Citation Nr: 18159254 Decision Date: 12/18/18 Archive Date: 12/18/18 DOCKET NO. 17-23 295 DATE: December 18, 2018 ORDER Service connection for migraine headaches is granted. Service connection for bilateral lower extremity neuropathy involving the sciatic nerve is denied. Service connection for a cervical spine disability is denied. Service connection for an acquired psychiatric disability, to include depression, posttraumatic stress disorder (PTSD), anxiety, sleep disturbances, and memory loss, is denied. FINDINGS OF FACT 1. Migraine headaches were not noted on the January 1994 service enlistment examination report. 2. The evidence of record shows that the Veteran’s migraine headaches clearly and unmistakably preexisted service, but does not clearly and unmistakably establish that the in-service increase in symptoms was due to the natural progress of the disease. 3. The evidence does not demonstrate a current disability of the bilateral sciatic nerves. 4. Symptoms of cervical spine and psychiatric disabilities were not continuous or recurrent in service or since service separation; cervical spine arthritis did not manifest to a compensable degree within one year of active service; and there is no medical nexus between the claimed cervical spine or psychiatric disability and active service. CONCLUSIONS OF LAW 1. Resolving reasonable doubt in the Veteran’s favor, the pre-existing migraine headaches were aggravated by active service and the criteria for service connection are met. 38 U.S.C. §§ 101, 1101, 1110, 1153, 5103(a), 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.306. 2. The criteria for service connection for bilateral lower extremity neuropathy involving the sciatic nerve have not been met. 38 U.S.C. §§ 101, 1101, 1110, 5103(a), 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304. 3. The criteria for service connection for a cervical spine disability have not been met. 38 U.S.C. §§ 101, 1101, 1110, 1112, 1113, 5103(a), 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.307, 3.309. 4. The criteria for service connection for an acquired psychiatric disability have not been met. 38 U.S.C. §§ 101, 1101, 1110, 5103(a), 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran, who is the Appellant in this case, had active service from May 1994 to June 2004. This matter comes before the Board of Veterans’ Appeals (BVA or Board) from a March 2015 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Lincoln, Nebraska. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Establishing service connection generally requires (1) competent 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) competent evidence of a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). The United States Court of Appeals for Veterans Claims (Court) has held that “Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability. In the absence of proof of a present disability there can be no valid claim.” Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); see also Rabideau v. Derwinski, 2 Vet. App. 141, 143-44 (1992). Where a veteran who served for ninety days or more during a period of war (or during peacetime service after December 31, 1946) develops certain chronic diseases, such as arthritis, to a degree of 10 percent or more within one year from separation from service, such diseases may be presumed to have been incurred in service even though there is no evidence of such disease during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. See 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. In this case, the medical evidence of record demonstrates a current diagnosis of cervical spine arthritis. Where the veteran asserts entitlement to service connection for a chronic disease but there is insufficient evidence of a diagnosis in service, service connection may be established under 38 C.F.R. § 3.303(b) by demonstrating a continuity of symptomatology since service or diagnosis within the presumptive period after service, but only if the chronic disease is listed under 38 C.F.R. § 3.309(a). Walker v. Shinseki, 708 F.3d 1331, 1338-39 (Fed. Cir. 2013); 38 C.F.R. § 3.307 (service connection authorized for chronic diseases diagnosed within the presumptive period). However, for the reasons set forth below, the Veteran was not diagnosed with arthritis within one year of separation from service, nor has there been continuity of symptomatology. With specific regard to continuity of symptomatology, for the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. With chronic disease as such in service, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. If a condition, such as arthritis, noted during service is not shown to be chronic, then generally, a showing of continuity of symptoms after service is required for service connection. 38 C.F.R. § 3.303(b). The remaining conditions at issue are not among the “chronic diseases” listed under 38 C.F.R. § 3.309(a); therefore, 38 C.F.R. § 3.309(b) (requiring continuity of a condition after service if chronicity is not found in service) does not apply to those disorders. See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). 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). 1. Service connection for migraine headaches is granted. The Veteran contends that she began experiencing migraine headaches during active service, and that she has experienced them consistently since separation from active service. For the reasons discussed below, the Board finds that there is clear and unmistakable evidence that the Veteran’s migraine headaches preexisted active service, but that there is not clear and unmistakable evidence that the Veteran’s preexisting migraine headaches were not aggravated or permanently worsened by active service; rather, the evidence is at least in relative equipoise as to whether the preexisting migraine headaches were aggravated or permanently worsened by service. Reviewing the most relevant medical evidence of record, the January 1994 enlistment examination report is negative for any finding of migraine headaches, and the Veteran denied “frequent or severe headaches” on her Report of Medical History. In September 1994, the Veteran reported severe headache, congestion, nausea, and vomiting for two days. She stated that she had frequent migraines. In January 1996, the Veteran reported vertigo occurring two times in the past week. She reported a history of migraines since she was a little girl, but stated that she had not been diagnosed with migraines. She reported seeing dots and flashes. The diagnosis was rule out migraines with labyrinthitis. A December 1996 MEB examination report demonstrates that the Veteran indicated that she had frequent or severe headaches on the Report of Medical History. She explained that she had migraine headaches since childhood. In June 1997, her migraine medication was refilled. In April 1998, the Veteran reported a ten-year history of headaches, described as initial pressure in right temporal area progressing to pounding with nausea, vomiting, scotoma, and photophobia. She stated her headaches lasted between one and three days, and that they occurred three times per month. The diagnosis was migraines. In June 1998, the Veteran was treated in the emergency room for migraine headaches. She sought treatment for a migraine headache again in May 2000 and November 2001. In December 2003, the Veteran reported that she experienced headaches one to two times per month. Following separation from service, in April 2007, it was noted she had a history of migraines well-controlled with medication, and that she experienced them about once every other month. The Veteran sought treatment for a headache in April 2008, and again in October 2008. At the latter visit, she reported that she had headaches one to two times weekly. In November 2009, she stated her headaches had been more intense and frequent since May 2009, and were associated with the aura of flashes of light. She had headaches almost daily, with very intense headaches two to three times per week. In June 2012, the Veteran reported having three migraines per month but stated that they were increasing in frequency. The Veteran was afforded a VA examination to evaluate her headaches in July 2016. The VA examiner opined that her headaches were not related to active service, reasoning that she had experienced headaches since childhood and thus preexisted active service. The examiner did not provide an opinion as to whether her preexisting migraines were aggravated by active service. After a review of all the evidence of record, lay and medical, the Board finds that preexisting migraine headaches were not noted at entrance to service in May 1994. The Veteran specifically denied frequent or severe headaches at the January 1994 enlistment examination. Because migraine headaches were not “noted” at the January 1994 service enlistment examination, the Veteran is entitled to the presumption of soundness at service entrance. 38 U.S.C. § 1111. The Board further finds that the Veteran had migraine headaches that clearly and unmistakably preexisted service, as demonstrated by the January and December 1996 service treatment records showing that the Veteran reported experiencing headaches since childhood, and, in particular, the April 1998 service treatment record showing that she reported a ten-year history of migraine headaches, placing inception of the headaches prior to enlistment. Next, the Board finds that there is not clear and unmistakable evidence that the Veteran’s preexisting migraine headaches were not aggravated or permanently worsened by active service, and, in fact, that the evidence is at least in relative equipoise as to whether the preexisting migraine headaches were aggravated or permanently worsened by service. As discussed above, at the time of her enlistment examination in January 1994, she denied experiencing frequent or severe headaches, and there is no indication that she was taking medication for headaches at the time of her enlistment. Her service treatment records first show complaints of headaches in September 1994, and started taking medication for her migraine headaches at least by 1997. The Veteran has also stated that, prior to active service, her headaches were not as severe as those she experienced during active service; this is corroborated by the January 1996 service treatment record which indicates that she reported that, while she had experienced headaches prior to active service, she had not been diagnosed with migraine headaches prior to active service, suggesting an increase in severity. As noted above, the July 2016 VA examiner did not provide an opinion as to whether the Veteran’s preexisting migraine headaches were aggravated by active service, and there are no negative opinions of record, nor is there any other indication in the medical evidence of record that her migraine headaches were not aggravated by active service. In sum, in the absence of clear and unmistakable evidence that the Veteran’s preexisting migraine headaches were not aggravated by active service, and in light of the documentation of the in-service migraine headaches necessitating beginning regular use of medication, and post-service migraine headaches outlined above, the Board has resolved reasonable doubt in the Veteran’s favor and finds that her preexisting migraine headaches were aggravated by active service. 2. Service connection for bilateral lower extremity neuropathy involving the sciatic nerve, a cervical spine disability, and an acquired psychiatric disability is denied. The Veteran contends that she has a bilateral sciatic nerve disability in her lower extremities, a cervical spine disability, and a psychiatric disability (including depression, PTSD, and anxiety) that are related to active service. In her August 2015 notice of disagreement, the Veteran stated that her service-connected back disability caused her current sciatic nerve issues, which are manifested by severe pain in her legs. She stated that her current neck arthritis was caused by twelve years of rucking, heavy lifting, and physical training. Finally, she contended that her depression, PTSD, and anxiety were caused by years of unreported sexual harassment to avoid stigma; she did not report the harassment because she feared that she would lose her job and did not want to be labeled. In addition to the laws and regulations outlined above, service connection for PTSD requires: medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a) (conforming to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV)); a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor occurred. 38 C.F.R. § 3.304(f). If a claim for service connection for PTSD is based on allegations of in-service personal assault, evidence from sources other than a veteran’s service records may corroborate a veteran’s account of the stressor incident. Examples of such evidence include, but are not limited to: records from law enforcement authorities, rape crisis centers, mental health counseling centers, hospitals, or physicians; pregnancy tests or tests for sexually transmitted diseases; and statements from family members, roommates, fellow service members, or clergy. Evidence of behavior changes following the claimed assault is one type of relevant evidence that may be found in these sources. Examples of behavior changes that may constitute credible evidence of the stressor and such evidence include, but are not limited to: a request for a transfer to another military duty assignment; deterioration in work performance; substance abuse; episodes of depression, panic attacks, or anxiety without an identifiable cause; or unexplained economic or social behavior changes. 38 C.F.R. § 3.304(f)(5). The regulation specifically provides that VA will not deny a PTSD claim that is based on in-service personal assault without first advising the claimant that evidence from sources other than a veteran’s service records or evidence of behavior changes may constitute credible supporting evidence of the stressor and allowing him or her the opportunity to furnish this type of evidence or advise VA of potential sources of such evidence. VA may submit any evidence that it receives to an appropriate medical or mental health professional for an opinion as to whether it indicates that a personal assault occurred. 38 C.F.R. § 3.304(f)(5). For the reasons discussed below, the Board finds that the weight of the evidence demonstrates that there is no current sciatic nerve disability; and that the weight of the evidence is against a finding of a medical nexus between the current cervical spine disability and psychiatric disability and active service. Turning to the most relevant evidence of record, the January 1994 service enlistment examination report is negative for any signs, symptoms, or report of a sciatic nerve problem, neck problem, or psychiatric disability. The Veteran denied neuritis, depression or excessive worry, and nervous trouble of any sort on the Report of Medical History. In June 1994, the Veteran reported numbness in her toes for two weeks. Neurovascular examination was intact. She was told to return if needed. At the December 1996 MEB examination, she denied depression or excessive worry and nervous trouble of any sort. In January 1997, the Veteran reported back pain but denied any leg symptoms or radiation of pain. In March 1997, she received a Good Conduct Medal for exemplary behavior, efficiency, and fidelity for the period of service from May 1994 to May 1997. In June 1998, the Veteran reported back pain since she injured it in 1994. She also reported occasional leg pain and numbness bilaterally. Straight leg raising test was negative. The diagnosis was probable pinched nerve in the low back. In April 1999, the Veteran received an Army Commendation Medal for unique style, professional demeanor, and dedication to mission accomplishment for the period of service from April 1998 to April 1999. In May 1999, she reported that she had seriously considered suicide in the last year. She also reported depression “sometimes.” In March 2000, she received a second Good Conduct Medal for the period of service from May 1997 to May 2000. In September 2001, she received another Army Commendation Medal for the period of service from April 1999 to October 2001. In January 2003, the Veteran reported bilateral hand pain and weakness. A cervical spine x-ray study was ordered to evaluate for cervical spine pathology, but the study was normal. A February 2003 treatment note indicates that the final diagnosis was suspected thoracic outlet syndrome. In December 2003, she reported a stiff neck from wearing Kevlar and having Kevlar dropped on her head the day prior. It was noted that she had a history of chronic back and neck pain relieved with Naprosyn. The diagnosis was a neck spasm and she was prescribed Flexeril and referred to a chiropractor. At a chiropractic evaluation later that month, the Veteran reported neck pain and numbness in her left toes and left leg and buttocks. The numbness was constant while her low back pain was intermittent. Straight leg raising was positive bilaterally. The diagnosis was lumbago and cervicalgia. The Veteran continued chiropractic treatment for her neck and back until June 2004. Following separation from service, in July 2005, the Veteran denied any neck, neurological, or psychological symptoms. In August 2006, the Veteran involved in motor vehicle accident and reported neck pain. On examination, there was decreased range of motion secondary to pain. She was diagnosed with a neck strain. In January 2008, she reported back pain but denied limb weakness, tingling, burning sensation, and numbness. Straight leg raising test was negative. Sensory examination was intact. In April 2008, she denied neck and psychological symptoms. Physical examination revealed no cervical spine abnormalities, and neurological examination was normal. In June 2008, the Veteran sought treatment in the emergency room for severe neck pain after she felt a mild pinch several days prior while drying herself with a towel. The pain then increased in severity. She also reported numbness in her left hand. She came into the emergency room wearing a neck collar. On examination, there was no midline cervical tenderness. There was spasm and trigger point tenderness of the left trapezius. She was diagnosed with a cervical muscle spasm, and by the time of discharge, it was marked as resolved. A treatment note from several days later in June 2008 indicates that the Veteran went to the emergency room the day prior for neck pain and spasm. She reported that she had been sitting at work and when she got up at the end of the day, she felt like her neck locked up. Currently she reported neck stiffness. She was diagnosed with torticollis. Approximately one week later, a cervical spine x-ray study was normal, and she reported that her neck pain had resolved. In late June 2008, the Veteran reported low back pain but denied any leg symptoms. She denied any history of depression, and denied neck and psychological symptoms. Straight leg raising test was negative. In November 2009, the Veteran sought treatment for memory loss. She reported that she recently started noticing problems with short-term memory loss, but it is also affecting her long-term memory in that she sometimes forgets her family or friend’s name or face. She reported diffuse neck pain in May 2009. On physical examination, she had full painless range of motion of the neck. Sensation was intact. Psychiatric evaluation revealed appropriate judgment and insight, full orientation, normal recent and remote memory, and mood and affect were appropriate. No diagnosis was rendered as to the reported memory loss or neck. In October 2010, the Veteran reported insomnia since she returned from Afghanistan (she was deployed as a civilian). She had no problems with insomnia while deployed. She also reported neck tightness; she strained her neck when she turned her neck suddenly three weeks prior and experienced a jolt of “electricity” down her neck. She had been having neck tightness on and off since then. She stated she needed a chiropractic adjustment. On physical examination, the cervical spine had no tenderness to palpation and range of motion was normal; pain was not elicited by motion, and there was no laxity or weakness. Diagnosis was insomnia and neck pain with benign physical examination. In November 2010, the Veteran reported feeling on edge all the time. Diagnoses were insomnia and adjustment disorder with anxiety and was prescribed medication. In February 2011, she reported improvement in her anxiety levels with medication. An April 2011 depression screen was negative. In May 2011, the Veteran denied neck pain and had full range of motion. She denied any anxiety or depression. In June 2012, a depression screen was negative. The clinician noted no anxiety, no emotional lability, and no decreased functioning ability. On physical examination, there was no tenderness of the neck. In October 2012, the Veteran reported back pain with spasms that radiated down her legs. Straight leg raising test was negative. Sensation in the legs was intact. In February 2014, she reported numbness in her toes. Straight leg raising test was negative. A thorough sensory examination of the lower extremities was negative. In May and August 2014, depression screens were negative. In September 2014, a CT of the cervical spine was performed because the Veteran had been assaulted with injury to her neck and face. The scan revealed no evidence of acute cervical spine injury. There was straightening of the cervical spine which may be positional versus secondary to muscle spasm, and degenerative disc disease at C5-C6 with multilevel spondylosis of the cervical spine. In October 2014, the Veteran denied any leg weakness or numbness. Straight leg raising test was negative. There were no sensory abnormalities. In January 2015, the Veteran reported radicular pain radiating down the left buttock to her toes and occasional pain in her right buttock and posterior thigh. Sensory examination was normal. No diagnosis was rendered. In March 2015, the Veteran reported anger, a short temper, fatigue, decreased interest, crying, depressed mood, and guilt. She discussed the incident in September 2014 when her husband tried to kill her and committed suicide, and stated she relived that moment in the form of flashbacks. She reported anxiety if she saw a picture of a gun muzzle. She expressed distress and guilt that she could have prevented what occurred. The diagnosis was depression as a result of the trauma in September 2014 in which her husband tried to kill her. Referral was made for counseling. In June 2015, the Veteran reported feeling better with medication and it was noted that she was being seen monthly for counseling for depression. Mood was euthymic and affect was normal. At a July 2016 VA back examination, the Veteran reported severe intermittent pain in the left leg, and moderate paresthesias and numbness in the left leg. However, sensory examination of the lower extremities was normal. Straight leg raising test was negative. The examiner specifically stated there were no objective findings of radiculopathy on examination. At a July 2016 VA psychiatric examination, the Veteran reported physical abuse by her mother from age two to age sixteen. She reported being sexually abused by the mailman at the age of seven, and sexually abused by an uncle at age ten. She reported being married three times, with the third marriage ending in 2014 when her husband attempted to kill her and committed suicide. She reported that during active service, she experienced sexual harassment during basic training, tech school, and at every duty station she served at. She reported that she incurred some serious disciplinary sanctions during her time in the military, although this is not reflected in the evidence of record. When asked further about this, she stated she was served an Article 15 for being AWOL, but explained that this was an administrative error. She reported being reduced in range from E5 to E4. Following separation from service, she reported that her work performance as a police officer and current job in intelligence was excellent. She reported that she attempted suicide at the age of fourteen, but did not receive any mental health treatment. She stated that she first sought mental health treatment in 2014 after her husband tried to kill her and committed suicide. The examiner concluded that the stressors of physical abuse by her mother, sexual abuse as a child, and domestic violence incident in 2014 met Criterion A (stressor sufficient to support a diagnosis of PTSD), but that the sexual harassment she experienced during active service did not meet Criterion A. The VA examiner opined that the Veteran’s depression and PTSD were not related to active service. He stated that her depression was a product of multiple sexual trauma suffered in childhood and persistent physical abuse she suffered in childhood (mother). In addition, her persistent re-experience of trauma and related PTSD symptoms were almost exclusively tied to an attempted murder-suicide incident in 2014. Given the aforementioned, he opined that her depression was incurred in childhood and her current PTSD was caused by a 2014 attempted murder-suicide incident. In an October 2016 statement, the Veteran stated that the July 2016 VA psychiatric examiner spent too much time discussing her pre-service stressors and the 2014 incident, and not enough time on her military stressors. However, the Board notes that the report includes discussion of stressors in active service and that the examiner considered and addressed them in reaching his conclusions. In a June 2017 Statement in Support of Claim, the Veteran elaborated on her claimed stressors, stating that a fellow service member chased her around with his genitalia exposed until an officer showed up and he stopped. She reported multiple incidents of sexual harassment which she did not report for fear of reprisal. After a review of all the evidence of record, lay and medical, the Board finds that the weight of the evidence is against a finding that there is a current bilateral sciatic nerve disability, manifested by radiculopathy or neuropathy. The Board acknowledges several occasions during active service when the Veteran reported lower extremity numbness or pain – in June 1994, June 1998, and December 2003. However, neurological examination in 1994 and 1998 was normal. Moreover, these symptoms were not continuous or recurrent and appear to have resolved. For instance, in January 1997, the Veteran reported back pain but denied any leg symptoms or radiation of pain. Moreover, following the 1998 report of numbness in the lower extremities, there is no documentation of any additional leg symptoms until 2003. The Board notes that straight leg raising test was noted to be positive by the chiropractor at that time, but he did not render any diagnosis for the lower extremity symptoms. Moreover, following separation from service, there was no further report of or treatment for lower extremity symptoms until October 2012, when she reported back pain that radiated down her legs, and even then, straight leg raising test was negative and sensory examination was normal. Indeed, since service separation in 2004, neurological examination of the lower extremities has been consistently negative, as discussed above (see treatment notes from July 2005, January 2008, April 2008, June 2008, October 2009, October 2012, February 2014, October 2014, January 2015, and March 2015, and July 2016 VA back examination report). The Board also finds that the weight of the competent medical evidence of record is against a finding that there is a current disability of the sciatic nerves, to include radiculopathy. Namely, the 2016 VA back examiner’s finding that there is no objective evidence of neuropathy in the lower extremities is the most probative evidence, and there are no contrary medical opinions of record. The Board notes that in accordance with 38 C.F.R. § 4.71a, under the General Rating Formula for Diseases and Injuries of the Spine, note (1), it states to “[e]valuate any associated objective neurologic abnormalities . . . ” (Emphasis added). Regarding the Veteran’s statements that she has a current bilateral sciatic nerve disability manifested by radiculopathy or neuropathy, the Board recognizes that lay witnesses may, in some circumstances, opine on questions of diagnosis and etiology. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. Sept. 14, 2009) (Board’s categorical statement that “a valid medical opinion” was required to establish nexus, and that a layperson was “not competent” to provide testimony as to nexus because she was a layperson, conflicts with Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007)). However, while the Veteran is competent to provide her lay description of symptoms, she is not competent to diagnose or opine on medical etiology for complex medical questions requiring specific medical knowledge and training. See Rucker v. Brown, 10 Vet. App. 67, 74 (1997) (stating that a lay person is not competent to diagnose or make a competent nexus opinion about a disorder as complex as cancer). This case involves complex medical matters involving the neurological system. The question of whether a lower extremity neurological disability exists required objective medical evidence. Without a showing of a current disability, the claim for service connection must be denied. “Congress specifically limits entitlement to service-connected disease or injury where such cases have resulted in a disability... in the absence of a proof of present disability there can be no claim.” Brammer, 3 Vet. App. at 225. In Saunders v. Wilkie, No. 2017-1466 (Fed. Cir. Apr. 3, 2018) the Federal Circuit held that the term "disability" as used in 38 U.S.C. 1110 “refers to the functional impairment of earning capacity, not the underlying cause of said disability,” and held that “pain alone can serve as a functional impairment and therefore qualify as a disability.” In other words, where pain alone results in functional impairment, even if there is no identified underlying diagnosis, it can constitute a disability. The Federal Circuit did emphasize that they were not holding a veteran could demonstrate service connection "simply by asserting subjective pain.... To establish the presence of a disability, the veteran will need to show that her pain reaches the level of functional impairment of earning capacity.” In other words, subjective pain in and of itself will not establish a current disability. Consideration should be given to the impact, or lack thereof, from pain, focusing on evidence of functional limitation caused by pain. In this case, the Veteran was physically examined in August 2016, which revealed no objective evidence of neurological abnormality of the lower extremities or functional impairment thereof. It is reiterated that reflexes and sensory exam were normal, and leg raise testing was negative. While the Veteran’s radiculopathy complaints were reported, there was no objective exam findings to support the reported radiculopathy. For these reasons, there is no current lower extremity disability, to include sciatic nerve disability, radiculopathy, or neuropathy. As such the Board does not reach the additional question of the relationship between the claimed disability and active service or a service-connected disability. Turning to the claimed cervical spine and psychiatric disabilities, the Board finds that the preponderance of the evidence demonstrates that symptoms of the claimed cervical spine and psychiatric disabilities were not continuous or recurrent in service. As noted above, the service treatment records show a single report of depression in 1999, with no further documentation of psychiatric symptoms in active service. The service treatment records also show a diagnosis of a neck spasm in December 2003, with chiropractic treatment until service separation in June 2004. However, following service separation, in July 2005, the Veteran denied any neck symptoms. Thus, the weight of the evidence shows that the psychiatric symptoms were not continuous or recurrent in active service, and the cervical spine symptoms had resolved at least by July 2005. Next, the preponderance of the evidence demonstrates that cervical spine arthritis did not manifest to a compensable degree within one year of service separation. The preponderance of the evidence demonstrates no arthritis symptoms during the one-year period after service, and no diagnosis or findings of arthritis of any severity during the one-year post-service presumptive period. Indeed, the evidence does not demonstrate a diagnosis of cervical spine arthritis until 2014. For these reasons, the Board finds that arthritis did not manifest to a compensable degree within one year of service separation; therefore, the presumptive provisions for arthritis are not applicable in this case. 38 C.F.R. §§ 3.307, 3.309. The Board next finds that the preponderance of the evidence demonstrates that symptoms of the cervical spine and psychiatric disabilities have not been continuous or recurrent since separation from active service in June 2004. Following separation from service in June 2004, the evidence of record does not show any complaints, diagnosis, or treatment for the claimed cervical spine disability until August 2006, as described above, following a motor vehicle accident. With regard to the psychiatric disability, the first documentation of reported symptoms was in November 2010. The absence of post-service complaints, findings, diagnosis, or treatment for the claimed disabilities for 2 and 6 years, respectively, after service separation until 2006 and 2010 is one factor that tends to weigh against a finding of continuous or recurrent symptoms of the claimed disabilities after service separation. See Buchanan v. Nicholson, 451 F.3d 1331, 1336 (Fed. Cir. 2006) (the lack of contemporaneous medical records is one fact the Board can consider and weigh against the other evidence, although the lack of such medical records does not, in and of itself, render the lay evidence not credible). Additional evidence demonstrating that symptoms of the claimed cervical spine and psychiatric disabilities have not been continuous or recurrent since service separation includes the July 2005 treatment note indicating that the Veteran denied any neck symptoms, as described above, and the report of neck pain in August 2006 following a post-service motor vehicle accident. In addition, she denied neck and psychological symptoms in April 2008. She next sought treatment for neck pain June 2008, following another post-service injury. She denied neck symptoms later that month, and again denied psychological symptoms. Psychiatric evaluation was normal in November 2009. She sought treatment for neck pain in October 2010 following a third post-service neck injury. These records provide highly probative evidence that she had not experienced symptoms of a cervical spine or psychiatric disability continuously since active service, and that she had multiple post-service injuries to her neck. With regard to the Veteran’s recent assertions made in the context of the current disability claim of continuous or recurrent symptoms of the claimed disabilities since service, the Board finds that these more recent assertions are outweighed by the other, more contemporaneous, lay and medical evidence of record, both in service and after service, and are not reliable. See Charles v. Principi, 16 Vet. App. 370 (2002). The Board finds that the Veteran’s assertions of continuous or recurrent symptoms of the claimed disabilities after service are not accurate because they are outweighed by other evidence of record that includes the more contemporaneous service treatment records, which show a single report of depression that resolved prior to separation, and a neck spasm that resolved shortly after service separation; the multiple post-service treatment records outlined above showing denial of cervical spine and psychological symptoms, and multiple post-service neck injuries; and the lack of any documentation of reports or treatment for the cervical spine disability until 2006, 2 years after service separation and following a motor vehicle accident, and for the psychiatric disability until 2010, 6 years after service separation. As such, the Board does not find that the evidence sufficiently supports continuous or recurrent symptoms of the claimed cervical spine and psychiatric disabilities since service so as to warrant a grant of service connection. Finally, the Board finds that the weight of the competent medical evidence weighs against a finding of a medical nexus between the current cervical spine and psychiatric disabilities and active service. In this regard, the Board finds that the July 2016 opinion of the VA psychiatric examiner, discussed above, is the most probative evidence of record. The VA opinion is competent and probative medical evidence because it is factually accurate and is supported by an adequate rationale. The VA examiner interviewed and examined the Veteran, was informed of the pertinent evidence, reviewed the Veteran’s claims file, and fully articulated the opinion in the report. There are no contrary competent medical opinions of record, and the VA examiner’s opinion is supported by the post-service treatment records, which show that the Veteran was diagnosed with depression secondary to the September 2014 domestic violence incident. Moreover, the medical evidence of record demonstrates that the Veteran had multiple post-service neck injuries which prompted her to seek treatment after service separation, and it does not otherwise suggest that there is an etiological relationship between the cervical spine disability and active service. The Board acknowledges the Veteran’s belief that her cervical spine and psychiatric disabilities are related to his active service. However, her statements alone do not establish a medical nexus. Indeed, while the Veteran is competent to provide evidence regarding matters that can be perceived by the senses, she is not shown to be competent to render medical opinions on questions of etiology. See Jandreau, 492 F.3d 1372; see also Barr v. Nicholson, 21 Vet. App. 303 (2007) (lay testimony is competent to establish the presence of observable symptomatology). As such, as a layperson, she is without the appropriate medical training and expertise to offer an opinion on a medical matter, including the diagnosis, etiology, or causation of a specific disability. The question of diagnosis and causation, in this case, involves complex medical issues that the Veteran is not competent to address. Jandreau. Based on the evidence of record, the weight of the competent evidence demonstrates no relationship between the Veteran’s cervical spine or psychiatric disability and her military service, including no credible evidence of continuous or recurrent symptoms of the claimed disabilities during active service, continuous or recurrent symptoms following service separation, or competent medical evidence establishing a link between the cervical spine or psychiatric disability and active service. Therefore, the Board finds that a preponderance of the lay and medical evidence that is of record weighs against the claim for service connection for the cervical spine and psychiatric disabilities, and outweighs the Veteran’s more recent contentions regarding in-service continuous or recurrent symptoms and continuous or recurrent post-service symptoms of the claimed disabilities. For these reasons, the claim must be denied. Because the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. JONATHAN B. KRAMER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. Sherrard, Counsel