Citation Nr: 18151128 Decision Date: 11/16/18 Archive Date: 11/16/18 DOCKET NO. 17-44 273 DATE: November 16, 2018 ORDER Entitlement to service connection for degenerative arthritis of the spine, claimed as upper back pain, is denied. Entitlement to service connection for degenerative arthritis of the left knee, claimed as left knee pain, is denied. Entitlement to service connection for degenerative arthritis of the right knee, claimed as right knee pain, is denied. Entitlement to service connection for bilateral hearing loss is denied. Entitlement to service connection for chronic obstructive pulmonary disease is denied. FINDINGS OF FACT 1. The Veteran’s degenerative arthritis of the spine did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disability is not otherwise etiologically related to an in-service injury, event, or disease. 2. The Veteran’s degenerative arthritis of the left knee did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disability is not otherwise etiologically related to an in-service injury, event, or disease. 3. The Veteran’s degenerative arthritis of the right knee did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disability is not otherwise etiologically related to an in-service injury, event, or disease. 4. The Veteran’s right ear does not meet the criteria for a hearing loss disability for VA purposes. 5. The Veteran’s left ear hearing loss did not manifest during active service, within one year of his separation from active service, and is not otherwise related to his active service. 6. The preponderance of the evidence is against finding that the Veteran has chronic obstructive pulmonary disease due to a disease or injury in service, to include specific in-service event, injury, or disease. CONCLUSIONS OF LAW 1. The criteria for service connection for degenerative arthritis of the spine are not met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309(a). 2. The criteria for service connection for degenerative arthritis of the left knee are not met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309(a). 3. The criteria for service connection for degenerative arthritis of the right knee are not met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309(a). 4. The criteria for service connection for bilateral hearing loss have not been met. 38 U.S.C. § 5108; 38 C.F.R. §§ 3.159, 3.303, 3.307, 3.309, 3.385. 5. The criteria for entitlement to service connection for chronic obstructive pulmonary disease have not been met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from April 1979 to December 1980. This matter is on appeal from a November 2015 rating decision, which denied entitlement to service connection for upper back pain, left knee pain, right knee pain, bilateral hearing loss, and chronic obstructive pulmonary disease. In September 2018, the Veteran submitted a Statement in Support of Claim supporting a Motion for Advance on Docket. The Board grants the Veteran’s motion to Advance on Docket due to homelessness. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). Service connection requires competent evidence showing: (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. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); 38 C.F.R. § 3.303. The benefit of the doubt rule provides that a veteran will prevail in a case where the positive evidence is in a relative balance with the negative evidence. Therefore, the Veteran prevails in a claim when: (1) the weight of the evidence supports the claim, or (2) when the evidence is in equipoise. It is only when the weight of the evidence is against the claim that the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 1. Entitlement to service connection for degenerative arthritis of the spine is denied. The Veteran contends that he has degenerative arthritis of the spine that is related to an in-service injury, event, or disease. The question for the Board is whether the Veteran has a chronic disease that manifested to a compensable degree in service or within the applicable presumptive period, or whether continuity of symptomatology has existed since service. The Board concludes that, while the Veteran has degenerative arthritis of the spine, which is a chronic disease under 38 C.F.R. § 3.309(a), it was not chronic in service or manifest to a compensable degree in service or within a presumptive period, and continuity of symptomatology is not established. Moreover, the preponderance of the evidence is against finding that this condition began during active service, or is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). A September 1980 service treatment record reported that the Veteran complained of thoracic back pain, for which he was prescribed Motrin. A December 1980 report of medical examination reported that the Veteran was cleared for discharge as no defects were noted. A February 1982 service treatment record reported that the Veteran was certified to be physically qualified for active duty/active duty for training, with no defects noted. A July 2004 VA treatment note reported that the Veteran had been experiencing hip pain, but reported “no back pain.” A February 2005 VA treatment note reported that the Veteran had experienced right lumbar pain for one week. The record reported a past medical history of “Chronic back spasms?” A September 2006 VA treatment note reported that the Veteran had experienced lower back pain that radiated to his legs for three days. The pain was caused by his use of a shovel for eight hours performing construction work. The examiner reported that the Veteran had a history of back spasms four to five years ago in which X-rays were negative. In November 2015, the Veteran was afforded a VA examination of his thoracolumbar spine. The examiner diagnosed the Veteran with degenerative arthritis of the lumbar spine. The Veteran complained of experiencing upper and lower back spasms when the weather is cold. He also reported that he cannot lift more than 50 pounds due to his back pain. The examiner provided a medical opinion in which she opined that the Veteran’s back pain was less likely than not (less than 50 percent probability) incurred in or caused by an in-service injury, event, or illness. As rationale, the examiner explained that “since the veteran had diagnosis of muscular back pain in service with normal physical exam on discharge in 1980, and veteran had normal back X-rays in 2006 with no spondylosis or spondylolisthesis, and advanced age is one of the strongest risk factors for osteoarthritis with over 80% of people age 50 with positive findings of osteoarthritis, it is less likely than not that his current lumbar degenerative arthritis and DISH [diffuse idiopathic skeletal hyperostosis] of the thoracic spine had its onset in service.” At an October 2017 Board hearing, the Veteran testified that, after his discharge, he had been treated periodically at a hospital in San Antonio for back cramps that were brought on by cold weather. As previously described, the Veteran’s service treatment records show that he complained of thoracic pain in September 1980, but was cleared for discharge with no defects noted at a separation examination in December 1980. The earliest evidence of a back condition after his discharge was the Veteran’s report of back spasms in February 2005, more than twenty-four years after the Veteran’s discharge from service. While not dispositive, the passage of so many years between discharge from active service and the objective documentation of a disability is a factor that weighs against a claim for service connection. Maxson v. Gober, 230 F.3d 1330 (Fed. Cir. 2000). Furthermore, there is no medical evidence indicating a link between the Veteran’s back condition and service. Thus, the Board finds that the Veteran’s degenerative arthritis of the spine did not have its onset in active service or for many years thereafter. A lay person is competent to address etiology in some limited circumstances in which nexus is obvious merely through lay observation, such as a fall leading to a broken leg. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). In this case, however, the record dates the onset of symptoms of a back condition to many years after separation from active service and the question of causation extends beyond an immediately observable cause-and-effect relationship. As such, the Veteran is not competent to address the etiology of his disability. Consequently, the Board gives more probative weight to the November 2015 VA examination report. The examiner found that the Veteran’s current back pain was less likely than not caused by or a result of military service as the Veteran had no reported back issues at his discharge examination in 1980 and had normal X-rays in 2006. Moreover, the examiner explained that advanced age is one of the strongest risk factors for osteoarthritis in over 80 percent of individuals who are fifty years of age. Based on a review of the foregoing evidence and the applicable laws and regulations, the Board finds that the preponderance of the evidence is against the Veteran’s claims for service connection for degenerative arthritis of the spine. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine; however, as the preponderance of the evidence is against the claims, that doctrine is not helpful to this claimant. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). Service connection has not been established and the Veteran’s claim for degenerative arthritis of the spine must be denied. 2. Entitlement to service connection for degenerative arthritis of the left knee is denied. 3. Entitlement to service connection for degenerative arthritis of the right knee is denied The Veteran contends that he has degenerative arthritis of the left knee and right knee that is related to an in-service injury, event, or disease. The question for the Board is whether the Veteran has a chronic disease that manifested to a compensable degree in service or within the applicable presumptive period, or whether continuity of symptomatology has existed since service. The Board concludes that, while the Veteran has bilateral degenerative arthritis of the knees, which is a chronic disease under 38 C.F.R. § 3.309(a), it was not chronic in service or manifest to a compensable degree in service or within a presumptive period, and continuity of symptomatology is not established. Moreover, the preponderance of the evidence is against finding that this condition began during active service, or are otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). A July 1979 service treatment record reported that the Veteran started having leg pain at the end of boot camp and now had pain in both knees, especially during running. The Veteran had full range of motion in his knees and experience no swelling or locking. He was diagnosed with “? chondromalacia patella.” A December 1980 report of medical examination reported that the Veteran was cleared for discharge as no defects were noted. A February 1982 service treatment record reported that the Veteran was certified to be physically qualified for active duty/active duty for training, with no defects noted. An October 2015 VA emergency department note reported that the Veteran complained of bilateral knee pain. The Veteran reported that he had experienced knee pain for several years but that he was not currently on medications or other therapies for his knees. He reported increasing pain over the last two weeks as well as a fall after his right knee gave out due to pain. Radiographic imaging showed mild degenerative changes of the bilateral knees. In November 2015, the Veteran was afforded a VA examination of his knees. The examiner diagnosed the Veteran with degenerative arthritis of the left knee and right knee. The Veteran reported that his knee gets stiff when he stands for long periods, without specifying whether he was describing his left or right knee. He also reported having difficulty going up and down stairs and falling due to pain in his right knee. The examiner provided a medical opinion in which she opined that the Veteran’s bilateral knee osteoarthritis was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. As rationale, the examiner explained that “since the veteran had a diagnosis of chondromalacia patella in service with normal X-rays, and normal physical exam on discharge in 1980, and records are silent for complaint of knee pain until 2015 (approximately 36 years later), and aging is the strongest risk factor for osteoarthritis, it is less likely than not that the veteran’s current bilateral knee osteoarthritis had its onset in service.” At an October 2017 Board hearing, the Veteran testified that, after his discharge, he sought treatment for his knees sometime in the 1980s at a hospital in San Antonio and that his knees have continued to bother him since service. As previously described, the Veteran’s service treatment records show that he complained of bilateral knee pain in July 1979, but was cleared for discharge with no defects noted at a separation examination in December 1980. The earliest evidence of a knee condition after his military service was the Veteran’s report of bilateral knee pain in October 2015, more than thirty-four years after the Veteran’s discharge from service. While not dispositive, the passage of so many years between discharge from active service and the objective documentation of a disability is a factor that weighs against a claim for service connection. Maxson, 230 F.3d at 1333. Furthermore, there is no medical evidence indicating a link between the Veteran’s knee conditions and service. Thus, the Board finds that the Veteran’s bilateral degenerative arthritis of his knees did not have its onset in active service or for many years thereafter. A lay person is competent to address etiology in some limited circumstances in which nexus is obvious merely through lay observation, such as a fall leading to a broken leg. Jandreau, 492 F.3d at 1377. In this case, however, the record dates the onset of symptoms of knee pain to many years after separation from active service and the question of causation extends beyond an immediately observable cause-and-effect relationship. As such, the Veteran is not competent to address the etiology of his disability. Consequently, the Board gives more probative weight to the November 2015 VA examination report. The examiner found that the Veteran’s current knee pain was less likely than not caused by or a result of military service. As rationale for her opinion, the examiner provided the following: (1) the Veteran had normal X-rays and diagnosis of chondromalacia patella after complaining of bilateral knee pain in service that was followed by a December 1980 physical examination at discharge that was normal; (2) the Veteran’s records after discharge are silent for complaints of knee pain until 2015; and (3) aging is the strongest risk factor for developing osteoarthritis. Based on a review of the foregoing evidence and the applicable laws and regulations, the Board finds that the preponderance of the evidence is against the Veteran’s claims for service connection for degenerative arthritis of the left knee and right knee. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine; however, as the preponderance of the evidence is against the claims, that doctrine is not helpful to this claimant. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). Service connection has not been established and the Veteran’s 4. Entitlement to service connection for bilateral hearing loss is denied. The Veteran contends that he has bilateral hearing loss that is related to an in-service noise exposure. VA regulations recognize an alternative method of entitlement to service connection for certain chronic diseases. Specifically, if the evidence of record reveals the Veteran has a current diagnosis that was chronic in service, or, if not chronic, that was seen in service with continuity of symptomatology demonstrated thereafter. 38 C.F.R. § 3.303(b); Savage v. Gober, 10 Vet. App. 488, 494-97 (1997). However, in Walker, the Federal Circuit overruled Savage and limited the applicability of the theory of continuity of symptomatology in service connection claims to those disabilities explicitly recognized as “chronic” in 38 C.F.R. § 3.309 (a). See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013); see also Fountain v. McDonald, 27 Vet. App. 258 (2015) (sensorineural hearing loss is considered a chronic disease for the purposes of 38 C.F.R. § 3.309(a)). As applied to the Veteran’s instant appeal, the Board notes that sensorineural hearing loss is considered a “chronic” disability under 38 C.F.R. § 3.309(a). As such, the theory of continuity of symptomatology remains valid in adjudicating the Veteran’s claim for entitlement to service connection for a bilateral sensorineural hearing loss disability and for his tinnitus. In addition to the above described VA regulations, the determination of whether a veteran has a disability based on hearing loss is governed by 38 C.F.R. § 3.385. For the purposes of applying the laws administered by VA, impaired hearing is considered a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. The Veteran served on active duty from April 1979 to December 1980. A March 1979 report of medical examination reported pure tone thresholds, in decibels, as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 5 5 5 5 5 LEFT 10 5 15 10 10 The Veteran’s service treatment records do not reflect any complaints of hearing loss or hearing difficulties. A December 1980 report of medical examination reported pure tone thresholds, in decibels, as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 5 5 5 0 10 LEFT 5 5 5 5 5 In August 2015, the Veteran filed a VA disability compensation claim for entitlement to service connection for bilateral hearing loss. In August 2017, the Veteran submitted a Form 9 on which he reported the following: “My MOS was infantry, always around a lot of noise and firing of weapons.” However, a review of the Veteran’s military personnel records indicates that he was not assigned as an infantryman during his entire enlistment period. The Veteran’s initial military occupational specialty (MOS) was basic infantryman. However, after the Veteran went absent without leave (AWOL) from July 21, 1979 to January 15, 1980, his MOS was changed to barracks and grounds man on January 18,1980. Therefore, the Veteran was AWOL for 178 of the 267 days that he was assigned as an infantryman. Moreover, he subsequently went AWOL for a period of 152 days from March 3, 1980 to August 2, 1980. Therefore, of the Veteran’s 609 days of active duty service, the Veteran was AWOL for 330 of those days. In September 2015, the Veteran was afforded a VA audio examination. Results from the audiogram reflect that pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 6000 8000 RIGHT 10 25 15 20 20 25 15 LEFT 20 25 15 20 15 25 30 Speech audiometry revealed speech recognition ability of 96 percent in the right ear and 88 percent in the left ear, using Maryland CNC tests. As a result of the testing, the examiner diagnosed the Veteran with mild sensorineural hearing loss at 8000 Hertz in the left ear. The examiner also reported that “[a]n exam could not be located in the VBMS records (no STR’s or MTR’s were available for review).” The examiner opined that the Veteran does not have right ear hearing loss. As rationale, the examiner provided the following: “Due to the fact that the veteran currently exhibits normal hearing in the right ear, 45 years after separation, it is the opinion of the examiner that his current hearing is not damaged due to military noise exposure as it continues to be within normal limits.” The examiner opined that the Veteran’s left ear hearing loss is not at least as likely as not caused by or a result of an event in military service. As rationale, the examiner provided the following: “Due to the fact that the veteran currently exhibits normal hearing through 6KHz and only a mild hearing loss at 8KHz in the left ear, 45 years after separation, it is the opinion of the examiner that his current hearing loss is less likely due to military noise exposure and more likely due to normal progression of aging and noise exposure throughout life. Right Ear Considering the Veteran’s right ear, none of the Veteran’s auditory threshold in the frequencies 500, 1000, 2000, 3000, or 4000 Hertz is 40 decibels or greater. Also, none of the Veteran’s auditory thresholds, for the right ear, for the frequencies 500, 1000, 2000, 3000, or 4000 Hertz is 26 or greater. Furthermore, the Veteran’s speech recognition score for the right ear exceed 94 percent. As described above, pursuant to 38 C.F.R. § 3.385, the Veteran has not been shown to have a hearing loss disability by VA standards in his right ear. Without a current hearing disability, as defined by VA, the Board must deny his claim as a matter of law. Left Ear Considering the Veteran’s left ear, none of the Veteran’s auditory threshold in the frequencies 500, 1000, 2000, 3000, or 4000 Hertz is 40 decibels or greater. Also, none of the Veteran’s auditory thresholds, for the left ear, for the frequencies 500, 1000, 2000, 3000, or 4000 Hertz is 26 or greater. However, the Veteran’s left ear hearing acuity, as evaluated by the Maryland CNC testing, was reported as 88 percent. Therefore, the Board finds the Veteran has satisfied the first element of service connection, the existence of a current left ear hearing loss disability, as the Veteran’s speech recognition score was less than 94 percent. 38 C.F.R. § 3.385. During this encounter, the Veteran’s left ear hearing acuity, as evaluated by the Maryland CNC testing, was reported as 88 percent. Therefore, the Board finds the Veteran has satisfied the first element of service connection, the existence of a current left ear hearing loss disability. Moreover, the Board finds that the Veteran had an in-service injury consisting of acoustic trauma from noise exposure. The Veteran’s reports of exposure to noise during service are credible because they are consistent with the circumstances of his service, to include as reflected by his MOS as an infantryman as shown in his military personnel records. See 38 U.S.C. § 1154(a). In reviewing all the evidence of record, the Board finds that the most probative evidence weighs against the Veteran’s claim for entitlement to service connection for left ear hearing loss. Although the Board finds that the Veteran experienced an in-service injury consisting of acoustic trauma from noise exposure, the most probative evidence does not relate the current left ear hearing loss disability to the Veteran’s active service, to include the in-service noise exposure. In this respect, the Board assigns probative weight to the September 2015 VA examination report and the medical opinion addressing the Veteran’s left ear hearing loss. The September 2015 VA examiner opined that the Veteran’s left ear hearing loss is not at least as likely as not caused by or a result of an event in military service. As rationale, the examiner noted that the Veteran exhibits normal hearing through 6000 Hertz and only a mild hearing loss at 8000 Hertz in the left ear decades after the Veteran’s separation; therefore, the hearing loss is more likely due to normal progression of aging and noise exposure throughout life. Although the examiner stated in 2015 that it had been 45 years since the Veteran’s separation, the Board notes that the correct duration was nearly 35 years. The Veteran has argued that his current left ear hearing loss is the result of in-service noise exposure. The Veteran is competent to report in-service noise exposure, his current symptoms, and the history of those symptoms. However, as summarized above, the objective medical evidence of record does not show bilateral hearing loss during active service. Furthermore, the record is absent for evidence of treatment for or complaint of bilateral hearing loss until August 2015, approximately 35 years after the Veteran’s separation from active service. The Veteran is not competent to diagnose himself with a hearing loss disability during the period from his separation from active service to September 2015, when he was first shown to have left ear hearing loss. He is also not competent to etiologically relate his current left ear hearing loss disability to his active service. Although there is no bright line exclusionary rule that a lay person cannot provide opinion evidence as to a nexus between an in-service event and a current condition, not all medical questions lend themselves to lay opinion evidence. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). In this case, the Veteran has not been shown to possess the medical knowledge or expertise necessary to diagnose a hearing loss disability or to provide an opinion on a complex medical matter such as the etiology of his current left ear hearing loss. See also Kahana v. Shinseki, 24 Vet. App. 428 (2011). Therefore, his statements as to the etiology of his left ear hearing loss do not weigh against the probative value of the September 2015 VA examiner’s negative nexus opinion. In summary, the record does not show that the Veteran had a left ear hearing loss at separation from active service. The record also does not show that the Veteran had a left ear hearing loss disability within the one-year period following his separation from active service. Rather, the competent evidence of record does not show a left ear hearing loss disability until approximately 35 years after the Veteran’s separation from active service. After considering all the evidence under the laws and regulations set forth above, the Board concludes that the Veteran is not entitled to service connection for left ear hearing loss because the most probative evidence is against a finding that there is a nexus between the current bilateral hearing loss disability and the Veteran’s active service. As the preponderance of the evidence is against the Veteran’s claim, the benefit-of-the-doubt rule is not for application, and the claim must be denied. See 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). 5. Entitlement to service connection for chronic obstructive pulmonary disease (COPD) is denied. The Veteran contends that he has COPD that is related to an in-service injury, event, or disease. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has a current diagnosis of COPD, 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. §§ 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). The Veteran’s service treatment records make no reference to treatment for COPD. A December 1980 report of medical examination reported that the Veteran was cleared for discharge as no defects were noted. A February 1982 service treatment record reported that the Veteran was certified to be physically qualified for active duty/active duty for training, with no defects noted. A May 2011 VA treatment note reported that the results of a pulmonary function test administered to the Veteran were consistent with COPD. Therefore, the Veteran was provided two inhalers for treatment. At an October 2017 hearing, the Veteran stated that he believed his COPD was related to his military service due to his smoking habit in service. As previously described, the Veteran’s service treatment records show no evidence of treatment for COPD. The earliest evidence of COPD was the diagnosis of COPD following a pulmonary function test in May 2011, more than three decades after the Veteran’s discharge from service. While not dispositive, the passage of so many years between discharge from active service and the objective documentation of a disability is a factor that weighs against a claim for service connection. Maxson, 230 F.3d at 1333. Furthermore, there is no medical evidence indicating a link between the Veteran’s COPD. Thus, the Board finds that the Veteran’s COPD did not have its onset in active service or for many years thereafter. A lay person is competent to address etiology in some limited circumstances in which nexus is obvious merely through lay observation, such as a fall leading to a broken leg. Jandreau, 492 F.3d at 1377. In this case, however, the record dates the onset of symptoms of COPD to many years after separation from active service and the question of causation extends beyond an immediately observable cause-and-effect relationship. As such, the Veteran is not competent to address the etiology of his disability. Based on a review of the foregoing evidence and the applicable laws and regulations, the Board finds that the preponderance of the evidence is against the Veteran’s claims for service connection for COPD. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine; however, as the preponderance of the evidence is against the claims, that doctrine is not helpful to this claimant. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). Service connection has not been established and the Veteran’s claim for COPD must be denied. KELLI A. KORDICH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. Moore, Associate Counsel