Citation Nr: 18150231 Decision Date: 11/14/18 Archive Date: 11/14/18 DOCKET NO. 16-40 537 DATE: November 14, 2018 ORDER Entitlement to service connection for degenerative disc disease of the cervical spine is denied. Entitlement to service connection for scar on chin is denied. Entitlement to service connection for bilateral foot condition is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that the Veteran has degenerative disc disease of the cervical spine due to a disease or injury in service, to include due to his fall from the guard tower. 2. The preponderance of the evidence is against finding that the Veteran’s reported scar on his chin is related to an in-service injury, event, or disease. 3. The preponderance of the evidence is against finding that the Veteran has a bilateral foot condition due to a disease or injury in service. CONCLUSIONS OF LAW 1. The criteria for service connection for degenerative disc disease of the cervical spine are not met. 38 U.S.C. §§ 1110, 1111, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 2. The criteria for service connection for scar on chin are not met. 38 U.S.C. §§ 1110, 1111, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 3. The criteria for service connection for bilateral foot condition are not met. 38 U.S.C. §§ 1110, 1111, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from May 1969 to November 1970. Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. § 1110, 1131; 38 C.F.R. § 3.303. “To establish a right to compensation for a present disability, 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. Shineski, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). 1. Degenerative Disc Disease of the Cervical Spine The Board concludes that, while the Veteran has a current diagnosis of degenerative disc disease of the cervical spine and the evidence shows that the Veteran complained of a sore neck after a fall during active service, the preponderance of the evidence weighs against finding that the Veteran’s diagnosis of degenerative disc disease began during service or is otherwise related to his in-service injury. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). The Veteran attended a VA examination in June 2016 and reported that, in 1970, he was leaning over the side of a guard tower and fell 17 feet. The Veteran stated that he did not report to medical until the next day to complain of neck pain and a laceration to his chin. Based upon physical examination and review of the record, the VA examiner opined that it is less likely than not that the Veteran’s cervical spine degenerative joint disease incurred in or is caused by the Veteran’s neck soreness during service. The examiner noted that the Veteran fell from the tower on June 10, 1970, and complained of neck pain; however, five days later the Veteran went to medical for a chest cold but did not complain of neck pain at that time. Review of the service treatment records reflect no further complaints of neck pain, specifically at a subsequent visit in October 1970 there was no complaint of neck pain and at the Veteran’s separation examination in November 1970, he reported that his “physical health is good.” The examiner also reviewed the Veteran’s post service medical records. The examiner reported that, in September and November 2013, when the Veteran established care through the VA, he did not list neck complaints as a concern. Furthermore, the first complaint related to the Veteran’s neck was not documented until July 11, 2014, despite being described as “chronic” and treatment was not requested until August 2014, approximately 44 years after the Veteran’s in-service injury. The examiner also noted that, during those 44 years, the Veteran worked as a repairman and never filed a worker injury report for neck pain or neck pain exacerbation. The Veteran provided a statement from Dr. T.D., who established that he has been treating the Veteran for chronic neck pain since March 2015. Dr. T.D. stated that the Veteran’s chronic neck pain started after a fall in Vietnam; however, Dr. T.D. does not provide a rationale linking the Veteran’s current neck pain to his fall from the guard tower in 1970. A mere conclusion without an underlying rationale is of no probative value. Miller v. West, 11 Vet. App. 345 (1998). In making all determinations, the Board must fully consider the lay assertions of record. The Veteran contends his degenerative disc disease of the cervical spine is a result of his in-service injury. Though the Veteran may be competent to describe the particular symptoms from which he suffers, determining the exact nature and etiology of degenerative disc disease requires medical knowledge or training and specialized testing which the Veteran is not shown to have. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The Board gives significant weight to the opinion of the VA examiner. This opinion was conducted by a health care professional, who reviewed the record and conducted a physical examination. This opinion is well supported by adequate rationale and specific citations to the medical evidence of record. See Nieves- Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). The report of the examination is probative of the issue on appeal. The Board notes that evidence of a prolonged period without medical complaint and the amount of time that elapsed since service can be considered. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). The VA examiner properly noted and considered that the Veteran had a 44-year period between his in-service injury and complaints of neck pain after service. As such, the Board finds the evidence is insufficient to warrant service connection for degenerative disc disease of the cervical spine. 2. Scar on Chin The Board concludes that the evidence does not establish that the Veteran incurred a laceration to his chin during active service that resulted in a scar. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); 38 C.F.R. § 3.303(a), (d). The Veteran alleges he is entitled to service connection for a scar as a result of a laceration to his chin after falling from the guard tower during active service. However, the treatment notes from June 10, 1970, when the Veteran went to medical due to his fall, do not mention a chin laceration. Review of the service treatment records reveal that they are silent for any complaints or treatments for a laceration to the chin. As such, the objective evidence does not establish that there was an in-service event, injury, or illness resulting in a laceration to the chin. To the extent that the Veteran alleges he has scar on his chin as a result of a fall in active service, this allegation is without probative value. There is no medical evidence establishing that the Veteran suffered a laceration to his chin in-service. The Board notes that the VA’s duty to provide a VA examination is not triggered. In determining whether VA’s duty to assist requires a VA medical examination or medical opinion, four factors are for consideration: (1) whether there is competent evidence of a current disability or persistent or recurrent symptoms of a disability; (2) whether there is evidence establishing that an event, injury, or disease occurred in service, or evidence establishing certain diseases manifesting during an applicable presumption period; (3) whether there is an indication that the disability or symptoms may be associated with the veteran's service or with another service-connected disability; and (4) whether there otherwise is sufficient competent medical evidence of record to make a decision on the claim. 38 U.S.C. § 5103A (d) (2012); 38 C.F.R. § 3.159 (c)(4) (2017); see McLendon v. Nicholson, 20 Vet. App. 79 (2006). The evidence of record does not establish that the Veteran had a laceration to his chin during active service. As such, a VA examination or opinion is not necessary. The Board finds that entitlement to service connection for scar on chin is not warranted. 3. Bilateral Foot Condition The Board concludes that, while the Veteran has a diagnosis of bilateral metatarsalgia and arthritis the preponderance of the evidence is against finding that it began during active service, or is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). The service treatment records establish that the Veteran suffered a stress fracture to his right foot in June 1969; however, the records are silent as to any complaints, treatments, or diagnoses pertaining to the Veteran’s left foot. Additionally, the service treatment records contain no notations indicating treatment or diagnoses of metatarsalgia or arthritis. The Veteran’s November 1970 separation examination did not indicate any abnormalities of the feet and the Veteran reported that his “physical condition is good.” See STR- Medical February 2014. The Veteran attended a VA examination for his bilateral foot condition in June 2016 and received the diagnoses of bilateral metatarsalgia and bilateral degenerative arthritis. The VA examiner opined that is less likely than not that the Veteran’s right foot conditions are related to the Veteran’s stress fracture of the right foot that incurred in service. The examiner noted that, in June 1969, the Veteran had a right foot stress fracture that was treated with a steel plate in his boot, ice and eight days of light duty; however, the Veteran’s separation examination was negative for foot pain. The Veteran sought care in September 2013, reporting a history of seven to eight years of foot pain, which would be approximately 34 years after service. The examiner noted that the Veteran reported his pain in the dorsum of the foot closer to the toes past talus mid metacarpal area and that x-rays in 2013 and 2016 document degenerative changes with osteophytes consistent with an arthritic condition. The VA examiner also opined that it is less likely than not that the Veteran’s left foot condition was incurred in or was caused by an in-service injury, event or illness. The examiner noted that the service treatment records are silent as to any symptoms, complaints, or examinations of the left foot during active duty. The Veteran’s post-service medical records indicate that the Veteran complained of foot pain for seven to eight years in September 2013, which again is approximately 34 years after active service. As such, the Veteran’s service treatment records do not support that a left foot condition incurred in or is a result of service. The Veteran’s physician, Dr. T.D., provided a statement reporting that the Veteran has post-traumatic degenerative joint disease of the feet and that he fractured the mid-metatarsal of the right foot during basic training. This statement has no probative value as it is a mere conclusion without an underlying rationale. Miller v. West, 11 Vet. App. 345 (1998). Dr. T.D. does not provide a medical explanation connecting the Veteran’s right foot fracture in service to his current diagnoses of bilateral metatarsalgia and arthritis. See Nieves- Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two). In making all determinations, the Board must fully consider the lay assertions of record. The Veteran is competent to describe the particular symptoms from which he suffers; however, determining the exact nature and etiology of metatarsalgia and arthritis requires medical knowledge or training and specialized testing which the Veteran is not shown to have. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The Board finds the opinion of the VA examiner probative and affords it significant weight as it is consistent with the objective evidence of record revealing no treatment for bilateral foot pain until decades after service. The examiner reviewed the records and noted that the Veteran’s foot pain first began about 2005, well after active service. In explaining his opinion, the examiner noted that the Veteran’s right foot stress fracture was of the second metatarsal; however, the Veteran’s pain is at the dorsum of the foot closer to toes past talus mid-metacarpal area. Additionally, the examiner noted that there is no indication of any injury or treatment in service for the left foot. As such, the Board finds that the preponderance of the evidence weighs against the Veteran’s claim for service connection for a bilateral foot condition. Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S. A. Prinsen, Associate Counsel