Citation Nr: 18147874 Decision Date: 11/06/18 Archive Date: 11/06/18 DOCKET NO. 18-42 727 DATE: November 6, 2018 ORDER Entitlement to service connection for a lumbar back disability with degenerative arthritis is denied. Entitlement to service connection for a left ankle disability is denied. Entitlement to service connection for a sinusitis with deviated septum disability is granted. FINDINGS OF FACT 1. A lumbar back disability with degenerative arthritis manifested more than one year after separation, and is not shown to be causally or etiologically related to an in-service event, injury, or disease. 2. A left ankle 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. 3. The evidence is in relative equipoise as to whether the Veteran’s sinusitis with deviated septum disability is related to service. CONCLUSIONS OF LAW 1. A lumbar back disability with degenerative arthritis was not incurred in or aggravated by service, and such incurrence may not be presumed. 38 U.S.C. §§ 1101, 1112, 1113, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2017). 2. The criteria for service connection for a left ankle 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). 3. Resolving reasonable doubt in the Veteran’s favor, a sinusitis with deviated septum disability was incurred as a result of service. 38 U.S.C. §§ 1131, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from January 1987 to February 1993. These matters initially came to the Board of Veterans’ Appeals (Board) on appeal from a May 2017 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Cleveland, Ohio. This appeal originally contained one additional issue: entitlement to service connection for chronic fatigue syndrome. In a May 2018 rating decision, the RO granted service connection for chronic fatigue syndrome, effective from February 14, 2017. As such, the issue is no longer in appellate status before the Board. Grantham v. Brown, 114 F.3d 1156, 1159 (Fed. Cir. 1997). The Board is cognizant of the Veteran’s separate appeal for an increased rating for his service-connected posttraumatic stress disorder (PTSD). However, as that appeal has not yet been certified before the Board, it is not ripe for adjudication and will not be discussed here. 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). Service Connection for Lumbar Back Disability with Degenerative Arthritis 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). Service connection may also be established for a current disability on the basis of a presumption that certain chronic diseases, to include arthritis, manifesting themselves to a certain degree within a certain time after service must have had their onset in service. 38 U.S.C. §§ 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309(a). For arthritis, the disease must have manifested to a degree of 10 percent or more within one year of service. 38 C.F.R. § 3.307(a)(3). Service connection for degenerative arthritis can also be established through continuity of symptomatology. Walker v. Shinseki, 708 F.3d 1331 (2013); 38 C.F.R. §§ 3.303(b), 3.309. For chronic diseases shown as such in service or within the applicable presumptive period, subsequent manifestations of the same chronic disease at any later date are service-connected unless attributable to an intercurrent cause. 38 C.F.R. § 3.303(b). For a chronic disease to be considered to have been “shown in service,” there must be a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings. Id. When the condition noted in service or within the presumptive period is not a chronic disease, a showing of continuity of symptomatology after discharge is required. Id. 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). 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 making that decision, the Board must determine the probative weight to be ascribed as among multiple medical opinions, and state the reasons and bases for favoring one opinion over another. See Winsett v. West, 11 Vet. App. 420, 424-25 (1998); see also Evans v. West, 12 Vet. App. 22, 30 (1998), citing Owens v. Brown, 7 Vet. App. 429, 433 (1995). This responsibility is particularly important where medical opinions diverge. The Board is also mindful that it cannot make its own independent medical determinations, and that there must be plausible reasons for favoring one medical opinion over another. See Evans at 31; see also Colvin v. Derwinski, 1 Vet. App. 171 (1991). 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 Degenerative Arthritis The Veteran asserts that he has a lower back condition that is chronically painful, which originated from his active service 1987 to 1993. He did not identify a specific incident or injury, but rather the stresses on his back resulting from his service as an infantryman in his approximately six years of active service. The Veteran received a VA Gulf War Examination in June 2014 that included a comprehensive physical examination of the Veteran, to include any areas that the Veteran chose to identify to the examiner for further examination. The Veteran complained of skin diseases, respiratory conditions, hypertension, intestinal conditions, migraine headaches, chronic fatigue syndrome, and for the musculoskeletal area, complaints of the shoulder and arm. No mention was made of a lumbar back condition or a left ankle complaint. The Veteran received a VA examination in March 2017 for his lumbar back degenerative arthritis claim. This examiner noted reports of chronic lower back pain, ranging from 3 to 7 on a scale to 10, with radiation down the right leg to the calf with numbness but no parasthesia. The examiner noted the Veteran takes no medication, has never had surgery, steroid injections, physical therapy, or chiropractic care. This examiner noted a November 2011 MRI from a private provider that indicated degenerative disease with an annular tear of the L5-S1 without protrusions or herniations. No significant canal stenosis, foraminal stenosis, or herniation was noted in that MRI. Thus, the finding for a current disability is met. During the Veteran’s active service from 1987 to 1993, he twice reported to service medical providers complaints of low back pain, in February and March 1987, related to physical fitness activity involving sit-ups during his basic training period. On his January 1993 separation examination, the Veteran reported a previous lower back strain from lifting boxes in his squadron, but that he had no current pain at the time. This VA examiner provided a negative nexus opinion for service connection, saying the Veteran’s diagnosed lumbar spine disability with degenerative arthritis 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 two in-service complaints resolved during his active service, and that the examining military physician found no back or arthritis problems. The examiner also noted the Veteran’s employment with North Carolina state law enforcement for over 20 years with no documented complaints of lumbar back problems. The medical records after service are silent for any back issues until a private 2011 diagnosis of a lumbar back strain at L5-S1 with degenerative arthritis. 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 while he was serving in an aircrew position. 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 after his basic training period of active service. The Veteran’s spouse provided a buddy statement in February 2017 as to the current state of her husband’s back, noting he has difficulty sleeping, can’t sit for extended periods of time, and is unable to lift anything heavy. 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. In addition, the Board finds that the gap in time between the Veteran’s last date of active service, in February 1993, to his initial evaluation by any medical provider regarding his lumbar back in 2011 to be probative of a lack of nexus between the diagnosed current disability and active service. A negative inference may be drawn from the absence of complaints or treatment for an extended period. See Maxson v. West, 12 Vet. App. 453, 459 (1999), aff’d sub nom. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). 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. The Board notes the lay statement of the Veteran’s spouse regarding the current state of the Veteran’s back disability, but she makes no comments regarding the nexus of the back disability back to active service. The Board also notes that the Veteran declined to mention his lumbar back concerns during his VA Gulf War Examination in June 2014. Upon review of the record, the Board concludes that entitlement to service connection for a lumbar back disability is not warranted. The Board notes a current diagnosis of the lumbar back disability, and thus the requirement for a current disability is shown. The Board acknowledges the Veteran’s contentions, and the Veteran’s post-service statements are noted. However, the separation physical of January 1993 is silent for any existing low back or lumbar back notation or related injury at the time of separation, and, 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. With regard to presumptive service connection for degenerative arthritis of the lower back, the weight of evidence shows no chronic symptoms of these conditions during active service, no continuous symptoms of the conditions since service, and that the conditions did not manifest to a compensable degree within one year of service. As such, presumptive service connection is not warranted. 38 C.F.R. §§ 3.303, 3.309. 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 on a direct or presumptive basis, 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 – Left Ankle Disability The Veteran asserts that he has a current left ankle disability that relates back to a left ankle injury suffered during active service in January 1992, when he made an unstable parachute landing fall, landing awkwardly on his left ankle. The Veteran received a VA Gulf War Examination in June 2014 that included a comprehensive physical examination of the Veteran, to include any areas that the Veteran chose to identify to the examiner for further examination. The Veteran complained of skin diseases, respiratory conditions, hypertension, intestinal conditions, migraine headaches, chronic fatigue syndrome, and for the musculoskeletal area, complaints of the shoulder and arm. No mention was made of a left ankle complaint. The Veteran received a VA examination in March 2017 for his left ankle claim. This examiner noted records of the January 1992 treatment for the injured ankle following a parachute jump, noting the diagnosis at the time of a left ankle sprain with a hairline fracture of the anterior talus. The examiner also noted the left ankle was followed with conservative treatment through November 1992. The examiner noted the Veteran takes no medication, has never had surgery, steroid injections, physical therapy, or chiropractic care. In the physical examination, the examiner made prominent note of the fact that when the Veteran was asked to walk so the examiner could observe the gait, the Veteran walked with a limp and favored the left ankle for which disability is being claimed. This examiner made a diagnosis of a chronic/recurrent lateral collateral ligament sprain for the left ankle, and also noted that imaging of the ankle showed no fractures or other abnormalities, and no degenerative or traumatic arthritis of the left ankle. This March 2017 VA examiner provided a negative nexus opinion for service connection, saying it was less likely as not (less than 50 percent probability) that the current ankle complaints are related to the acute ankle strain in service from January 1992. The examiner’s rationale was that the in-service injury appeared to have resolved by service separation, though it was noted in the history on the separation examination, and that there were no complaints until the current claim. This examiner specifically noted there was a lack of current findings on examination and a lack of evidence of any chronicity since 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 parachute landing fall leading to his left ankle strain. However, the Board notes that the Veteran’s service treatment records indicate he had recovered enough four months after the incident to resume regular physical training, including three-mile training runs, per a June 1992 service orthopedic treatment note. The Veteran’s spouse provided a buddy statement in February 2017 as to the current state of her husband’s left ankle, noting he has limited mobility and the ankle is frozen at times. She indicated that the left ankle hinders his daily activities, including taking walks and going to the gym and working out. 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 left ankle disability. 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 left ankle sprain 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. In addition, the Board finds that the gap in time between the Veteran’s last date of active service, in February 1993, to his initial evaluation by any medical provider regarding his left ankle in 2017 to be probative of a lack of nexus between the diagnosed current disability and active service. A negative inference may be drawn from the absence of complaints or treatment for an extended period. See Maxson v. West, 12 Vet. App. 453, 459 (1999), aff’d sub nom. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). 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. The Board notes the lay statement of the Veteran’s spouse regarding the current state of the Veteran’s left ankle disability, but she makes no comments regarding the nexus of the left ankle disability back to active service. Upon review of the record, the Board concludes that entitlement to service connection for a left ankle disability is not warranted. The Board notes a diagnosis of the left ankle sprain, and thus the requirement for a current disability is shown. The Board acknowledges the Veteran’s contentions, and the Veteran’s post-service statements are noted. However, the Board notes the Veteran favored his claimed ankle when asked to walk during a review of his gait, indicating an inconsistency with other evidence. See Caluza v. Brown, 7 Vet. App. 498 (1995). The Board also notes that the Veteran declined to identify his left ankle disability when asked about any musculoskeletal complaints in his June 2014 VA Gulf War Examination, three years prior to this claim. 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 left ankle 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 left ankle disability on a direct basis, 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 – Sinusitis with Deviated Septum The Veteran is claiming service connection for a sinus disability, asserting that he endured multiple bouts of sinus issues during active service that have continued into the present day. The Veteran received a VA Gulf War Examination in June 2014. Part of the complaints listed by the Veteran was a respiratory condition that he said originated in service, especially during his service during Operations Desert Shield and Desert Storm from August 1990 to April 1991. During this comprehensive examination, the examiner also noted the presence of a current respiratory condition. This examiner recorded multiple episodes of upper respiratory infections with fever, sore throats, tonsillitis, sinus congestion, and cough during the Veteran’s active service. The Veteran denied a chronic cough but was noted to have an upper respiratory infection, for which he was taking over-the-counter medications. In the medical opinion accompanying this examination, the examiner specified that the Veteran’s respiratory condition noted on this examination is at least as likely as not (50 percent or greater probability) a continuation of the sinus/respiratory/pharyngitis symptoms identified in the Veteran’s service treatment records. The examiner’s rationale was the Veteran’s enlistment physical examination was normal with no mention of any sinus or respiratory difficulties, but that he was treated on active duty multiple times for sinus, upper respiratory, and pharyngitis symptoms beginning in 1987, his first year of active service. The Veteran received another VA examination for his claimed sinusitis in March 2017. Here, the examiner diagnosed both chronic sinusitis and a deviated nasal septum (traumatic). Thus, the requirement for a current disability is met, having been shown on two different VA examinations. The March 2017 VA examiner provided a negative opinion for service connection for the claimed sinusitis, saying the Veteran did not have evidence of a chronic sinus condition in service. In the opinion section of his report, the examiner said the Veteran did not have a diagnosis of chronic sinusitis at the moment, though he did note such a diagnosis in diagnostic section of his examination report. The Veteran’s service treatment records indicate multiple complaints of and treatment for sinus-related conditions, beginning approximately one month after active service commenced while the Veteran was in basic training and continuing through his period of service. On his separation physical examination in January 1993, the Veteran noted recurrent sinus problems in his report of medical history. In February 2017, the Veteran’s spouse provided a lay statement where she noted the Veteran has had continuous issues with sinusitis, and usually cannot breathe out of both nostrils. She also noted the Veteran has a tenderness in his sinus area to the touch and has constant drainage from his sinuses. She also remarked that he routinely produces blood when he blows his nose. Weighing against the Veteran’s claim is the March 2017 VA examiner’s opinion, which offered a negative nexus opinion for service connection. This examiner’s rationale was that there was a lack of records after active service, and that he did not have a chronic sinus condition in service. No explanation was offered to the existence and progression of the Veteran’s symptoms over time. When assessing the probative value of a medical opinion, 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). A medical opinion that contains only data and conclusions is not entitled to any weight. “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 v. Peake, 22 Vet. App. 295, 304 (2008). The Board considers that March 2017 VA opinion to be of limited probative value. The Board notes the presence of multiple complaints of and treatment for sinus problems during active service in the Veteran’s service treatment records, in contrast to the VA examiner’s notation about such a lack of records. Also, and significantly, this VA examiner did not take note of the June 2014 VA Gulf War Examination with its positive opinion for service connection. To have probative value, a medical opinion must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. Nieves-Rodriguez at 305. Here, the March 2017 examiner, along with the RO adjudicators who authored the May 2017 rating decision and the August 2018 statement of the case, failed to note the presence in the claims file of the June 2014 VA examination along with its positive opinion. Weighing in the Veteran’s favor is the June 2014 VA examination and positive nexus opinion. Here, the examiner accurately noted the Veteran’s in-service history as well as his statements regarding his sinus condition. This examiner had sufficiently clear and well-reasoned rationale, as well as a basis in objective supporting medical literature and clinical data. 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). Also weighing in the Veteran’s favor are his statements regarding his sinus condition along with the buddy statement of his spouse, which corroborates the Veteran’s statements regarding his sinusitis complaints. Lay evidence may establish a diagnosis of a simple medical condition, a contemporaneous medical diagnosis, or symptoms that later support a diagnosis by a medical professional. Jandreau, 492 F.3d at 1377. In this case, the Board finds that the evidence is, at a minimum, in equipoise that the Veteran’s diagnosed sinusitis was incurred in service. The Board acknowledges the March 2017 VA opinion, in which the examiner reasoned that the Veteran’s current condition was less likely as not caused by the claimed in-service injury. The Board finds this opinion to be less persuasive than the Veteran’s lay statements, along with his spouse’s statement, and the positive nexus opinion of the June 2014 VA examiner. Thus, the Board finds that the third element of service connection, a causal relationship between the present disability and the disease or injury incurred or aggravated during service is met. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). (CONTINUED ON NEXT PAGE) Therefore, resolving reasonable doubt in the Veteran’s favor, it is at least as likely as not that the Veteran’s diagnosed sinusitis with deviated septum is linked to the Veteran’s in-service complaints of and treatment for multiple complaints of sinus problems. The Veteran is therefore entitled to the benefit of the doubt. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Accordingly, service connection is warranted for a sinusitis disability. MICHAEL A. PAPPAS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Setter, Associate Counsel