Citation Nr: 18144782 Decision Date: 10/25/18 Archive Date: 10/25/18 DOCKET NO. 10-31 613A DATE: October 25, 2018 ORDER Service connection for a back disability is denied. Service connection for a bilateral knee disability is denied. Service connection for a bilateral hip disability is denied. FINDING OF FACT Neither a back disability, nor a bilateral knee disability, nor a bilateral hip disability originated during service or within one year of discharge from service, are not otherwise etiologically related to service, and are not caused or aggravated by a service-connected disability. CONCLUSION OF LAW The criteria for service connection for a back disability, a bilateral knee disability, and a bilateral hip disability have not been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.159, 3.102, 3.303, 3.309, 3.310 (2018). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from July 1968 to July 1972. This case initially came before the Board of Veterans’ Appeals (Board) on appeal from August 2010 and September 2011 rating decisions. The Veteran participated in a videoconference hearing before the undersigned in September 2013, and a transcript of this hearing has been associated with the record. In March 2017, the Board denied the Veteran’s claims. The Veteran appealed this decision to the United States Court of Appeals for Veterans Claims (Court), which vacated the Board’s March 2017 decision pursuant to an April 2018 Joint Motion for Remand (Joint Motion). VA provided the Veteran with adequate notice in October 2009 and February 2011. 38 U.S.C. §§ 5103, 5103A (2012); 38 C.F.R. § 3.159 (2018); Mayfield v. Nicholson, 19 Vet. App. 103, (2005), rev’d on other grounds, Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006). VA has also complied with the duty to assist. Service Connection In general, service connection may be granted for disability or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. In order to establish service connection for a claimed disability, there must be (1) medical evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in service incurrence or aggravation of a disease or injury; and (3) evidence, generally medical, of a nexus between the claimed in service disease or injury and the current disability. Hickson v. West, 12 Vet. App. 247 (1999). Arthritis is a chronic disease, and service connection may be established based on a continuity of symptomatology. 38 C.F.R. § 3.309(a); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Service incurrence will be presumed for arthritis if manifested to a compensable degree within the year after separation from active service. 38 U.S.C. § 1112; 38 C.F.R. §§ 3.307, 3.309. Service connection may additionally be established on a secondary basis for a disability that is proximately due to or the result of a service connected disease or injury. 38 C.F.R. § 3.310(a); Harder v. Brown, 5 Vet. App. 183 (1993). Additional disability resulting from the aggravation of a non service connected disability by a service connected disability is also service connected. 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439 (1995). To establish service connection for a claimed disability on a secondary basis, there must be evidence of a current disability, a service connected disability, and medical evidence of a nexus between the service connected disability and the current disability. Wallin v. West, 11 Vet. App. 509 (1998). Factual History - Service Connection for a Back Disability During service, in December 1969, the Veteran complained of low back pain. X-rays of the Veteran’s back were normal. In the Veteran’s May 1972 separation examination, the Veteran’s spine was noted to be normal. Following service, in a January 1976 report of medical history, the Veteran denied ever having experienced symptoms such as arthritis, rheumatism, bursitis, or back pain. In a January 1976 physical examination, the Veteran’s spine was noted to be normal, and the Veteran was qualified for reenlistment in the Naval Reserve. In July 1981, the Veteran stated that he had experienced a gradual onset of back pain over the preceding three months. The Veteran indicated that he had experienced previous episodes of back pain, but he recalled no injury and stated that he had undergone no previous treatment. X-ray examination showed that the Veteran had degenerative disc disease. In September 1981, it was noted that the Veteran had developed back pain approximately three months before without any known injury. In September 1981, the Veteran underwent a left L4 hemilaminotomy and L4-L5 discectomy. In April 1993, the Veteran filed a claim for service connection for a back disability, claiming that he had received treatment for his back disability since 1978. The Veteran stated that he experienced back problems during service while serving as a seaman third class, but once he joined the signal corps, his back problems subsided because he did not engage in as much physical labor. The Veteran’s former spouse stated that they had purchased a water bed in 1973 to relieve pressure on his back. In July 1993, the Veteran’s former spouse again indicated that the Veteran frequently complained of back pain both before and after his service. In August 1993, the Veteran’s former employer indicated that the Veteran wore a back brace during his period of employment from 1973 to 1980. The Veteran underwent a VA examination in July 1993, at which time the Veteran reported that he had not worked for two years as a result of his back disability. The Veteran stated that he had experienced aches and pains in his back during service. Following service, he worked with printing machines and his low back pain worsened. The Veteran reported that just before 1982, he developed intense pain in his low back and underwent a discectomy and laminectomy. The examiner diagnosed the Veteran with an L5-S1 discectomy with residuals of decreased range of motion, and degenerative disc disease. In April 2004, it was noted that the Veteran had undergone a back surgery 20 years before at L4-L5, and he again complained of back pain. An MRI examination showed mild disc protrusion at L3-L4 and stenosis. In June 2005, the Veteran again complained of pain in his lower back. In the Veteran’s June 2006 claim for disability benefits from the Social Security Administration (SSA), the Veteran attributed his inability to work to rheumatoid arthritis and cervical surgery, which he indicated first bothered him in January 2000. In September 2009, the Veteran filed his current claim for service connection. Also in September 2009, a private clinician stated that the Veteran hurt his back after he was thrown out of his rack onto the deck during service, with several other sailors falling on him. The Veteran did not report the injury until December 1969. The Veteran reported that he again experienced pain in his back in August 1970, but the Veteran did not report such injury because of “peer pressure” not to go to sick bay. The clinician noted that the Veteran’s 1972 employer stated that the Veteran experienced “numerous bouts of back pain” and began wearing a brace. The clinician noted that such accounts were corroborated by the Veteran’s former and current wives. The clinician believed the Veteran’s account that he suffered from back pain in-service, and he found that the Veteran’s current back issues related to his lifting, bending, and twisting in the military. The clinician concluded that the Veteran’s back disability began in the military and progressed in severity from that time. The Veteran underwent a VA examination in April 2010, at which time the examiner noted, according to the Veteran’s own statement, that the majority of the Veteran’s active duty was spent performing light-duty activities as a signalman. The examiner further noted that following service, the Veteran worked full-time for years as a pressman and printer, which involved walking and standing all day and engaging in heavy physical labor. The examiner noted that the Veteran performed this heavy physical labor for nine years before his development of major low back problems in 1981. The examiner disagreed with the September 2009 conclusion of the private clinician that the Veteran’s low back disability related to service, in part because that clinician had not physically examined or treated the Veteran. Instead, the examiner observed that the Veteran had simply provided the clinician with his subjective report of historical details, all of which the clinician found to be credible. The examiner noted that the clinician’s analysis might not have had the full benefit of review of the totality of the Veteran’s medical records. The examiner concluded that the Veteran’s back disability was not caused by or the result of his military service. As a rationale for this opinion, the examiner found that the Veteran’s in-service complaint of back pain was isolated, minor, and self-limiting, and he returned to full, unrestricted duty following this complaint. The Veteran had no other complaints of back pain in service, and he did not report back pain in either his 1972 separation examination or 1979 Reserve examination. In July 2010, the Veteran complained of a 35-year history of back pain, corresponding to a 1975 onset date of back pain. In his June 2013 videoconference hearing, the Veteran denied ever injuring his back during service, and he instead attributed his back disability to “ongoing issues with the feet”. In October 2014, the examiner who conducted the September 2012 examination, upon re-examination of the evidence, further concluded that the Veteran’s service-connected right foot disability had not caused or aggravated his back disability. In July 2015, the Veteran reported a recurrence of low back pain approximately 6 months before, with an acute worsening 3 months before. The Veteran underwent an additional VA examination in May 2016, at which time the examiner diagnosed the Veteran with degenerative joint and disc disease of the lumbosacral spine. The Veteran complained of midline low back pain that began gradually in “1976, probably”. The Veteran denied ever injuring his back. The examiner opined that it was less likely than not that the Veteran’s back disability related to his military service. As a rationale for this opinion, the examiner noted that the Veteran experienced a single low back strain injury in December 1969 from which he recovered and returned to full duty with no further complaints. The Veteran denied any low back problems at both his May 1972 discharge examination and his January 1976 Reserve examination. The Veteran engaged in heavy lifting while working as a printer after service, and he routinely worked very long hours five or six days weekly. The examiner found that the Veteran likely would have been unable to tolerate such work if his military injury had resulted in a back problem, and this type of work itself was a risk factor for degenerative changes of the spine. Instead, the examiner found that the medical evidence showed that the Veteran had onset of his chronic low back pain in approximately 1981, or nine years after discharge. The examiner further found that the Veteran’s back disability was not the result of, nor was it aggravated by, his service-connected foot disability. As a rationale for this opinion, the examiner noted that a foot problem could potentially cause degenerative changes in the spine primarily through an alteration in gait. In this case, the examiner noted that multiple medical notes indicated that the Veteran had a normal gait many years after the onset of his chronic low back pain. The examiner noted that at the time of the examination, the Veteran’s gait was slightly stiff consistent with hypertonia of the lumbar paraspinal muscles, hip pain, or trochanteric pain, but was otherwise normal without any asymmetry or signs of foot pain. The examiner concluded that the Veteran’s mild gait abnormality was not due to a foot problem. Factual History - Service Connection for a Bilateral Knee Disability During service, in the Veteran’s May 1972 separation examination, the Veteran’s lower extremities were noted to be normal. Following service, in a January 1976 report of medical history, the Veteran denied ever having experienced symptoms such as cramps in his legs, arthritis, rheumatism, bursitis, or a “trick” or locked knee. In a January 1976 physical examination, the Veteran’s lower extremities were noted to be normal, and the Veteran was qualified for reenlistment in the Naval Reserve. Following service, in November 1980, the Veteran reported experiencing a one-month history of pain in his right knee. The Veteran stated that he had fallen and injured his knee one month before. The impression was rule out internal derangement of the right knee. In April 1993, the Veteran’s spouse stated that the Veteran complained of symptoms of morning stiffness, with the Veteran taking great effort to move after waking up. In April 2005, the Veteran complained of continuing pain in his knees. In June 2005, the Veteran complained of pain in his knees. In December 2005, the Veteran complained of increasing pain and recent swelling of his knee. In January 2006, the Veteran complained of persistent left knee pain. While a January 2006 treatment record indicated that the Veteran’s left knee showed “some early degenerative type changes,” a January 2006 x-ray showed that the Veteran’s left knee was normal, without destructive lesions, or traumatic or arthritic changes. The Veteran was otherwise assessed with rheumatoid arthritis. In the Veteran’s June 2006 claim for disability benefits from the SSA, the Veteran attributed his inability to work to rheumatoid arthritis and cervical surgery, which he indicated first bothered him in January 2000. In October 2008, the Veteran complained of a two-month history of pain and swelling in his right knee. The Veteran believed that he hurt his knee after falling off of a ladder two months before. The Veteran was assessed with right knee prepatellar bursitis that was expected to resolve without treatment. In June 2010, the Veteran denied having a history of knee injury. In January 2011, the Veteran filed his current claim of entitlement to service connection, stating that he had knee problems either as the direct result of active duty service or as a result of his service-connected foot disability. In September 2012, an examiner found that the Veteran’s service treatment records were silent for any complaints relating to the knees. Instead, the examiner noted that the Veteran suffered an injury to his right knee in November 1980, and he was diagnosed with degenerative joint disease and a torn medical meniscus in June 2010. The examiner found that the Veteran’s in-service foot callus was not chronic or disabling in any way. The examiner noted that the Veteran’s post-service medical records were silent for any evaluations, treatments, or pathologic diagnoses relating to the Veteran’s right foot callus. The examiner noted that degenerative changes or chronic pain in one weight-bearing lower extremity may induce degenerative changes in an anatomically separate weight-bearing joint through a chronic stress mechanism secondary to a chronically altered gait. Despite this, however, the examiner found no evidence that the Veteran’s foot callus was ever chronic or severe enough to warrant podiatry treatments. The examiner further noted that the Veteran had a normal gait until at least January 2008. The examiner concluded that the Veteran’s knee disability was due to natural aging and rheumatoid arthritis, rather than his service-connected right foot callus. The examiner further found that tears to the meniscus are caused by trauma to the knee, not foot callus. In a June 2013 videoconference hearing, the Veteran argued that he had a right knee disability because of problems with his foot that had “gone up [his] right side”. In September 2013, the Veteran indicated that he had an onset of right knee pain six and a half years before. The Veteran denied a history of injury. In April 2014, the Veteran indicated that he had an onset of right knee pain six and a half years before. The Veteran denied a history of injury. In October 2014, the examiner who conducted the September 2012 examination, upon re-examination of the evidence, further concluded that the Veteran’s service-connected right foot disability had not aggravated his bilateral knee disability. The Veteran underwent an additional VA examination in May 2016, at which time the examiner diagnosed the Veteran with a right total knee replacement and degenerative arthritis of the bilateral knees. The Veteran reported that his right knee pain began gradually 10 to 20 years ago, and he denied experiencing any injuries. The Veteran stated that his left knee injury began gradually 5 to 6 years ago. The examiner found that the Veteran’s knee disability was not the result of, nor was it aggravated by, his service-connected foot disability. As a rationale for this opinion, the examiner noted that a foot problem could potentially cause degenerative changes in the knees primarily through an alteration in gait. In this case, the examiner noted that multiple medical notes indicated that the Veteran had a normal gait many years after the onset of his chronic bilateral knee pain. The examiner noted that at the time of the examination, the Veteran’s gait was slightly stiff consistent with hypertonia of the lumbar paraspinal muscles, hip pain, or trochanteric pain, but was otherwise normal without any asymmetry or signs of foot pain. The examiner concluded that the Veteran’s mild gait abnormality was not due to a foot problem. Factual History - Service Connection for a Bilateral Hip Disability During service, in the Veteran’s May 1972 separation examination, the Veteran’s spine and lower extremities were noted to be normal. Following service, in a January 1976 report of medical history, the Veteran denied ever having experienced symptoms such as arthritis, rheumatism, or bursitis. In a January 1976 physical examination, the Veteran’s lower extremities were noted to be normal, and the Veteran was qualified for reenlistment in the Naval Reserve. In April 1993, the Veteran’s spouse stated that the Veteran complained of symptoms of morning stiffness, with the Veteran taking great effort to move after waking up. In May 2005, the Veteran complained of pain in his hips. In the Veteran’s June 2006 claim for disability benefits from the SSA, the Veteran attributed his inability to work to rheumatoid arthritis and cervical surgery, which he indicated first bothered him in January 2000. In January 2011, the Veteran filed his current claim of entitlement to service connection, stating that he had hip problems either as the direct result of active duty service or as a result of his service-connected foot disability. In September 2012, an examiner noted that the Veteran’s service treatment records were silent for any complaints relating to the hips. The examiner found that the Veteran’s in-service foot callus was not chronic or disabling in any way. The examiner noted that the Veteran’s post-service medical records were silent for any evaluations, treatments, or pathologic diagnoses relating to the Veteran’s callus. The examiner noted that degenerative changes or chronic pain in one weight-bearing lower extremity could induce degenerative changes in an anatomically separate weight-bearing joint through a chronic stress mechanism secondary to a chronically altered gait. Despite this, however, the examiner found no evidence that the Veteran’s right foot callus was ever chronic or severe enough to even warrant podiatry treatments. The examiner further noted that the Veteran had a normal gait until at least January 2008. The examiner concluded that the Veteran’s hip disability was due to natural aging and rheumatoid arthritis, rather than a right foot callus. In a June 2013 videoconference hearing, the Veteran claimed that his hip disability related to his service-connected right foot callus. In October 2014, the examiner who conducted the September 2012 examination, upon re-examination of the evidence, further concluded that the Veteran’s service-connected right foot disability had not aggravated his bilateral hip disability. The Veteran underwent an additional VA examination in May 2016, at which time the examiner diagnosed the Veteran with osteoarthritis and trochanteric pain syndrome of the bilateral hips. The Veteran stated that his hip pain began gradually over 10 years ago. The examiner found that the Veteran’s hip disability was not the result of, nor was it aggravated by, his service-connected foot disability. As a rationale for this opinion, the examiner noted that a foot problem could potentially cause degenerative changes in the hips through an alteration in gait. In this case, the examiner found that multiple medical notes indicated that the Veteran had a normal gait many years after the onset of his chronic bilateral hip pain. The examiner noted that at the time of the examination, the Veteran’s gait was slightly stiff consistent with hypertonia of the lumbar paraspinal muscles, hip pain, or trochanteric pain, but was otherwise normal without any asymmetry or signs of foot pain. The examiner concluded that the Veteran’s mild gait abnormality was not due to a foot problem. Service Connection Analysis The evidence shows that the Veteran currently has back, bilateral hip, and bilateral knee disabilities. The Veteran received in-service treatment for a back strain during active duty service. The Veteran is otherwise service-connected for a callus of the right foot. With a current disability, an in service incident, and a service-connected disability, the remaining question is whether the evidence supports a connection between the Veteran’s current disabilities and either his in service experiences or his service-connected disability. As an initial matter, the Board notes that in March 2017, it denied the Veteran’s claims for service connection. The Veteran appealed this decision, and the Court, pursuant to an April 2018 Joint Motion, vacated the Board’s March 2017 decision. The Joint Motion found that the Board’s decision failed to fully explain its conclusion that the Veteran would have been expected to file a claim for service connection sooner if he had indeed experienced symptoms of a back disability since service. The Joint Motion additionally found that the Board’s decision failed to address evidence potentially favorable to the Veteran, including the September 2009 opinion stating that sufferers of back injuries often delay reporting their symptoms. Lastly, the Joint Motion found that the Board erred by favoring the April 2010 opinion over the September 2009 private opinion because the September 2009 opinion did not account for the Veteran’s post-service work as a printer; the Joint Motion indicated that the September 2009 opinion indicated that the Veteran’s back pain pre-dated his work as a printer. The Board will proceed to an analysis of the facts in this case consistent with the guidance provided in the April 2018 Joint Motion. Upon a complete review of the record, the Board finds that the medical evidence weighs against a finding that the Veteran’s disabilities relate directly to service. While the Veteran has generally not directly claimed that his hip and knee disabilities are directly related to service, the Board, for the sake of completeness, will include such claims in its analysis. The Board places great weight on the opinions of VA examiners that the Veteran’s claimed disabilities do not relate directly to service, because such opinions were offered following a physical examination of the Veteran and a full review of both the medical evidence of record and the Veteran’s own contentions. Further, the Board finds that these opinions are consistent with the evidence of record and clearly explain their conclusions. With that said, the Board acknowledges that in September 2009, a private clinician opined that the Veteran’s back disability indeed related to service. As noted above, the April 2018 Joint Motion found that the Board did not fully address the probative value of this evidence, and the Board will therefore explain in detail the reasons that it places relatively less probative weight on this opinion. The September 2009 opinion relied heavily on the Veteran’s current assertions regarding the nature and duration of his symptoms without discussion of evidence to the contrary. In this regard, the Board notes that the mere transcription of lay history, unenhanced by any additional medical comment by the transcriber, does not become competent medical evidence merely because the transcriber is a medical professional. LeShore v. Brown, 8 Vet. App. 406 (1995). For example, the clinician stated that the Veteran suffered from numerous bouts of back pain for years, living with the pain because he had little money, before ultimately seeking treatment in 1981. This statement is contrary to the evidence of record, which shows that in January 1976, the Veteran denied ever having experienced a history of back pain. Similarly, when seeking treatment in July 1981 and September 1981, the Veteran himself generally stated that he had experienced a gradual onset of back pain over the preceding three months. Additionally, the September 2009 opinion is inconsistent with the Veteran’s later statements in which he denied experiencing an in-service injury to his back at all. For example, in June 2013, the Veteran denied an in-service injury to his back and instead attributed his back disability to his service-connected right foot disability. Thus, while the September 2009 clinician may well be correct that sufferers of back injuries often delay reporting their symptoms, this statement does not address the Veteran’s previous self-reported history of a shorter duration of symptoms, nor does it take into consideration the Veteran’s later assertion that he did not suffer a back injury during service. The failure of the September 2009 clinician to consider such evidence when rendering an opinion detracts from the probative value of his opinion. In addition to the failure of the September 2009 clinician to consider evidence contrary to the Veteran’s then-current assertions, the September 2009 clinician mischaracterized certain evidence of record. For example, the clinician indicated that the Veteran’s employer had stated that by the time the Veteran began working as a printer’s apprentice, “he had numerous bouts of back pain and began wearing a back belt for support in an attempt to alleviate his pain”. The clinician stated that the Veteran’s back pain had been corroborated by the Veteran’s former employer. Upon review of the record, the Board observes that in August 1993, the Veteran’s former employer stated only that the Veteran wore a back brace during his employment from 1973 to 1981, and it did not refer to the Veteran suffering from back pain at all. The clinician’s mischaracterization of the statement from the Veteran’s former employer further detracts from the probative value of his opinion. For these reasons, the Board places little probative weight in the opinion of the September 2009 clinician. Furthermore, the medical evidence weighs against a finding that the Veteran’s claimed disabilities are related to his service-connected right foot callus. Medical examiners, upon consideration of the evidence of the record, have consistently found that the Veteran’s claimed disabilities were not caused or aggravated by his service-connected right foot callus. There is no competent medical evidence connecting the Veteran’s claimed disabilities to his service-connected right foot callus, and the April 2018 Joint Motion found no error in the Board’s March 2017 analysis arriving at the same conclusion. To the extent that the Veteran believes that his disabilities are related to his service or to his service-connected right foot callus, the Board notes that the Veteran is competent to provide testimony concerning factual matters of which he has first hand knowledge and experiences through his senses. Barr v. Nicholson, 21 Vet. App. 303 (2007); Washington v. Nicholson, 19 Vet. App. 362 (2005). Further, under certain circumstances, lay statements may support a claim for service connection by supporting the occurrence of lay observable events or the presence of disability, or symptoms of disability, susceptible of lay observation. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). VA provided the Veteran with examinations based in part on the competency of those observations. Lay persons are also competent to provide opinions on some medical issues, such as when the Veteran began experiencing symptoms such as pain. Kahana v. Shinseki, 24 Vet. App. 428 (2011). However, as to the etiology of back, hip, and knee disabilities, the issue of causation of such medical conditions is a medical determination outside the realm of common knowledge of a lay person. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Thus, although the Board has carefully considered the lay contentions of record suggesting that the Veteran’s disabilities are related to his service or to his service connected disability, the Board ultimately affords the objective medical evidence of record, which weighs against finding such a connection, with greater probative weight than the lay opinions, because such evidence was provided by medical professionals and concerned the Veteran’s orthopedic system, the internal functioning of which is not readily perceivable by the use of a person’s senses. The Board has also considered whether the Veteran has presented a continuity of symptomatology associated with his claimed disabilities, and it finds that he has not done so. Following service, the medical evidence does not support a finding that the Veteran complained of symptoms relating to his back until 1981, at earliest, approximately nine years after his separation from service. See Maxson v. Gober, 230 F.3d 1330 (Fed. Cir. 2000) (proper to consider the veteran’s entire medical history, including the lengthy period of absence of complaint with respect to the condition now raised). While the Board acknowledges the lay contentions that the Veteran experienced symptoms associated with his back disability consistently since service, the Board finds these contentions to lack credibility given that the Veteran failed to mention such symptoms at any time for nine years following service. The Veteran’s spine and lower extremities were found to be normal at the time of his May 1972 separation from service. Additionally, the Veteran stated, for example in January 1976, that he had never experienced symptoms relating to his currently-claimed disabilities. In July 1981, and September 1981, the Veteran reported that he had experienced only a three-month duration of such symptoms. The Veteran did not, at these times, relate his symptoms to his military service. The Veteran, at his June 2013 hearing, stated that he had not experienced an in-service injury to his back. The Board thus finds that the weight of the evidence record does not support a finding that the Veteran experienced symptoms of his claimed disabilities continuously since service. (Continued on the next page)   The medical nexus element thus cannot be met via a continuity of symptomatology. Furthermore, the Board finds that the Veteran’s claimed disabilities were not shown within one year following separation from service. Therefore, presumptive service connection is not warranted. The Board concludes that the weight of the evidence is against granting service connection, and the claims are denied. 38 U.S.C. § 5107(b) (2012); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). THOMAS O'SHAY Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J.A. Flynn