Citation Nr: 18149533 Decision Date: 11/09/18 Archive Date: 11/09/18 DOCKET NO. 16-38 026 DATE: November 9, 2018 ORDER Entitlement to an initial rating in excess of 10 percent for degenerative joint disease (DJD), right knee is denied. Entitlement to a compensable rating for status post right fibular fracture is denied. Entitlement to an initial rating in excess of 10 percent for scar, status post right leg fracture from October 7, 2014, is granted. Entitlement to a rating in excess of 10 percent for scar, status post right leg fracture from March 13, 2018, is denied. Entitlement to an initial compensable rating for scar, status post right leg fracture is denied. Entitlement to service connection for tuberculosis is denied. FINDINGS OF FACT 1. The Veteran’s right knee DJD was manifested by painful motion with motion functionally limited to, at worst, forward flexion to 80 degrees and extension to 10 degrees; the knee did not evidence subluxation, lateral instability, cartilage dislocation or removal, or genu recurvatum. 2. The Veteran’s status post right fibular fracture did not evidence any nonunion or malunion. 3. From October 7, 2014, the Veteran had one scar, status post right leg fracture that was painful and unstable. 4. From March 3, 2018, the Veteran had one scar, status post right leg fracture that was not painful or unstable. 5. For the period on appeal, the Veteran’s scar, status post right leg fracture was not shown to cause separate functional limitation. 6. The Veteran does not have tuberculosis. CONCLUSIONS OF LAW 1. The criteria for a disability rating higher than 10 percent for right knee DJD have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. § 4.71a, Diagnostic Code (DC) 5003-5260 (2018). 2. The criteria for a compensable disability rating for status post right fibular fracture have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.3, 4.27, 4.71a, Diagnostic Code (DC) 5262 (2018). 3. From October 7, 2014, the criteria for an initial rating in excess of 10 percent for scar, status post right leg fracture have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.321, 4.1-4.3, 4.7, 4.118, Diagnostic Code (DC) 7804 (2018). 4. From March 13, 2018, the criteria for a rating in excess of 10 percent for scar, status post right leg fracture have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.321, 4.1-4.3, 4.7, 4.118, Diagnostic Code (DC) 7804 (2018). 5. The criteria for a compensable rating for scar, status post right leg fracture have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.3, 4.7, 4.14, 4.118, Diagnostic Code (DC) 7805. 6. The criteria for service connection for tuberculosis have not been met. 38 U.S.C. §§ 1110, 1112, 1131, 1137, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.309, 3.371, 3.374 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from April 1972 to October 1983. These matters come before the Board of Veterans’ Appeals (Board) on appeal from an March 2015 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Atlanta, Georgia. Under applicable law, VA has a duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C. §§ 5103, 5103A (2012); 38 C.F.R. § 3.159 (2018). VA’s duty to notify was satisfied in a letter dated in November 2014. There is no indication in this record of a failure to notify. See Scott v. McDonald, 789 F.3rd 1375 (Fed. Cir. 2015). With regard to the duty to assist, all relevant, identified, and available evidence has been obtained. The Veteran was provided VA examinations, the reports of which are adequate for the purpose of evaluating the proper disability rating. The Veteran has not referred to any additional, relevant, available evidence. Thus, the Board finds that VA has satisfied the duty to assist. Smith v. Gober, 14 Vet. App. 227 (2000); Dela Cruz v. Principi, 15 Vet. App. 143 (2001); Quartuccio v. Principi, 16 Vet. App. 183 (2002). Increased Ratings Disability ratings are determined by applying the criteria set forth in VA’s Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The basis of disability ratings is the ability of the body as a whole, or of the psyche, or of a system or organ of the body, to function under the ordinary conditions of daily life, including employment. 38 C.F.R. § 4.10 (2018). The determination of whether an increased rating is warranted is based on review of the entire evidence of record and the application of all pertinent regulations. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. However, the evaluation of the same disability under various diagnoses, known as pyramiding, is to be avoided. 38 C.F.R. § 4.14 (2018). While the veteran’s entire history is reviewed when making a disability determination, where service connection has already been established and increase in the disability rating is at issue, it is the present level of the disability that is of primary concern. Francisco v. Brown, 7 Vet. App. 55 (1994). However, staged ratings are appropriate for an increase rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). 1. Right knee DJD and status post right fibular fracture During the entire pendency of the appeal, the Veteran’s right knee DJD, characterized by limitation of extension, has been rated under Diagnostic Code 5003-5261. A hyphenated diagnostic code is used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the rating assigned. The additional code is shown after the hyphen. The hyphenated diagnostic code in this case indicates that degenerative arthritis, under Diagnostic Code 5003, is the service-connected disability, and the residual condition to which the arthritis is rated by analogy is limitation of extension of the right knee, which is rated under Diagnostic Code 5261. 38 C.F.R. § 4.71a (2018). Degenerative joint disease of the knee is rated under Diagnostic Code 5010. Diagnostic Code 5010 directs that traumatic arthritis substantiated by X-ray findings should be rated as degenerative arthritis under Diagnostic Code 5003. Under Diagnostic Code 5003, degenerative arthritis established by X-ray findings will be rated on the basis of limitation of motion under the appropriate codes for the specific joint or joints involved. If the limitation of motion is non-compensable, a rating of 10 percent is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added, under Diagnostic Code 5003. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. 38 C.F.R. § 4.71a (2018). When flexion of the knee is limited to 45 degrees, a 10 percent rating is warranted. When flexion is limited to 30 degrees, a 20 percent evaluation is warranted. A 30 percent rating is warranted when flexion of the leg is limited to 15 degrees. 38 C.F.R. § 4.71a, DC 5260. When extension of the knee is limited to 10 degrees, a 10 percent evaluation is warranted. When extension is limited to 15 degrees, a 20 percent evaluation is warranted. When limited to 20 degrees, a 30 percent rating is warranted. When extension is limited to 30 degrees, a 40 percent evaluation is warranted. A 50 percent evaluation is warranted when extension of the leg is limited to 45 degrees. 38 C.F.R. § 4.71a, DC 5261. Diagnostic Code 5262 provides that impairment of the tibia and fibula characterized by malunion with slight knee or ankle disability warrants a 10 percent rating, malunion with moderate knee or ankle disability warrants a 20 percent rating, and malunion with marked knee or ankle disability warrants a 30 percent rating. Impairment of the tibia and fibula manifested by nonunion with loose motion, requiring a brace, warrants a maximum 40 percent rating. 38 C.F.R. § 4.71a (2018). Diagnostic Code 5263 provides a maximum 10 percent rating for genu recurvatum that is acquired and traumatic, with weakness and insecurity in weight bearing objectively demonstrated. 38 C.F.R. § 4.71a (2018). Disability of the musculoskeletal system is primarily the inability, due to damage or infection in the parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. It is essential that the examination on which ratings are based adequately portrays the anatomical damage and the functional loss with respect to all of these elements. In evaluating disabilities of the musculoskeletal system, it is necessary to consider, along with the schedular criteria, functional loss due to flare-ups of pain, fatigability, incoordination, pain on movement, and weakness. DeLuca v. Brown, 8 Vet. App. 202 (1995). The functional loss may be due to absence of part, or all, of the necessary bones, joints, and muscles, or associated innervation, or other pathology and evidenced by visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. § 4.40. Pain on movement, swelling, deformity, or atrophy of disuse as well as instability of station, disturbance of locomotion, interference with sitting, standing, and weight bearing are relevant considerations for determination of joint disabilities. 38 C.F.R. § 4.45. Painful, unstable, or malaligned joints, due to healed injury, are entitled to at least the minimal compensable rating for the joint. 38 C.F.R. § 4.59; Burton v. Shinseki, 25 Vet. App. 1 (2011). However, painful motion alone is not a functional loss without some restriction of the normal working movements of the body. Mitchell v. Shinseki, 25 Vet. App. 43 (2011). Post-service medical treatment records indicate that the Veteran complained of right knee pain as it related to his back pain. Specifically, records note that the Veteran reported low back pain which throbbed continuously and radiated down his right leg below the knee. Additionally, a treatment note in December 2015 indicates that the Veteran reported one fall in the last 12 months due to his leg giving out. The Veteran was afforded a VA examination in February 2015 in which the examination notes diagnoses of DJD of the right knee and status post right fibular fracture of the right leg. The Veteran indicated that he had pain daily and had difficulties with prolonged standing and getting up. Additionally, the Veteran reported that he experienced flare-ups in which it was difficult to move and sometimes his knee or leg would lock up. The examination notes that the Veteran experienced pain, weakness, fatiguability, and incoordination; additionally, there was limitation of functional ability of the joint during flare-ups or repeated use over time. The examiner indicated that the additional limitation was described as increased pain and stiffness with decreased speed and mobility, but the examiner indicated that providing the degree of additional range of motion loss was not feasible without resorting to mere speculation. The examination notes the Veteran’s right knee flexion was limited to 80 degrees and extension was not limited. These findings were the same after repetitive-use testing. The examiner indicated that the Veteran experienced functional loss in that he experienced less movement than normal in his right leg; interference with sitting, standing, or weight-bearing on his right side; and pain on movement bilaterally. The examination notes that the Veteran had tenderness or pain to palpation for joint line or soft tissues of bilateral knees. The Veteran’s muscle strength and stability tests were normal. There was no evidence or history of subluxation or dislocation. The examiner noted that the Veteran had a fibular impairment which manifested as “shin splints” in his right leg, reporting symptoms of sharp pain. The examiner also indicated that the Veteran had a meniscus condition bilaterally, evidenced by frequent episodes of joint “locking” and joint pain. The Veteran underwent another VA examination in April 2017, which noted a right knee fracture and degenerative arthritis of the right knee. The examination notes that the Veteran did not experience flare-ups. The Veteran reported having functional impairment in that his mobility was limited. The examination notes that the Veteran’s disability disturbed locomotion and interfered with standing; prolonged standing and walking were limited by the right knee and lower leg conditions. The examination indicates that there was no fibular impairment. The examiner indicated that the Veteran occasionally used a cane for his knee and feet conditions. The examiner noted that the Veteran’s right knee flexion was limited to 120 degrees and his extension was limited to 10 degrees; the examiner indicated neither range of motion or pain contributed to functional loss. The examination notes that there was evidence of pain with weigh bearing, and there was evidence of crepitus. The examination notes that the there was no additional functional loss or range of motion after repetitive-use testing. Strength and stability tests were normal. No history of subluxation or recurrent effusion was noted. The examination indicates that the Veteran did not have a meniscus condition. The examination notes that there was functional impact on the Veteran’s ability to engage in prolonged standing, walking, bending, stooping, squatting, crawling, and climbing. Finally, the examiner indicated that there was pain on passive range of motion testing, pain when the joint was used when non-weight bearing, and the opposing joint was undamaged. The Veteran was afforded another VA examination in March 2018, which provided a diagnosis of bilateral degenerative arthritis. The Veteran indicated that he had constant knee pain, which worsened with weather, movement, and walking. He also reported that he was not able to move or walk without pain in his knees. The examination notes that the Veteran’s flexion was limited to 95 degrees and his extension was limited to 5 degrees, and although pain was noted on examination, the examiner found that the pain did not result in functional loss. The examiner noted that there was pain with weight bearing, no evidence of crepitus, and the Veteran was able to perform repetitive-use testing without any additional loss of function or range of motion. The examiner indicated that the Veteran did not have a fibula impairment. The examination notes that the Veteran constantly used a cane for his disability. The examination notes that the Veteran did not report flare-ups or functional loss due to his disability. No additional contributing factors were noted. The Veteran’s muscle strength on flexion and extension were indicated as 4 out of 5. No atrophy, ankylosis, subluxation, or instability was noted. The examiner indicated that the Veteran did not have a meniscus condition. Finally, the examination notes that there was evidence of pain on passive range of motion testing, no evidence of pain when the joint was used in non-weight bearing situations, and both joints were claimed an evaluated. The Veteran’s right knee degenerative joint disease (DJD) has been evaluated as 10 percent disabling throughout the appeal period under 38 C.F.R. § 4.71a, Diagnostic Code 5003-5261. Additionally, the Veteran is service-connected for status post right fibular fracture, receiving a noncompensable rating for the period on appeal under DC 5262. As an initial matter, regarding the February 2015 VA examination, the Board acknowledges that the examiner could not describe any additional range of motion limitations during flare-ups without resorting to speculation. The Board is cognizant of Sharp v. Shulkin, 29 Vet. App. 26, 33 (2017), however, notes that the examiner indicated that the additional limitation was described as increased pain and stiffness with decreased speed and mobility, thus sufficiently addressing the functional loss experienced by the Veteran during flare-ups. In addition, the Court, in Correia v. McDonald, 28 Vet. App. 158, 168-70 (2016), held that the final sentence of 38 C.F.R. § 4.59 requires that VA examinations include joint testing for pain on both active and passive motion, in weight-bearing and non weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint. However, retroactive motion testing cannot be performed to determine the range of motion in the manner now required by Correia. An examiner’s assessment of the range of motion findings required by that case would, at this point, amount to pure speculation on the part of any examiner. Upon review of the evidence, the Board finds that the evidence does not support an increased rating higher than 10 percent for the Veteran’s right knee under any relevant diagnostic codes. The Veteran’s right knee range of motion was never limited to an extension of 15 degrees, which would warrant a 20 percent rating. Additionally, a separate rating under 5260 is not warranted because the Veteran’s flexion was never limited to 45 degrees, warranting a 10 percent rating. The Veteran’s most limiting extension and flexion were 10 degrees and 80 degrees respectively. Therefore, an increased rating based on limitation of motion of the right knee is not warranted. The Board also finds that a separate or higher rating for instability for the right knee under DC 5257 is not warranted. The Board acknowledges that the Veteran credibly reported giving way of his right leg in a December 2015 treatment record. However, none of the VA examinations found instability on testing. As such, although the Veteran has not specifically claimed feelings of instability, the medical evidence indicates no right knee instability. Therefore, the Board finds that a separate rating for recurrent subluxation and lateral instability is not warranted. Separate ratings under DCs 5256, 5259, or 5263 are also not warranted. There is no medical evidence of record indicating ankylosis, or the removal of cartilage, or genu recurvatum throughout the appeal period. While the Board acknowledges the February 2015 examination notes that the Veteran had a meniscus condition, in which the Veteran experienced frequent locking and pain, no dislocated cartilage or effusion in the joints was noted to warrant a separate rating under DC 5258. The Board finds that a compensable rating under 5262 is also not warranted. There is no medical evidence of nonunion or malunion of the tibia and fibula in the Veteran’s right extremity. Although some loss of range of motion of the knees has been noted, the Veteran has generally had full strength in his joints. Additionally, range of motion has already been contemplated under DC 5261. Thus, a higher rating under Diagnostic Code 5256 is not warranted for status post right fibular fracture. Additionally, under Diagnostic Code 5003 and 5010, a 10 percent evaluation is the highest possible evaluation for the Veteran’s right knee disability, as the right knee joint is a single major joint. The Board acknowledges that the evidence reflects that the Veteran has complained of pain. However, there is no medical evidence to suggest that the Veteran displayed functional loss of his right knee at any time during the period on appeal. Thus, even considering the pain on motion noted by the VA examiners and complained of by the Veteran, the Board concludes that his right knee disability was not so disabling as to approximate the level of impairment required for assignment of a higher rating under the limitation of motion criteria during the period on appeal. The Board thus finds that the 10 percent rating assigned for the right knee during the period on appeal sufficiently compensates the Veteran for the extent of his functional loss due to limited movement and pain. See 38 C.F.R. §§ 4.40, 4.45 (2017); DeLuca v. Brown, 8 Vet. App. 202 (1995). 2. Right leg scar In evaluating skin and scar residuals, the Board notes that during the appeal period, changes were made to certain Diagnostic Codes under 38 C.F.R. § 4.118. Effective August 13, 2018, VA amended its regulations governing skin disabilities. VA’s intent is that the claims pending prior to the effective date will be considered under both old and new rating criteria, and whatever criteria is more favorable to the Veteran will be applied. For applications filed on or after the effective date, only the new criteria will be applied. 83 Fed. Reg. 32592 (July 13, 2018). As the Veteran filed his claim before the August 13, 2018 effective date, the Board will consider whether either the old or new rating criteria is more favorable to the Veteran. The pre-amended Diagnostic Code 7801 provided disability ratings for burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are deep and nonlinear. 38 C.F.R. § 4.118, Diagnostic Code 7801 (2017). In contrast, the amended Diagnostic Code 7801 contemplates burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are associated with underlying soft tissue damage. 38 C.F.R. § 4.118, Diagnostic Code 7801 (August 13, 2018). Both the old and new criteria provide that a 10 percent rating is awarded when the area of the scar(s) covers at least 6 square inches (39 square centimeters) but less than 12 square inches (77 square centimeters). A 20 percent rating is warranted when the area of the scar(s) covers at least 12 square inches (77 square centimeters) but less than 72 square inches (456 square centimeters). A 30 percent rating is warranted when the area of the scar(s) covers at least 72 square inches (456 square centimeters) but less than 144 square inches (929 square centimeters). A 40 percent rating is assigned when the area of the scar(s) covers at least 144 square inches (929 square centimeters) or greater. 38 C.F.R. § 4.118, Diagnostic 7801. Note (1) to the pre-amended Diagnostic Code 7801 stated that a deep scar is one associated with underlying soft tissue damage. Prior to August 13, 2018, Diagnostic Code 7802 provided rating criteria for burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are superficial and nonlinear. 38 C.F.R. § 4.118, Diagnostic 7802 (2017). The amended version is for burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are not associated with underlying soft tissue damage. 38 C.F.R. § 4.118, Diagnostic Code 7802 (August 13, 2018). Both versions state that a 10 percent disability rating is warranted when the area of the scar covers 144 square inches (929 square centimeters) or greater. Under both the old and new rating criteria, Diagnostic Code 7804 provides disability ratings for scars that are unstable or painful. A 10 percent rating is warranted for one or two scars that are unstable or painful. A 20 percent rating is warranted for three or four scars that are unstable or painful. A 30 percent rating is warranted for five or more scars that are unstable or painful. Note (1) states that an unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. Note (2) provides that if one or more scars are both unstable and painful, an additional 10 percent should be added to the evaluation based on the total number of unstable or painful scars. Note (3) states that scars evaluated under diagnostic codes 7800, 7801, 7802, or 7805 may also receive an evaluation under this diagnostic code, when applicable. 38 C.F.R. § 4.118, Diagnostic 7804. Under the old rating criteria, Diagnostic Code 7805 provided that other scars (including linear scars) and other effects of scars evaluated under Diagnostic Codes 7800, 7801, 7802, and 7804 require the evaluation of any disabling effect(s) not considered in a rating provided under Diagnostic Codes 7800-7804 under an appropriate Diagnostic Code. 38 C.F.R. § 4.118, Diagnostic Code 7805 (2017). The Board notes that this diagnostic code is largely unchanged under the new amendments apart from the replacement of the phrase “(including linear scars)” with “and other effects of scars evaluated under diagnostic codes 7800, 7801, 7802, or 7804.” 38 C.F.R. § 4.118, Diagnostic Code 7805 (August 13, 2018). The Veteran’s post-service treatment records are silent for any complaints or treatment for his scar, status post right leg fracture. In February 2015, the Veteran was afforded a VA examination, in which the examiner indicated that the Veteran had one scar on his right lower leg that measured 10 centimeters by 2 centimeters. The examination indicates the scar was painful. One section of the examination indicates that the scar was stable, while another section of the examination indicates that it was unstable. The examiner noted that the scar had hyperpigmentation, loss of skin covering, and loss of muscle. The examination report indicates that the scar did not result in the limitation the Veteran’s motion or other functioning. The Veteran underwent an additional VA examination in March 2018. The examiner noted one deep, nonlinear scar on the Veteran’s right lower leg, measuring 6 centimeters by 4 centimeters and an approximate total area of 24 centimeters squared. The examination notes that the scar was not painful or unstable and it did not result in limitation of function. For the period from October 7, 2014, the Board finds that an initial rating in excess of 10 percent is warranted. While the Board notes conflicting evidence regarding the stability of the scar, given the description provided by the examiner that the scar had hyperpigmentation, loss of skin covering, and loss of muscle, the Board finds this supports a determination that the scar was unstable. Thus, as the Veteran’s scar was both painful and unstable for the period from October 7, 2014, an additional 10 percent is warranted under DC 7804. A higher rating is not warranted because the Veteran did not have three or more scars. Therefore, the Board finds that an initial rating of 20 percent, but no higher, for the Veteran’s right leg scar is warranted for the period from October 7, 2014. 38 C.F.R. § 4.118, DC 7804. However, under DC 7804, a 20 percent rating for the period from March 13, 2018, the date of the Veteran’s most recent scar examination, is not warranted because the Veteran had only one right leg scar, rather than three or four scars, and it was not painful or unstable. As the Veteran had one right leg scar that was stable, not painful, and did not limit his motion or ability to function, his right leg scar continues to warrant a rating of 10 percent and nothing higher for the period from March 13, 2018. The Board has considered whether other ratings are applicable to the Veteran’s scar status post right leg fracture. A disability rating under Diagnostic Codes 7801 or 7802 for nonlinear scars is not warranted because the Veteran’s scar was not at least 6 square inches, as noted for a 10 percent rating under DC 7801, or at least 144 square inches, as noted for a 10 percent rating under DC 7802. Furthermore, there is no basis to assign a compensable rating for the Veteran’s right leg scar under DC 7805. Although the Veteran’s February 2015 VA examination indicates the Veteran experiences pain, this symptom is already accounted for under DC 7804. Assigning other ratings based on the same symptom that is already accounted for would be tantamount to pyramiding. 38 C.F.R. § 4.14. The Board notes that neither VA examination indicates any functional impairment. Accordingly, the Board finds that the Veteran’s impairment due to his right leg scar is more consistent with a noncompensable disability rating and that the level of disability necessary to support the assignment of a compensable rating under DC 7805 is absent. The Board additionally notes that DC 7800 is not applicable as it relates specifically to scars of the head, face, or neck. In summary, the Board finds that an initial rating of 20 percent for the Veteran’s service-connected scar, status post right leg fracture is warranted for the period from October 7, 2014 and a rating no higher than 10 percent is warranted from the period from March 13, 2018 under DC 7804. 38 C.F.R. § 4.118, DC 7804. Moreover, for the period on appeal, the Veteran is not entitled to an initial compensable rating under DC 7805 for his service-connected scar, status post right leg fracture. 38 C.F.R. § 4.118, DC 7805. Service Connection Service connection may be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred or aggravated in active military service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). In general, service connection requires (1) 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 of a nexus between the claimed in-service disease or injury and the current disability. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). A lay person is competent to report observable symptomatology of an injury or illness. Barr v. Nicholson, 21 Vet. App. 303, 307-08 (2007). In order to be competent, the individual must have personal knowledge, derived from his or her own observations. Layno v. Brown, 6 Vet. App. 465, 471 (1994). Once evidence is determined to be competent, the Board must determine whether such evidence is also credible. See id. at 469. Furthermore, in determining whether service connection is warranted for a disability, VA is responsible for deciding whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 3. Tuberculosis The Veteran asserts that he contracted and was treated for tuberculosis while in service. Specifically, the Veteran claims that his entire unit was treated for tuberculosis and, due to this treatment, he learned that he was allergic to penicillin after going into anaphylactic shock. The Veteran submitted lay statements from his wife and his friend that corroborate the Veteran’s assertion. The Veteran’s June 1983 separation examination indicates that the Veteran had tuberculosis. Also in June 1983, the Veteran’s dental records indicate that while he was allergic to penicillin, he indicated that he did not have tuberculosis. A May 1984 military reserve medical evaluation record indicates that the Veteran was allergic to penicillin, but he did not have tuberculosis. Post-service treatment records, while consistently documenting the Veteran’s penicillin allergy, are largely silent for any complaints, treatment, or diagnosis of tuberculosis. One treatment record dated in March 2016 notes that the Veteran reported that he contracted tuberculosis in the military; the tuberculosis treatment medications gave him urinary tract infections for which he received penicillin causing him to go into anaphylactic shock. Despite the frequent documentation of the Veteran’s allergy to penicillin, there is no competent medical evidence of record providing a diagnosis of tuberculosis. The Veteran is competent to report his symptoms; however, to the extent that such assertions purport to establish a current disability or the etiology of any such disability, such assertions do not provide persuasive support for the claim, as the Veteran is not shown to possess the medical training to render competent opinions about such complex medical matters. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F. 3d 1331 (Fed. Cir. 2006). The Board emphasizes that Congress has specifically limited entitlement to service connection for disease or injury to cases where such incidents have resulted in disability. See 38 U.S.C. § 1101. Thus, evidence of a current disability is a fundamental requirement for a grant of service connection. See McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). As such, the Board finds that the preponderance of the evidence is against the claim for service connection for tuberculosis. Accordingly, the benefit-of-the-doubt rule does not apply, and the claim is denied. See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102; 4.3; Gilbert, 1 Vet. App. at 55. THOMAS H. O'SHAY Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD D. Hite, Associate Counsel