 307-08 (2007). In order for lay evidence to be competent, the individual must have personal knowledge, derived from his/her own senses, of what is being attested; “[c]ompetent testimony is thus limited to that which the witness has actually observed, and is within the realm of his personal knowledge.” Layno v. Brown, 6 Vet. App. 465, 471 (1994). Here, the Veteran is competent to testify about his symptoms relating to his claimed low back condition. However, there is nothing in the record to suggest that the Veteran has the appropriate training, experience, or expertise to render a medical opinion regarding etiology of a low back strain or injury. See 38 C.F.R. § 3.159 (a)(1) (setting forth that competent medical evidence means evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions). While the Veteran is competent to report what he has experienced, he is not competent to ascertain the etiology of any current condition, as the causative factors for such are not readily subject to lay observation. See Layno v. Brown, 6 Vet. App. 465 (1994); Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (concerning rheumatic fever); see also Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Accordingly, his assertions to that effect are of no probative value. There are no competent medical opinions of probative value in favor of a positive nexus to active service from any VA examiner or medical treatment provider from any source. Upon review of the record, the Board concludes that entitlement to service connection for a lumbar back disability is not warranted. The Board acknowledges the Veteran’s contentions, and the Veteran’s post-service complaints are noted. However, the separation physical of November 2011 is silent for any low back or lumbar back notation or related injury, and there is no competent evidence to tie the current assertion to any in-service disease or injury. The Board thus finds the Veteran fails the third prong of the test for entitlement to direct service connection. See Davidson v. Shinseki, 581 F.3d 1313, 1315-16 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); 38 C.F.R. § 3.303. Based on the above, the Board finds that the weight of the competent and credible evidence demonstrates that the Veteran’s claimed lumbar back disability was not incurred in service. For these reasons, the Board finds that a preponderance of the evidence is against the claim of service connection for a lumbar back disability, and the claim must be denied. Because the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not for application. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Evidence and Analysis – Residuals, Broken Nose Disability The Veteran asserts that he has residual difficulties resulting from a broken nose, to possibly include being struck by a vehicle door. The Veteran was provided with a VA examination for his nose disability in February 2016. The Veteran reported he sometimes has pain in his nose and it is hard for him to breathe through his nose all the time. The examiner noted the Veteran’s report of a broken nose in service, and noted she could find no evidence of an injury to the Veteran’s face or any evidence of a broken nose or treatment for one. The examiner did note a very fine line across the bridge of the nose which the Veteran considered a scar, but the examiner recorded it as non-tender, flat, smooth, and not measurable. X-rays were taken as part of this examination, which showed no evidence of nasal injury. The paranasal sinuses were clear, with no bony destructive changes seen, and with no soft tissue abnormalities evident. The examiner did note the presence of allergy-related rhinitis via enlarged nasal turbinates but did not consider that related to the Veteran’s report of a broken nose in service. Because the VA examiner could not make a diagnosis of any current disability related to the Veteran’s claim of residuals for a broken nose, there was no formal opinion for service connection provided. The Board notes the statements from the Veteran regarding his disability regarding residuals of a broken nose. Generally, lay evidence is probative with regard to a disease with “unique and readily identifiable features” that is “capable of lay observation.” See Barr v. Nicholson, 21 Vet. App. 303, 308-09 (2007). Lay evidence on its own can be sufficient evidence of a diagnosis if (1) the 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. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Additionally, a lay person may speak to etiology in some limited circumstances in which nexus is obvious merely through observation, such as sustaining a fall leading to a broken leg. Id. A layperson cannot provide evidence as to more complex medical questions and, specifically, cannot provide an opinion as to etiology in such cases. See Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (concerning rheumatic fever). See 38 C.F.R. § 3.159(a)(2). The Board finds the February 2016 VA examination to be highly probative as it is sound and thorough, and had sufficiently clear and well-reasoned rationale, as well as a basis in objective supporting medical literature and clinical data for its conclusions. See Bloom v. West, 12 Vet. App. 185, 187 (1999); Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998); see also Claiborne v. Nicholson, 19 Vet. App. 181, 186 (2005). The Veteran’s claims file contains no evidence of any private medical provider that has made a diagnosis of any nose or nasal sinus cavity disability. The Veteran’s service treatment records are completely silent for any complaints of or treatment for a nose-related disability. In the absence of proof of a present disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Here, there is no diagnosis of a current disability of residuals of a broken nose or any other nasal-related disability by any medical examiner, in service, or in 2016 from VA. The service treatment records are completely silent for any nose injury, illness or incident that could give rise to a current disability. The Veteran, in his separation report of medical history, did not report a nose condition. A VA examination from 2016 does not document a nose condition. No private medical provider has diagnosed a nose condition. Thus, the Veteran’s claim does not meet the first prong of service connection, the requirement of a current disability. See Davidson v. Shinseki, 581 F.3d 1313, 1315-16 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); 38 C.F.R. § 3.303. Based on the above, the Board finds that the weight of the competent and credible evidence demonstrates that the Veteran’s claimed residuals of a broken nose were not incurred in service. For these reasons, the Board finds that a preponderance of the evidence is against the claim of service connection for a disability involving the residuals of a broken nose, and the claim must be denied. Because the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not for application. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Evidence and Analysis – Irritable Bowel Disability The Veteran contends he has an irritable bowel syndrome disability, because he was treated for a bout of loose stools in 2010 during active service. In the alternative, the Veteran also asserts that because of his Southwest Asia service, that he entitled to service connection for chronic disability that cannot be attributed to a known clinical diagnosis (undiagnosed illness) or for a medically unexplained multisymptom illness (e.g., chronic fatigue syndrome, fibromyalgia, or irritable bowel syndrome). See 38 C.F.R. § 3.317. However, the Board notes from the Veteran’s claims file that his deployed service consisted of two tours in Afghanistan. 38 C.F.R. § 3.317(e) defines the Southwest Asia theater of operations as Iraq, Kuwait, Saudi Arabia, the neutral zone between Iraq and Saudi Arabia, Bahrain, Qatar, the United Arab Emirates, Oman, the Gulf of Aden, the Gulf of Oman, the Persian Gulf, the Arabian Sea, the Red Sea, and the airspace above these locations. Because the Veteran does not meet the geographical service requirement, he is not eligible to qualify for entitlement to service connection pursuant to 38 C.F.R. § 3.317, and the Board therefore need not proceed further with service connection analysis pursuant to that regulation. Thus, the Board will proceed with an analysis for direct service connection. The Veteran received a VA examination for his claimed intestinal condition in January 2014. The examiner noted a history of irritable bowel syndrome, but noted no symptoms of bowel disturbance with abdominal distress, otherwise unexplained weight loss, malnutrition, or other pertinent gastrointestinal findings. Laboratory diagnostic testing revealed normal blood cell counts and no anemia. This examiner provided a negative nexus opinion regarding direct service connection, opining that the claimed condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. The examiner’s rationale was that she noted the Veteran’s sole possible in-service incident of April 2010 when he reported to sick call with loose stools, which the treatment note recorded as lasting for 3 days. Medical providers noted the Veteran had been taking prescription antibiotics prior to his loose stools complaint. They provided an over-the-counter anti-diarrheal medication for 3 days, and the remainder of the Veteran’s service treatment records, to include his separation examination, were silent for any gastrointestinal problem. The examiner concluded that the Veteran’s sole instance of a gastrointestinal complaint during active service was a temporary condition that resolved. The Board finds the VA examination report and opinion to be of great probative value. Indeed, the examiner considered the Veteran’s contention, the claims file, and clinical medical evidence before providing a negative opinion. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (the probative value of a medical opinion is derived from a factually accurate, fully articulated, and soundly reasoned opinion). A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). The examiner’s negative opinion was supported by a sufficiently clear and well-reasoned medical rationale and was consistent with the verifiable facts regarding the Veteran’s contentions. See Bloom v. West, 12 Vet. App. 185, 187 (1999); Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998); see also Claiborne v. Nicholson, 19 Vet. App. 181, 186 (2005). The Veteran has reported in lay statements his account of that initial incident and his subsequent medical treatment. However, the Board notes that the Veteran’s service treatment records are silent for any treatment of any other gastrointestinal condition or distress during active service, including subsequent to the lone April 2010 treatment report. The Board acknowledges that the Veteran is competent to testify as to his beliefs that his disabilities are related to service. Barr v. Nicholson, 21 Vet. App. 303, 307-08 (2007). In order for lay evidence to be competent, the individual must have personal knowledge, derived from his/her own senses, of what is being attested; “[c]ompetent testimony is thus limited to that which the witness has actually observed, and is within the realm of his personal knowledge.” Layno v. Brown, 6 Vet. App. 465, 471 (1994). Here, the Veteran is competent to testify about his symptoms relating to his claimed irritable bowel condition. However, there is nothing in the record to suggest that the Veteran has the appropriate training, experience, or expertise to render a medical opinion regarding etiology of irritable bowel syndrome. See 38 C.F.R. § 3.159 (a)(1) (setting forth that competent medical evidence means evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions). While the Veteran is competent to report what he has experienced, he is not competent to ascertain the etiology of any current condition, as the causative factors for such are not readily subject to lay observation. See Layno v. Brown, 6 Vet. App. 465 (1994); Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (concerning rheumatic fever); see also Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Accordingly, his assertions to that effect are of no probative value. There are no competent medical opinions of probative value in favor of a positive nexus to active service from any VA examiner or medical treatment provider from any source. Upon review of the record, the Board concludes that entitlement to service connection for an irritable bowel syndrome disability is not warranted. The Board acknowledges the Veteran’s contentions, and the active duty service treatment of the gastrointestinal complaint is noted. However, the separation physical of November 2011 is silent for any irritable bowel syndrome notation or related gastrointestinal disorder, and there is no competent evidence to tie the current assertion to any in-service disease or injury. The Board thus finds the Veteran fails the third prong of the test for entitlement to direct service connection. See Davidson v. Shinseki, 581 F.3d 1313, 1315-16 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); 38 C.F.R. § 3.303. Based on the above, the Board finds that the weight of the competent and credible evidence demonstrates that the Veteran’s claimed irritable bowel syndrome was not incurred in service. For these reasons, the Board finds that a preponderance of the evidence is against the claim of service connection for an irritable bowel syndrome disability, and the claim must be denied. Because the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not for application. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Evidence and Analysis – Migraine Headache Disability The Veteran asserts he is entitled to service connection for migraine headaches, pointing out that he experienced headaches shortly after being struck in the face by a door to a HMMWV (high mobility multipurpose wheeled vehicle) during active service. The Veteran also reported stress in his current occupation as a heating and air conditioning technician, which caused intermittent headaches. The Veteran received a VA examination for his headaches claim in February 2016. The examiner noted that the Veteran’s private primary care physician had diagnosed him with migraine headaches in May 2012. The Veteran described his headaches as being on top of his head, sometimes across the front, or in the back, dependent on the incident. The Veteran also indicated that he has not sought treatment for his headaches and treats them with over-the-counter medication when required. The examiner noted a CT scan of the Veteran’s head revealed “no acute process” in the brain. The examiner also reported that there are no signs of hemorrhage in the brain, and the imaging indicates the ventricles, sulci, and cisterns of the brain are normal in configuration, with no intra or extra-axial fluid collection. The visualized paranasal sinuses and mastoid air cells were noted as clear, and there were no remarkable observations of the Veteran’s skull. The Veteran was also noted to have headaches in relation to his alcohol use, as documented by post-service VA treatment records. The Veteran was seen in the emergency room in January 2016 and reported he drank a fifth of hard alcohol daily, but that his drinking did not have an impact on his headaches. This VA examiner provided a negative nexus opinion for service connection, saying that it is less likely than not (less than 50 percent probability) that the Veteran’s headaches were incurred in or caused by an in-service injury, event, or illness. The examiner’s rationale was that headaches can occur for a large variety of reasons and are common symptoms of many conditions, to include stress, eye strain, hangovers. The examiner specifically noted that the Veteran’s complaint of being struck in the face of the HMMWV door was not documented in the Veteran’s service treatment records, and no other complaint, diagnosis, or treatment for headaches was noted in the Veteran’s service treatment records. The Board finds the VA examination report and opinion to be of great probative value. Indeed, the examiner considered the Veteran’s contention, the claims file, and clinical medical evidence before providing a negative opinion. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (the probative value of a medical opinion is derived from a factually accurate, fully articulated, and soundly reasoned opinion). A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). The examiner’s negative opinion was supported by a sufficiently clear and well-reasoned medical rationale and was consistent with the verifiable facts regarding the Veteran’s contentions. See Bloom v. West, 12 Vet. App. 185, 187 (1999); Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998); see also Claiborne v. Nicholson, 19 Vet. App. 181, 186 (2005). The Veteran has reported in lay statements his account of his headaches and his subsequent medical treatment. However, the Board notes that the Veteran’s service treatment records are silent for any treatment of any headaches or related incidents during active service, including subsequent to the vehicle door incident reported by the Veteran but not mentioned in his service medical records. The Board acknowledges that the Veteran is competent to testify as to his beliefs that his disabilities are related to service. Barr v. Nicholson, 21 Vet. App. 303, 307-08 (2007). In order for lay evidence to be competent, the individual must have personal knowledge, derived from his/her own senses, of what is being attested; “[c]ompetent testimony is thus limited to that which the witness has actually observed, and is within the realm of his personal knowledge.” Layno v. Brown, 6 Vet. App. 465, 471 (1994). Here, the Veteran is competent to testify about his symptoms relating to his claimed headaches. However, there is nothing in the record to suggest that the Veteran has the appropriate training, experience, or expertise to render a medical opinion regarding etiology of migraines or other types of headaches. See 38 C.F.R. § 3.159 (a)(1) (setting forth that competent medical evidence means evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions). While the Veteran is competent to report what he has experienced, he is not competent to ascertain the etiology of any current condition, as the causative factors for such are not readily subject to lay observation. See Layno v. Brown, 6 Vet. App. 465 (1994); Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (concerning rheumatic fever); see also Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Accordingly, his assertions to that effect are of no probative value. There are no competent medical opinions of probative value in favor of a positive nexus to active service from any VA examiner or medical treatment provider from any source. Upon review of the record, the Board concludes that entitlement to service connection for a migraine headache disability is not warranted. The Board acknowledges the Veteran’s contentions, and the active duty service incident of the Veteran being hit by a vehicle door is noted. However, the separation physical of November 2011 is silent for any headaches notation or related disorders, and there is no competent evidence to tie the current assertion to any in-service disease or injury. The Board thus finds the Veteran fails the third prong of the test for entitlement to direct service connection. See Davidson v. Shinseki, 581 F.3d 1313, 1315-16 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); 38 C.F.R. § 3.303. Based on the above, the Board finds that the weight of the competent and credible evidence demonstrates that the Veteran’s claimed migraine headaches disability was not incurred in service. For these reasons, the Board finds that a preponderance of the evidence is against the claim of service connection for a migraine headaches disability, and the claim must be denied. Because the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not for application. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. WITHDRAWN ISSUES The Board may dismiss any appeal that fails to allege specific error of fact or law in the determination being appealed. 38 U.S.C. § 7105 (2012). An appeal may be withdrawn as to any or all issues involved in the appeal at any time before the Board promulgates a decision. 38 C.F.R. § 20.204 (2017). Withdrawal may be made by the Veteran or by his or her authorized representative. Id. In written correspondence to VA dated December 15, 2015, the Veteran, through his representative, stated that he would like to withdraw the issues of entitlement to an increased rating in excess of 10 percent for each of his service-connected bilateral pes planus, bilateral hearing loss, and tinnitus disabilities. As a matter of law, a withdrawal of an appeal is effective when received. See 38 C.F.R. § 20.204 (b)(3) (2017). Thus, there remain no allegations of errors of fact or law for appellate consideration with respect to these matters. As the Board does not have jurisdiction to review these claims, they are therefore dismissed. Michael Pappas Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Setter, Associate Counsel