Citation Nr: 18153951 Decision Date: 11/28/18 Archive Date: 11/28/18 DOCKET NO. 10-25 175 DATE: November 28, 2018 ORDER Entitlement to service connection for a back disability, to include as claimed due to an undiagnosed illness, is denied. Entitlement to service connection for a neck disability, to include as claimed due to an undiagnosed illness, is denied. Entitlement to service connection for a right shoulder disability, to include as claimed due to an undiagnosed illness, is denied. FINDINGS OF FACT 1. The Veteran’s low back, right shoulder, and neck symptoms have all been attributed to known clinical diagnoses and not to an undiagnosed illness or another medically unexplained multi-symptom illness. 2. There is no credible evidence of continuity of any low back, right shoulder, or neck symptoms in and since service; and the most persuasive medical opinion evidence of record weighs against finding that there existed a medical relationship, or nexus, between any later diagnosed disability and service. CONCLUSIONS OF LAW 1. The criteria for service connection for low back disability, to include as due to undiagnosed illness or other qualifying chronic disability, are not met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1117, 1131, 1137, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.317. 2. The criteria for service connection for neck disability, to include as due to undiagnosed illness or other qualifying chronic disability, are not met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1117, 1131, 1137, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.317. 3. The criteria for service connection for right shoulder disability, to include as due to undiagnosed illness or other qualifying chronic disability, are not met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1117, 1131, 1137, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.317. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1976 to August 1996. These matters come before the Board of Veterans' Appeals (Board) from a December 2008 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In February 2013, the Veteran and his spouse testified at a hearing at the RO before a Veterans Law Judge. A transcript of the hearing is of record. The Veterans Law Judge who presided at the February 2013 hearing is no longer with the Board. In an April 2016 letter, VA advised the Veteran of his right to testify at a hearing before a different Veterans Law Judge who would decide the claim. 38 C.F.R. § 20.717. The letter advised the Veteran that, if he did not reply within 30 days of the date of the letter, the Board would assume that the Veteran did not wish to attend another hearing. The Veteran did not respond. When the case was before the Board in November 2014, the Board, in pertinent part, denied the claims for service connection for a back disability, a neck disability, and a right shoulder disability. The Veteran appealed the Board's November 2014 decision denying service connection for disabilities of the back, cervical spine, and right shoulder to the United States Court of Appeals for Veterans Claims (Court). The Secretary of VA and a representative of the Veteran (parties) filed a Joint Motion for Remand (JMR). In the JMR, the parties agreed that the Board needed to obtain the Veteran's service records from Southwest Asia during the required period and then determine whether he was eligible for service connection for any of the claimed disabilities due to an undiagnosed illness. In a March 2016 Order, the Court granted a March 2016 Joint Motion for Remand (JMR) signed by both parties and remanded the issues to the Board for action consistent with the terms of the joint motion. In August 2016 the Board remanded these issues for additional development consistent with the instructions in the JMR. In June 2017 the Board again remanded these issues for additional development. A review of the claims file shows that there has been substantial compliance with the Board’s June 2017 remand directives. See Stegall v. West, 11 Vet. App. 268 (1998); see also Dyment v. West, 13 Vet. App. 141 (1999) (holding that another remand is not required under Stegall where the Board’s remand instructions were substantially complied with), aff’d, Dyment v. Principi, 287 F.3d 1377 (2002). Service Connection In general, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 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); see also Caluza v. Brown, 7 Vet. App. 498 (1995). Generally, in order to prove service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999). However, if a veteran serves 90 days or more of active, continuous service during a period of war, or during peacetime service after December 31, 1946, and certain chronic diseases, including arthritis, become manifest to a compensable degree within a prescribed period post service (one year for arthritis), service connection for the disease may be established on a presumptive basis, notwithstanding that there is no in-service record of the disorder. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. This presumption may be rebutted by affirmative evidence to the contrary. 38 U.S.C. § 1113; 38 C.F.R. § 3.307 (d). The existence of a chronic in-service disease may be shown through a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity during service. In order to establish the existence of a chronic disease during service, the evidence must show 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 or a diagnosis including the word “chronic.” 38 C.F.R. § 3.303 (b). If chronicity during service is not shown, a showing instead of continuity of symptoms after separation from service is required to support the claim. 38 C.F.R. § 3.303 (b). Notwithstanding the lack of evidence of disease or injury during service, service connection may still be granted if all of the evidence, including that pertinent to service, establishes that the disability was incurred during service. See 38 U.S.C. § 1113 (b); 38 C.F.R. § 3.303 (d); Cosman v. Principi, 3 Vet. App. 503, 505 (1992). Service connection may also be granted for any disease diagnosed after discharge if all of the evidence establishes that the disease was incurred during service. 38 C.F.R. § 3.303 (d). Additionally, service connection for certain listed chronic diseases, which include arthritis, may be awarded on a presumptive basis, and will be presumed to have been incurred during active service, even though there is no evidence of the disability during service if such disability becomes manifest to a compensable degree within one year of separation from active duty. That presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. The Veteran has contended that his claimed disabilities are related to service, to include service in the Southwest Asia theater of operations during the Persian Gulf War. For veterans with service in the Southwest Asia theater of operations during the Persian Gulf War, service connection may be established under 38 U.S.C. § 1117; 38 C.F.R. § 3.317. Under this law and regulation, service connection may be warranted for a Persian Gulf veteran who exhibits objective indications of “a qualifying chronic disability” that became manifest during active military, naval or air service in the Southwest Asia theater of operations during the Persian Gulf War, or to a degree of 10 percent or more not later than December 31, 2021. 38 C.F.R. § 3.317 (a)(1). For purposes of 38 C.F.R. § 3.317, qualifying chronic disabilities include, among other things, an undiagnosed illness. 38 C.F.R. § 3.317 (a)(2). To obtain service connection for an undiagnosed illness or combination of undiagnosed illnesses, a veteran needs to show (1) that he or she is a Persian Gulf veteran; (2) who exhibits objective indications of chronic disability resulting from an illness or combination of illnesses manifested by one or more signs or symptoms such as those listed in paragraph (b) of 38 C.F.R. § 3.317; (3) that have become manifest either during active military, naval or air service in the Southwest Asia theater of operations during the Persian Gulf War, or to a degree of 10 percent or more not later than December 31, 2021 and (4) that such symptomatology by history, physical examination, and laboratory tests cannot be attributed to any known clinical diagnosis. 38 U.S.C. § 1117; 38 C.F.R. § 3.317 (a). “Objective indications of chronic disability” include both “signs,” in the medical sense of objective evidence perceptible to an examining physician, and other, non-medical indicators that are capable of independent verification. 38 C.F.R. § 3.317 (a)(3). Signs or symptoms that may be manifestations of an undiagnosed illness include, but are not limited to, the following: (1) fatigue; (2) signs or symptoms involving skin; (3) headache; (4) muscle pain; (5) joint pain; (6) neurologic signs or symptoms; (7) neuropsychological signs or symptoms; (8) signs or symptoms involving the respiratory system (upper or lower); (9) sleep disturbances; (10) gastrointestinal signs or symptoms; (11) cardiovascular signs or symptoms; (12) abnormal weight loss; and (13) menstrual disorders. 38 C.F.R. § 3.317 (b). For purposes of 38 C.F.R. § 3.317, disabilities that have existed for six months or more and disabilities that exhibit intermittent episodes of improvement and worsening over a six-month period will be considered chronic. The six-month period of chronicity will be measured from the earliest date on which the pertinent evidence establishes that the signs or symptoms of the disability first became manifest. 38 C.F.R. § 3.317 (a)(4). Laypersons, are competent to report on matters observed or within his or her personal knowledge, to include the occurrence of injury, and as to the nature, onset, and continuity of symptoms experienced or observed. See 38 C.F.R. § 3.159 (a)(2); Charles v. Principi, 16 Vet. App. 370 (2002). Layno v. Brown, 6 Vet. App. 465, 470 (1994). The Board, however, retains the discretion to determine the credibility and probative value of all evidence of record, including lay evidence. See Buchanan v. Nicholson, 451 F.3d 1331, 1335 (Fed. Cir. 2006). When there is an approximate balance in the evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. In Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990), the United States Court of Appeals for Veterans Claims (Court) held that that an appellant need only demonstrate that there is an “approximate balance of positive and negative evidence” in order to prevail. The Court has also stated, “It is clear that to deny a claim on its merits, the evidence must preponderate against the claim.” Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert. 1. Entitlement to service connection for low back disorder, to include as due to an undiagnosed illness. The Veteran contends his claimed low back disability is related to service, to include his service in the Southwest Asia theater of operations during the Persian Gulf War. A September 1979 treatment record reveals a history of lower back pain for three days, from lifting heavy boxes. Examination revealed tenderness. The Veteran was taken off PRP duty for seven days. A September 1996 retirement examination record reveals the Veteran’s history of “painful or ‘trick’ shoulder or elbow.” He also reported a history of a head injury. He did not indicate whether there was recurrent back pain. He explained that he was injured in a car accident and sporting incident, and that he sustained a laceration of the right eye because of the car accident and a cracked bone in the neck because of the sporting incident. Evaluation revealed normal clinical findings for all relevant systems, including the spine, neck, and upper extremities. February 2009 medical records reveal histories of right shoulder and low back pain. The records reveal the Veteran’s history of chronic low back pain for several years. An MRI revealed multilevel spondylosis, endplate hypertrophy and bulge of the annulus and disc primarily involving L3-4 and L4-5. A March 2009 VA treatment record reveals the Veteran’s history of fracturing C-5 during service in a baseball game in 1981. He also reported experiencing low back pain later in Italy, for which he received treatment. A March 2010 VA examination record reveals the Veteran’s history of twisting the lower back in approximately 1983, while working. The Veteran reported that he was treated with medication, and the condition resolved. The Veteran added that he had intermittent problems with his low back since that time. After examination and review of radiographic images, the Veteran was diagnosed with lumbar degenerative disc disease that was consistent with natural age. The examiner found no evidence to support chronicity of a low back condition, explaining that the service treatment records were silent regarding treatment for low back pain after the initial visit in 1979. The examiner added that the evidence showed there was no causative relationship between spondylosis found on MRI in 2009 and low back pain/strain. Thus, the examiner determined it was less likely than not caused by or related to service. The May 2014 VA examination record reveals the Veteran’s history in approximately 1980 of developing a twinge or spasm of the low back without real treatment. The Veteran explained that he had intermittent twinges or spasms periodically, that in 1990, he had a five-minute episode of pain, and that after service, he got periodic twinges and spasms. The record reveals a diagnosis of degenerative disc disease of the lumbar spine. The examiner noted that the Veteran was treated once in service for a muscular strain in 1979 and “went on to complete a full military career, which included clearance for, and participation in, full contact sports” and that the discharge “examination was negative for complaint, diagnosis or treatment of lumbar issues.” The examiner further noted that the Veteran “entered a strenuous career building swimming pools and worked as armed Security on a U.S. Military Base, where he serves without limitations of duty.” The examiner determined that the “complaint in service appear[ed] to be acute, self-limiting, benign and without sequelae.” The examiner noted that there was no nexus supported in the medical literature of muscular strain as a cause of degenerative disc/joint disease. Instead, the examiner determined the degenerative disc/joint disease appeared to be the result of natural aging. Therefore, it was the examiner’s opinion that the degenerative disc/joint disease was less likely than not caused by, related to, or worsened beyond natural progression by military service or muscular strain treated in service. At a VA examination in August 2017, the examiner indicated that all evidence of record was reviewed. The examiner noted the Veteran reported medical history and diagnosis of degenerative arthritis of the spine. The examiner opined the Veteran’s back condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. The examiner explained the Veteran’s degenerative joint disease (DJD) of the lumbar spine is less likely than not incurred from back symptoms or from any other clinical chronic disability secondary to his service in Southwest Asia during the Persian Gulf War. The examiner further explained that this was based on medical records containing only a single clinical note of back issues in August 1979 of lower back pain (LBP) for period of 3 days without recurrence which suggests that the current DJD of the lumbar spine is not due to military service. The Veteran asserts that the back disability began during service and continued since service. The Veteran is competent to report back pain during and since service, and the Board finds the history is credible and consistent with the medical records. Although the Veteran is competent to report a history of back pain, the Veteran is not competent to diagnose a chronic back disability manifested by intermittent pain as opposed to a distinct episodes of pain or even multiple episodes of acute disorder manifested by pain and other symptoms, and based on the absence of a diagnosis until many years after service, and the VA examiners’ probative determinations that a current back disability is not related to service, to include the reported episodes of back pain, the Board finds the preponderance of the evidence establishes that no chronic back disorder was present until more than one year after the Veteran’s discharge from service. Although the Veteran might believe that his back disability is related to service, the probative medical evidence does not corroborate these assertions, and the record does not suggest the Veteran, who is a layperson, is competent to determine the cause of his back disability. Therefore, the Veteran’s lay opinion is less probative than the medical opinion against the claim. Following review of the evidence, the Board the overall evidence of records fails to reveal a disability picture that links the Veteran’s claimed condition to military service as incurred or caused by or worsened by military service or service-condition. The preponderance of the evidence remains unfavorable. Initially, the Board finds the evidence shows that no chronic back disability was present until more than one year following the Veteran’s discharge from service. Although the service treatment records reflect complaints pertaining to the back, examination was normal at separation, and the medical records, to include the retirement examination record, do not reveal any subsequent history of back pain until more than 10 years after discharge (and almost 30 years after the 1979 treatment). Additionally, there is no probative medical opinion of record linking the Veteran’s low back condition to service. Furthermore, when taken in aggregate the VA examinations in 2010, 2014, and 2017 show that the Veteran’s back disability was not related to service, to include the in-service complaints, treatment or an undiagnosed illness. Accordingly, the claim must be denied. In reaching this decision, the Board has considered the doctrine of reasonable doubt but has determined that it is not applicable to this claim because the preponderance of the evidence is against the claim. 2. Entitlement to service connection for a cervical spine (neck) disorder, to include as due to an undiagnosed illness. The Veteran contends his claimed cervical spine disability is related to service, to include his service in the Southwest Asia theater of operations during the Persian Gulf War. November 1980 medical reports indicate that the Veteran was playing football when he was tackled and injured. Examination revealed full range of motion and strength. There was pain in part of the cervical spine. It was believed there might be a cervical fracture at C-4, but X-ray images were normal. The Veteran was admitted for observation for two days and discharged to duty with limitation to deskwork with a diagnosis of distortion of the cervical rachis. The Veteran was told to rest and wear a supporting collar for seven days. The ultimate diagnosis was traumatic cervical radiculitis. A May 1987 examination record reveals normal clinical findings for the neck, spine, and upper extremities. The record notes that the Veteran had traumatic cervical radiculitis in November 1980 with no complications and no sequelae. A March 1992 examination record reveals normal clinical findings for the upper extremities, spine, and neck. An undated form prepared sometime after 1994 reveals the Veteran’s history of a football injury and cracked bone in the neck in November 1981 and a car accident in February 1983. A September 1996 retirement examination record reveals the Veteran’s history of “painful or ‘trick’ shoulder or elbow.” He also reported a history of a head injury. He did not indicate whether there was recurrent back pain. He explained that he was injured in a car accident and sporting incident, and that he sustained a laceration of the right eye because of the car accident and a cracked bone in the neck because of the sporting incident. Evaluation revealed normal clinical findings for all relevant systems, including the spine, neck, and upper extremities. A September and October 2007 private treatment record reveals histories of cervical injury and fracture requiring traction during service and seven rotator cuff tears during service. The Veteran also reported numbness in the fingers. The records indicate that the Veteran owned a concrete company and built swimming pools for a company, doing “a lot of the manual labor himself.” The physician reported that although the Veteran had evidence of prior injury of the neck, he did not have any clinical evidence of radiculopathy or myelopathy, and the physician believed the finger symptoms were due to carpal tunnel syndrome. A November 2008 VA examination record reveals the Veteran’s history of cracking the bones at C-4-5-6 while playing team sports in 1981. He reported midline pain in the cervical spine and decreased motion. The examiner noted that the service medical records showed that the Veteran presented for treatment after being jarred while playing football in November 1980. The examiner further noted that initial review of the X-rays showed questionable fracture of C-4, that the Veteran was admitted for observation, and that at discharge, neurology review of the X-rays was negative with no mention of any fracture. The examiner added that there was no further mention of the cervical spine injury or complaints during service. After examination, the Veteran was diagnosed with degenerative disc disease of C5-C6. The examiner found no evidence to support definitive diagnosis of fracture of the cervical vertebrae during service and no evidence of old trauma on radiographs. Instead, the examiner found the degenerative changes were consistent with natural aging. A May 2014 VA examination record reveals the Veteran’s history of neck problems beginning in 1980-81, when he cracked a bone in C4-6. He reported he was in traction for a week, wore a neck brace for several months, and had physical therapy and avoided heavy lifting for six months. He added that he first sought care for his neck after service in 2000-2002. The record reveals a diagnosis of cervical spondylosis. The examiner noted that although the Veteran experienced a soft tissue injury of his neck in service, it was ultimately determined that there was no associated cervical spine fracture, the injury was subsequently determined to be resolved without sequelae, and the Veteran went on to a full career in the military without limitations of duty or complaints regarding his neck. The examiner also noted that the Veteran was subsequently cleared for participation in full contact sports and that evaluation of the spine was normal at separation. The examiner reported that although there were complaints of episodic pain since service, these complaints as likely as not represented acute events associated with a vigorous occupation/lifestyle that were self-limiting and without sequelae. The examiner added that cervical spondylosis is a general term for age-related wear and tear. The examiner determined the cervical spondylosis was the sole source of the Veteran’s current complaints of pain and limitation of motion. It was therefore the examiner’s opinion that the cervical spondylosis was less likely than not caused by, related to, or worsened beyond natural progression by military service or acute injury while in service. The examiner added that for people with chronic or recurrent pain, the initial episode or episodes were not necessarily related to the chronic condition. The examiner explained that although sprain or strain involves the muscles and ligaments (soft tissues) of the spinal region, spondylosis is a degenerative process involving the discs and vertebral bodies and one is not the cause of, or related to, the other. In August 2017 an examiner found the Veteran’ cervical spine (neck) disability was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. The examiner explained the DJD of the cervical spine is less likely than not incurred from a neck injury from football injury in 1980 during service, neck symptoms from any other clinical chronic disability, or secondary to his service in Southwest Asia during the Persian Gulf War. The examiner indicated this was based on a review of medical records containing clinical notes of a singular event of neck injury in 1980 with negative X-ray for fracture and was able to continue his career without restriction or recurrence of neck issues. The examiner further noted, X-ray in 1980 did not show any DJD which is a sign of wear and tear from use over the years, not from an isolated and very remote event in the distant past. The Veteran asserts that the neck disability began during service and continued since service. The Veteran is competent to report neck pain during and since service, and the Board finds the history is credible and consistent with the medical records. However, although the Veteran is competent to report a history of neck pain during and since service, the Veteran is not competent to diagnose a chronic disability manifested by intermittent pain as opposed to distinct episodes of pain or even multiple episodes of acute disorder manifested by pain and other symptoms, and based on the absence of a diagnosis of until years after service and the VA examiners’ probative determinations that a current neck disability is not related to service, to include the reported episodes of neck symptoms, the Board finds the preponderance of the evidence establishes that no chronic neck disorder was present until more than one year after the Veteran’s discharge from service. Although the Veteran might believe that his neck disability is related to service, the probative medical evidence does not corroborate these assertions, and the record does not suggest the Veteran, who is a layperson, is competent to determine the cause of his neck disability. Thus, the Veteran’s lay opinion is less probative than the medical opinion against the claim. Following review of the evidence, the Board concludes the overall evidence of records fails to reveal a disability picture that links the Veteran’s claimed condition to military service as incurred or caused by or worsened by military service, to include as an undiagnosed illness. The preponderance of the evidence remains unfavorable. Initially, the Board finds the evidence shows that no chronic neck disability was present until many years after the Veteran’s discharge from service. Although the service treatment records reflect neck issue, examination was normal at separation, and the medical records, to include the retirement examination record, do not reveal any subsequent history of neck pain many years after service. The Board finds when taken in aggregate the VA examinations in 2010, 2014, and 2017 show that the Veteran’s neck disability was not related to service, to include the in-service complaints, treatment or an undiagnosed illness. The Boards also notes there is no probative medical opinion of record linking a neck disability to service. Although the Veteran might believe that his neck disability is related to service, the probative medical evidence does not corroborate these assertions, and the record does not suggest the Veteran, who is a layperson, is competent to determine the cause of his neck disability. In any event, the Veteran’s lay opinion is less probative than the medical opinion against the claim. Accordingly, the claim must be denied. In reaching this decision, the Board has considered the doctrine of reasonable doubt but has determined that it is not applicable to this claim because the preponderance of the evidence is against the claim. 3. Entitlement to service connection for a right shoulder disorder, to include as due to an undiagnosed illness. The Veteran asserts that the right shoulder disability, specifically the rotator cuff sprain that required surgery in 1998, began during service and continued since service, to include his service in the Southwest Asia theater of operations during the Persian Gulf War. A May 1977 treatment record reveals the Veteran’s history of right shoulder blade soreness for one week. He explained that he had discomfort when he flexed his neck. Examination was essentially negative, and the Veteran was assessed with muscle strain. A January 1978 radiographic record suggests a history of injury of the right upper arm while playing football. Radiographic imaging of the right humerus revealed no fracture. The Veteran was assessed with contusion. January 1981 treatment records reveal treatment for left shoulder pain after a skiing injury. The diagnoses included questionable left rotator cuff tear. A July 1981 treatment record indicates that the Veteran requested clearance to play football because he had a neck injury nine months earlier. The record of a subsequent July 1981 physical for football indicates that examination was “essential normal” and the Veteran was cleared to play football. A March 1992 examination record reveals normal clinical findings for the upper extremities, spine, and neck. A June 1992 treatment record reveals the Veteran’s history of right shoulder pain. He explained that he injured the rotator cuff approximately eight years earlier and then reinjured it the previous night playing softball. He explained that he noticed a popping sensation the previous night. The Veteran was diagnosed with impingement syndrome. He was put on profile for eight days. A January 1996 treatment record reveals the Veteran’s history of injuring the right shoulder the previous day playing sports. He reported right shoulder pain with motion. There was no skin damage, swelling, or erythema, and the Veteran could move the arm and fingers “ok.” He was noted to raise the shoulder “with some difficulty,” and the shoulder felt stiff. The Veteran was told to take a pain reliever and to report to sick call in the morning for assessment. The follow-up record reveals the Veteran’s history of pain at the top of the shoulder since falling on the shoulder two days earlier. There was no loss of function, swelling, weakness, or evidence of fracture. There was obvious discomfort and motion was reduced secondary to pain, though the Veteran was still able to reach overhead. The Veteran was diagnosed with right shoulder sprain. A January 1996 physical therapy record reveals a provisional diagnosis of questionable acromioclavicular injury. The record indicates that the Veteran reported a history of right shoulder pain for several years with recent injury. He denied dislocation but reported a questionable rotator cuff injury in 1983. After examination, the Veteran was diagnosed with Grade 1 acromioclavicular separation. A follow-up physical therapy record indicates that the condition had resolved. A September 1996 retirement examination record reveals the Veteran’s history of “painful or ‘trick’ shoulder or elbow.” He also reported a history of a head injury. He did not indicate whether there was recurrent back pain. He explained that he was injured in a car accident and sporting incident, and that he sustained a laceration of the right eye because of the car accident and a cracked bone in the neck because of the sporting incident. Evaluation revealed normal clinical findings for all relevant systems, including the spine, neck, and upper extremities. In July 1998, the Veteran underwent arthroscopy of the shoulder with extensive surgical debridement to repair a ruptured supraspinatus tendon or musculotendinous cuff. The diagnosis code was sprain of rotator cuff. During his November 2008 VA examination, the Veteran reported incurring a small tear in the right shoulder at work in the 1980’s. He reported that he went to physical therapy at that time and that between the 1980’s and discharge, he tore it seven times. The Veteran reported continued discomfort in the right shoulder until undergoing surgery in 1998/1999. The examiner noted that the service treatment records revealed right shoulder strain in May 1977, complaints of pain and injury eight years earlier in 1992, and complaints of shoulder injury in January 1996. The examiner found the service medical records were negative for a diagnosis of rotator cuff tear. After examination, the Veteran was diagnosed with status-post right rotator cuff repair with persistent loss of range of motion. The examiner found no objective evidence of rotator cuff tear or suspicion of tear during service. The examiner further found that the acute episodes of strain and impingement showed no evidence of chronicity in service. The examiner determined the rotator cuff repair was not caused by or related to service. February 2009 medical records reveal histories of right shoulder and low back pain. The records reveal the Veteran’s history of chronic low back pain for several years. An MRI revealed multilevel spondylosis, endplate hypertrophy and bulge of the annulus and disc primarily involving L3-4 and L4-5. A March 2009 VA treatment record reveals the Veteran’s history of fracturing C-5 during service in a baseball game in 1981. He also reported experiencing low back pain later in Italy, for which he received treatment, and then later still having right shoulder injuries, with at least eight separate shoulder injuries. The May 2014 VA examination record also reveals the Veteran’s history of right shoulder problems since 1980, when he slid into first base and jammed his shoulder while playing softball. He reported that he was told he had a rotator cuff injury, for which he went through therapy. He indicated that approximately two years later, he had another injury and went through therapy again, and that in 1985 and 1991 and twice in 1996, he developed right shoulder problems again, requiring use of a sling and therapy. He denied limitation at the time of retirement and indicated that he developed a problem in 1998, when he had the shoulder “rebuilt.” The examiner diagnosed right shoulder rotator cuff tendinopathy, status-post rotator cuff repair, with mild degenerative joint disease of the right shoulder. The examiner noted that the Veteran experienced several events in service that were documented as limited right shoulder musculoskeletal events and that were found to be resolved without sequelae. The examiner further noted that the Veteran was determined to have a normal upper extremity at the separation examination and that the final physical therapy evaluation in January 1996 showed full range of motion and resolved condition. Finally, the examiner noted that the Veteran was ultimately operated on two years post service for a rotator cuff tear. The examiner indicated that “these are not events which wax and wane, with periods without symptoms; these events tend to present with ongoing and unremitting symptomatology.” Thus, the examiner determined it was less likely than not that the rotator cuff tear for which the Veteran underwent surgery in 1998 was present at discharge from military service. The examiner further determined the mild degenerative joint disease of the right shoulder was a condition of ageing, with no evidence supporting an association with musculoskeletal complaints in-service. The examiner reported consideration of the Veteran’s history of right shoulder problems after service. The examiner explained that pain was “simply not reliable as a diagnostic or prognostic indicator” because it “may represent a local condition or be the result of referred symptoms” and the “same local pain, subjectively, may represent many different and/or unrelated etiologies.” It was therefore the examiner’s opinion that the right shoulder rotator cuff tendinopathy, status-post rotator cuff repair, with mild degenerative joint disease of the right shoulder was less likely than not caused by, related to, or worsened beyond natural progression by military service or acute injury while in service. The August 2017 examiner opined the Veteran’s shoulder disability was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. The examiner explained the conditions DJD and s/p right shoulder surgery were less likely than not incurred from shoulder injury or from shoulder symptoms from any clinical chronic disability secondary to his service in Southwest Asia during the Persian Gulf War. The examiner found based on medical records containing sporadic clinical notes of unrelated shoulder injury in 1978 with negative X-ray for fracture, pain in 1992 with impingement with resolution, pain in 1996 with normal ROM and retirement physical in July 1996 of completely normal exam of shoulders that indicate the Veteran did not have a chronic right shoulder issue that would have prohibit him from continuing his career without restriction as well as the fact there was a 13 year gap from his last injury in the service to 2009 when an MRI showed abnormality of the right shoulder leading to surgery. Further, the allegation of prior surgery of the right shoulder in 1997/1998 is unsubstantiated due to loss of records in 2006 or misplaced records or etc., which this examiner was unable to verify. The Veteran asserts that the right shoulder disability, specifically the rotator cuff sprain that required surgery in 1998, began during service and continued since service. Although the Veteran is competent to report his symptoms including shoulder pain, the record does not suggest that he is competent to attribute his symptoms to a specific shoulder disability - namely degenerative joint disease or rotator cuff sprain. This is a determination that requires medical testing and evaluation, particularly because, as noted by the 2014 VA examiner, pain can be multifactorial and due to distinct conditions rather than one chronic condition. Thus, the Board finds the Veteran’s history of shoulder pain during and since service is not probative evidence of a chronic disability during service. Although the Veteran might believe that his right shoulder disability is related to service, the probative medical evidence does not corroborate these assertions, and the record does not suggest the Veteran, who is a layperson, is competent to determine the cause of his right shoulder disability. In any event, the Veteran’s lay opinion is less probative than the medical opinion against the claim. Following review of the evidence, the Board concludes the overall evidence of records fails to reveal a disability picture that links the Veteran’s claimed condition to military service as incurred or caused by or worsened by military service, to include as an undiagnosed illness. Initially, the Board the evidence shows that no chronic right shoulder disability was present until more than one year following the Veteran’s discharge from service. Although the service treatment records reflect right shoulder complaints and treatment on multiple occasions, the records indicate that the condition had resolved as of January 1996, and the separation examination showed normal clinical findings for the shoulder. Furthermore, when taken in aggregate the VA examinations in 2010, 2014, and 2017 show that the Veteran’s right shoulder disability was not related to service, to include the in-service complaints, treatment or an undiagnosed illness. The VA examiners, collectively, has provided probative opinions that a current right shoulder disability was not related to service, to include the in-service complaints, treatment, or illness. Additionally, there is no probative medical opinion of record linking the Veteran’s shoulder condition to service.   Accordingly, the claim must be denied. In reaching this decision, the Board has considered the doctrine of reasonable doubt but has determined that it is not applicable to this claim because the preponderance of the evidence is against the claim. L. M. BARNARD Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Whitley, Associate Counsel