Citation Nr: 20004281 Decision Date: 01/17/20 Archive Date: 01/17/20 DOCKET NO. 16-28 428 DATE: January 17, 2020 ORDER 1. Reopening of service connection for arthritis of the left shoulder and neck is granted. 2. Reopening of service connection for a left arm disability is granted. 3. Service connection for arthritis of the left shoulder and arthritis of the neck is denied. 4. Service connection for arthritis of the left hip is denied. 5. Service connection for a left arm disability is denied. 6. Service connection for a lung disability, to include as due to in-service exposure to asbestos, is denied. 7. Service connection for a psychiatric disorder, to include posttraumatic stress disorder (PTSD) and adjustment disorder with anxiety and depression, is denied. FINDINGS OF FACT 1. An October 2003 rating decision denied service connection for arthritis of the left shoulder and neck due to lack of a nexus between the disabilities and service. 2. The Veteran did not file a timely notice of disagreement to the October 2003 rating decision to deny service connection for arthritis of the left shoulder and neck, and no new and material evidence was received within one year of the rating decision. 3. Evidence received since the October 2003 rating decision, including VA treatment records dated November 2013, December 2014, and February 2015, pertain to the previously unestablished fact of an in-service injury to the Veteran’s left shoulder and neck. 4. The Veteran has arthritis of the left shoulder and neck. 5. The Veteran did not experience an in-service injury, disease, or event related to left shoulder or neck arthritis. 6. Symptoms of arthritis of the left shoulder and neck did not have onset during service, have not been continuous since service discharge, were not manifest to a degree of 10 percent within one year of service discharge, and arthritis is not otherwise related to service. 7. The Veteran has arthritis of the left hip. 8. The Veteran did not experience an in-service hip injury, disease, or event. 9. Symptoms of arthritis of the left hip did not have onset during service, have not been continuous since service discharge, were not manifest to a degree of 10 percent within one year of service discharge, and arthritis is not otherwise related to service. 10. A September 2009 Board decision denied service connection for left arm disability due to lack of an in-service injury and lack of a nexus between the current disability and service. 11. Evidence received since the September 2009 Board decision, including VA treatment records dated November 2013, December 2014, and February 2015, pertain to the previously unestablished fact of an in-service injury to the Veteran’s left arm. 12. The Veteran has pain and decreased sensation in the left arm. 13. The Veteran did not experience an in-service injury, disease, or event of the left arm. 14. A left arm disability did not have its onset during service and is not otherwise related to service. 15. The Veteran has a lung disability, including asbestosis, Chronic Obstructive Pulmonary Disease (COPD), and granulomas. 16. The Veteran was exposed to asbestos during service for a period of two years from May 1966 to May 1968. 17. The Veteran was exposed to asbestos over the course of several decades during civilian work after discharge from service. 18. The lung disability did not have onset during service and is not otherwise related to service, to include asbestos exposure during service. 19. The Veteran does not have a current diagnosis of PTSD. 20. The Veteran has a current diagnosis of adjustment disorder with anxiety and depression. 21. The Veteran did not experience an in-service injury, disease, or event to which his current psychiatric disorder is related. 22. The current psychiatric disorder did not have onset in service and is not otherwise related to service. CONCLUSIONS OF LAW 1. The October 2003 rating decision denying service connection for arthritis of the left shoulder and neck became final. 38 U.S.C. § 7105; 38 C.F.R. §§ 20.302, 20.1103. 2. Evidence received since the October 2003 rating decision is new and material to reopen service connection for arthritis of the left shoulder and neck. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 3. The criteria for service connection for arthritis of the left shoulder and neck have not been met. 38 U.S.C. §§ 1110, 1112, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309. 4. The criteria for service connection for arthritis of the left hip have not been met. 38 U.S.C. §§ 1110, 1112, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309. 5. The September 2009 Board decision denying service connection for a left arm disability was final when issued. 38 U.S.C. § 7104; 38 C.F.R. § 20.1100. 6. Evidence received since the September 2009 Board decision is new and material to reopen service connection for a left arm disability. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 7. The criteria for service connection for a left arm disability have not been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303. 8. The criteria for service connection for a lung disability, to include as due to in-service exposure to asbestos, have not been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303. 9. The criteria for service connection for a psychiatric disorder, to include PTSD and adjustment disorder with anxiety and depression, have not been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from May 1966 to May 1968. An October 2003 rating decision denied service connection for arthritis of the left shoulder and neck. In September 2009, the Board of Veterans’ Appeals (Board) denied service connection for residuals of a left arm disability. The Veteran did not appeal these decisions, and they became final. The Veteran declined a Board hearing in this case. The issues of service connection for a left hip disability and service connection for a lung disability are on appeal from September 2014 and March 2015 rating decisions which denied service connection for these disabilities, respectively. The issue of service connection for PTSD is on appeal from a June 2018 rating decision. Reopening with New and Material Evidence Legal Authority Generally, a claim which has been denied may not thereafter be reopened and allowed based on the same record. 38 U.S.C. § 7105. However, pursuant to 38 U.S.C. § 5108, if new and material evidence is presented or secured with respect to a claim which has been disallowed, the VA Secretary shall reopen the claim and review the former disposition of the claim. New evidence is defined as existing evidence not previously submitted to agency decision makers. Material evidence is defined as existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156 (a). In determining whether evidence is “new and material,” the credibility of the new evidence must be presumed. Justus v. Principi, 3 Vet. App. 510, 513 (1992). The threshold for determining whether new and material evidence raises a reasonable possibility of substantiating a claim is low. See Shade v. Shinseki, 24 Vet. App. 110, 117 (2010). Furthermore, in determining whether this low threshold is met, VA should not limit its consideration to whether the newly received evidence relates specifically to the reason why the claim was last denied, but instead should ask whether the evidence could reasonably substantiate the claim were the claim to be reopened, either by triggering the VA Secretary’s duty to assist or through consideration of an alternative theory of entitlement. Id. at 118. Regardless of the RO’s determination as to whether new and material evidence had been received, the Board must address the issue of the receipt of new and material evidence in the first instance because it determines the Board’s jurisdiction to reach the underlying claims and to adjudicate the claims de novo. See Woehlaert v. Nicholson, 21 Vet. App. 456, 460-61 (2007) (citing Barnett v. Brown, 83 F.3d 1380, 1383 (Fed. Cir. 1996)). If the Board determines that the evidence submitted is both new and material, it must reopen the case and evaluate the claim in light of all the evidence. Justus, 3 Vet. App. at 512. Such evidence is presumed to be credible for the purpose of determining whether the case should be reopened; once the case is reopened, the presumption as to credibility no longer applies. Id. at 513. Service Connection Legal Authority Service connection may be granted for a disability resulting from disease or disability incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may 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). Service connection generally requires (1) medical 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) medical evidence of a nexus between the claimed in service disease or disability and the current disability. The Veteran currently has arthritis which is a “chronic disease” under 38 C.F.R. § 3.309(a). Therefore, the presumptive provisions of 38 C.F.R. § 3.303(b) for “chronic” in-service symptoms and “continuous” post-service symptoms apply. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Where the evidence shows a “chronic disease” in service or “continuity of symptoms” after service, the disease shall be presumed to have been incurred in service. 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 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). Additionally, where a veteran served 90 days or more of active service, and certain chronic diseases, such as arthritis, become manifest to a degree of 10 percent or more within one year after the date of separation from such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. While the disease need not be diagnosed within the presumption period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. 38 C.F.R. §§ 3.307, 3.309(a). With any claim for service connection (under any theory of entitlement), it is necessary for a current disability to be present. See Brammer v. Derwinski, 3 Vet. App. 223 (1992); see also McClain v. Nicholson, 21 Vet. App. 319 (2007) (service connection may be warranted if there was a disability present at any point during the claim period, even if it is not currently present); Romanowsky v. Shinseki, 26 Vet. App. 289 (2013) (when the record contains a recent diagnosis of disability immediately prior to a veteran filing a claim for benefits based on that disability, the report of diagnosis is relevant evidence that the Board must address in determining whether a current disability existed at the time the claim was filed or during its pendency). Service connection for PTSD requires the following three elements: (1) a current medical diagnosis of PTSD (presumed to include the adequacy of the PTSD symptomatology and the sufficiency of a claimed in-service stressor in accordance with 38 C.F.R. § 4.125(a)), (2) credible supporting evidence that the claimed in-service stressor(s) actually occurred, and (3) medical evidence of a causal relationship between current symptomatology and the specific claimed in-service stressor(s). See 38 C.F.R. § 3.304(f). In adjudicating a claim for service connection for PTSD, the Board is required to evaluate evidence based on places, types, and circumstances of service, as shown by the veteran’s military records and all pertinent medical and lay evidence. Hayes v. Brown, 5 Vet. App. 60, 66 (1993); See also 38 U.S.C. § 1154(a); 38 C.F.R. § 3.304(f). If VA determines that the veteran engaged in combat with the enemy and that the alleged stressor is related to combat, then the veteran’s lay testimony or statements are accepted as conclusive evidence of the occurrence of the claimed stressor. 38 U.S.C. § 1154(b); 38 C.F.R. § 3.304(f). No further development or corroborative evidence is required, provided that the claimed stressor is “consistent with the circumstances, conditions, or hardships of the veteran’s service.” Id. If, however, VA determines that the veteran did not engage in combat with the enemy or that the alleged stressor is not related to combat, the veteran’s lay testimony by itself is not sufficient to establish the occurrence of the alleged stressor. Instead, the record must contain service records or other evidence to corroborate the veteran’s testimony or statements. See Moreau v. Brown, 9 Vet. App. 389, 394 (1996). If a stressor claimed by a veteran is related to the veteran’s fear of hostile military or terrorist activity and a VA psychiatrist or psychologist, or a psychiatrist or psychologist with whom VA has contracted, confirms that the claimed stressor is adequate to support a diagnosis of PTSD and that the veteran’s symptoms are related to the claimed stressor, in the absence of clear and convincing evidence to the contrary, and provided the claimed stressor is consistent with the places, types, and circumstances of the veteran’s service, the veteran’s lay testimony alone may establish the occurrence of the claimed in-service stressor. “Fear of hostile military or terrorist activity” means that a veteran experienced, witnessed, or was confronted with an event or circumstance that involved actual or threatened death or serious injury, or a threat to the physical integrity of the veteran or others, such as from an actual or potential improvised explosive device; vehicle-imbedded explosive device; incoming artillery, rocket, or mortar fire; grenade; small arms fire, including suspected sniper fire; or attack upon friendly military aircraft, and the veteran’s response to the event or circumstance involved a psychological or psycho physiological state of fear, helplessness, or horror. 38 C.F.R. § 3.304(f). If a veteran did not engage in combat with the enemy, or the claimed stressors are not related to combat, and the stressor is not related to “fear of hostile military or terrorist activity,” then the veteran’s testimony alone is not sufficient to establish the occurrence of the claimed stressors and his testimony must be corroborated by credible supporting evidence. Cohen v. Brown, 10 Vet. App. 128 (1997); Moreau v. Brown, 9 Vet. App. 389 (1996); Dizoglio v. Brown, 9 Vet. App. 163 (1996). Furthermore, service department records must support, and not contradict, the claimant’s testimony regarding non-combat stressors. Doran v. Brown, 6 Vet. App. 283 (1994). The question of whether a veteran was exposed to a stressor in service is a factual one, and VA adjudicators are not bound to accept uncorroborated accounts of stressors or medical opinions based upon such accounts. Wood v. Derwinski, 1 Vet. App. 190 (1991), aff’d on reconsideration, 1 Vet. App. 406 (1991). Hence, whether a stressor was of sufficient gravity to cause or support a diagnosis of PTSD is a question of fact for medical professionals and whether the evidence establishes the occurrence of stressors is a question of fact for adjudicators. The Veterans Claims Assistance Act of 2000 (VCAA) and implementing regulations impose obligations on the Department of Veterans Affairs (VA) to provide claimants with notice and assistance. 38 U.S.C. §§ 5102, 5103, 5103A, 5107, 5126 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.326(a). The Board finds that the duties to notify and assist have been met. Neither the Veteran nor the representative has raised contentions regarding notice or assistance. Accordingly, the duty to notify and assist will not be further addressed. 1. Reopening Service Connection for Arthritis of the Left Shoulder and Neck In this case, an October 2003 rating decision denied service connection for arthritis of the left shoulder and neck on the grounds that there was no in-service injury to the left shoulder or neck, arthritis of the left shoulder and neck did not have onset during service, symptoms had not been continuous since service discharge, symptoms did not manifest to a degree of 10 percent or more within one year of service discharge, and arthritis is not otherwise related to service. The Veteran did not file a timely Notice of Disagreement with this decision. As such, the October 2003 rating decision became final as to the evidence then of record, and is not subject to revision on the same factual basis. See 38 U.S.C. § 7105; 38 C.F.R. §§ 3.156(a), (b), 20.302, 20.1103. Since the October 2003 rating decision denying service connection for arthritis of the left shoulder and neck, VA has received additional lay and medical evidence that pertains to an in-service injury to the Veteran’s left shoulder and neck. For example, VA has received VA treatment records dated November 2013, December 2014, and February 2015, which tend to show that the Veteran experienced an injury to the left shoulder and neck during service, a fact not previously established at the time of the October 2003 rating decision. The credibility of new evidence is presumed for the purposes of reopening the claim. This new evidence relates to the unestablished fact of an in-service injury to the Veteran’s left arm, so could reasonably substantiate the issue of service connection for arthritis of the left shoulder and neck. For this reason, the Board finds that the additional evidence is new and material to reopen service connection for arthritis of the left shoulder and neck. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). 2. Reopening Service Connection for a Left Arm Disability In this case, a September 2009 Board decision denied service connection for a left arm disability the grounds that there was no in-service injury of the left arm, and there was no nexus between the current disability and service. The September 2009 Board decision was final when issued as to the evidence then of record, and is not subject to revision on the same factual basis. See 38 U.S.C. § 7104; 38 C.F.R. §§ 3.156(a), (b), 20.1100. Since the September 2009 Board decision denying service connection for a left arm disability, VA has received additional lay and medical evidence that pertains to an in-service injury to the Veteran’s left arm. For example, VA has received VA treatment records dated November 2013, December 2014, and February 2015, which tend to show an in-service injury to the Veteran’s left arm, a fact not previously established at the time of the September 2009 Board decision. The credibility of new evidence is presumed for the purposes of reopening the claim. This new evidence relates to the unestablished fact of in-service injury to the Veteran’s left arm and could reasonably substantiate the issue of service connection for a left arm disability. For this reason, the Board finds that the additional evidence is new and material to reopen service connection for a left arm disability. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). 3. & 4. Service Connection for Arthritis of the Left Shoulder, Arthritis of the Neck, and Arthritis of the Left Hip The Veteran asserts that the arthritis of his left shoulder, neck, and left hip is related to service. Specifically, in an August 2008 statement, the Veteran’s counsel asserted that the Veteran injured his left shoulder and neck while building a fence at Camp Pendleton, California, when he ended up hanging with all of his weight on his left wrist, arm, and left side of his neck in an accident while constructing a fence. The Veteran has also asserted generally that his arthritis of the left hip is related to service. At a December 2007 Board hearing, the Veteran testified that, while using equipment to build a fence during service, his left thumb got caught in the mechanism of a machine and the machine lifted him into the air by his left thumb. The Veteran testified that he was able to compensate by holding his body up by his right hand until someone disengaged the machine and released his hand, and he was subsequently treated for a dislocated thumb. The Veteran testified that at the time he thought that only his hand was injured as a result of the accident. The Veteran also testified that a car fell on the left side of his body in October 2001, many years after service discharge. The Veteran is currently diagnosed with arthritis of the neck, arthritis of the left shoulder, and arthritis of the left hip. Specifically, a November 2014 VA imaging report shows a diagnosis of degenerative intervertebral disc space narrowing of the cervical spine, mild acromioclavicular glenohumeral arthropathy of the left shoulder, and moderate degenerative change of the left hip. After a review of all the evidence of record, lay and medical, the Board finds that the weight of the evidence demonstrates that the current left shoulder, left hip, and neck arthritis were not caused by, or related to, an injury, event, or disease in service. Service treatment records do not contain any complaints of or treatment for shoulder, hip, or neck pain during service. The May 1968 Report of Medical Examination at separation from service shows a normal clinical evaluation of the Veteran’s neck, spine, and other musculoskeletal systems. A February 1968 treatment record shows that while the Veteran required reconstruction of the ulnar collateral ligament of the first metacarpophalangeal joint of the thumb, positive physical findings were confined to the left hand, and that the remainder of the physical examination was within normal limits. This tends to show that the Veteran’s current arthritis is not related to his left thumb injury during service. Moreover, the evidence does not demonstrate chronic symptoms of degenerative arthritis in the left shoulder, left hip, or neck during service or continuous symptoms of arthritis of the left shoulder, left hip, or neck since service separation. Service treatment records do not reflect any history of degenerative arthritis during service. The lay and medical evidence weighs against a finding that symptoms of arthritis were manifest to a degree of 10 percent or more within one year of service discharge. Rather, the evidence shows that symptoms of arthritis were not manifest until many years after service discharge, as discussed below. The lay and medical evidence also weighs against a finding of continuous symptoms of arthritis of the left shoulder, left hip, and neck since service separation; therefore, presumptive service connection under the provisions of 38 C.F.R. § 3.303(b) is not warranted based on either “chronic” in-service or “continuous” post-service symptoms, or symptoms manifest to 10 percent or more within one year of service discharge. As discussed above, neither the service treatment records nor the physical examination performed the month of service separation indicated any history, findings or diagnosis of degenerative arthritis in left shoulder, left hip, or neck. The first evidence of neck arthritis is in March 1997 progress notes, which shows an x-ray diagnosis of degenerative joint disease of the cervical spine. Thus, the first evidence and diagnosis of degenerative arthritis in the neck was not shown on x-ray until March 1997, over 20 years after service separation from service. A May 1999 pain management consultation note shows a history of arthritis and neck and back problems, but does not state whether any x-ray evidence was reviewed in reaching this determination. The first evidence of symptoms of a left shoulder disability is in November 2013 VA occupational therapy consultation notes, over 40 years after service discharge, wherein the Veteran reported an in-service injury in 1966 or 1967 when his left arm was caught and pulled by a rope. The Veteran described experiencing episodes of fluctuating paresthesia circumferential to his left hand and shoulder, along with sore neck muscles on the left side. A November 2014 VA imaging report shows a diagnosis of degenerative intervertebral disc space narrowing of the cervical spine, and mild acromioclavicular glenohumeral arthropathy of the left shoulder. Thus, the first evidence and diagnosis of degenerative arthritis in the left shoulder was not shown on x-ray until November 2013, over 40 years after service separation from service. The first evidence of symptoms of a left hip disability is in a November 2014 VA imaging report, which shows a diagnosis of moderate degenerative change of the left hip. A December 2014 rheumatology consultation report also shows that the Veteran reported osteomyelitis (a bone infection) of the left hip at age two and current crepitus in his left hip with pain and limitation of motion. Thus, the first evidence of symptoms of left hip arthritis were not shown until the November 2014 VA imaging report, over 40 years after service separation from service. The approximately 40 year period between service and the onset of degenerative arthritis in the left shoulder and left hip, and 20 year period for arthritis of the neck that is shown by the weight of both the lay and medical evidence, is a factor that weighs against a finding of in-service incurrence, including by continuous symptoms since service from which service incurrence could be presumed. See Buchanan v. Nicholson, 451 F.3d 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); see also Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (the passage of many years between discharge from active service and the medical documentation of a claimed disability is one factor to consider as evidence against a claim of service connection). The same evidence also shows that symptoms of degenerative arthritis of the left shoulder and neck did not manifest to a degree of 10 percent or more within one year of service separation; therefore, presumptive service connection under the provisions of 38 C.F.R. § 3.303(a) is not warranted. Specifically, the medical and lay evidence reflects that the Veteran was first diagnosed with degenerative arthritis of the left shoulder, left hip, and neck many years after service discharge. As degenerative arthritis did not manifest within one year of service separation, the criteria for manifestation of left shoulder, left hip, and neck arthritis in the form of degenerative arthritis to a compensable (i.e., at least 10 percent) degree within one year of service separation are not met. See 38 C.F.R. § 4.71a, Diagnostic Code 5003. On the question of direct nexus between the current left shoulder, left hip, and neck arthritis and service, the Board finds that the preponderance of the lay and medical evidence is against a finding that the currently diagnosed left shoulder, left hip, and neck arthritis are causally related to service. While the Board finds the Veteran competent to report left shoulder, left hip, and neck pain and symptoms during service, the weight of the evidence shows that symptoms of arthritis of the left shoulder, left hip, and neck began many years after service discharge, and that the Veteran was not diagnosed with or treated for neck arthritis, left shoulder arthritis, or left hip arthritis until after service in March 1997, November 2013, and November 2014, respectively. As discussed above, service treatment records do not reflect any complaints or treatment for left shoulder pain during service. Rather, the record shows that the Veteran experienced sudden pain upon injuring his left shoulder in November 1983 while doing overhead lifting, and subsequently sought treatment for left shoulder pain in November 1983, over 13 years after service discharge. See November 1983 Medical Treatment Record. A February 1968 treatment record shows that the Veteran required reconstruction of the ulnar collateral ligament of the first metacarpophalangeal joint of the thumb, but that positive physical findings were confined to the left hand, and that the remainder of the physical examination was within normal limits. This tends to show that the Veteran’s current left shoulder arthritis and neck arthritis are not related to his left thumb injury during service. Evidence supportive of the Veteran’s claim for service connection of left shoulder arthritis, neck arthritis, and a left arm disability includes February 2015 VA Physical Therapy Consultation notes which show “[left upper extremity] shoulder elevation limitation [history] since the military associate[d] to an injury in the left shoulder aspect, cervical left side” and “[history] of a left side shoulder and upper back injury at the military in the 66-67, SN,” a November 2013 VA Occupational Therapy Consultation which reflects the Veteran’s report of an old in-service injury in 1966 or 1967 when his left arm was caught and pulled by a rope and suffering from “episodes of fluc[t]uating paresthesia circumferential [left] hand to shoulder [and] ‘sore’ [left] neck muscles,” a December 2014 VA Rheumatology Consult which notes limitation of motion of the neck and chronic decreased sensation in the left upper extremity for more than 40 years after an accident, and a February 2015 VA Physical Therapy Consultation, which reflects that the Veteran had elevation limitation of the shoulder since the military. The Board finds that the more recent reports of an in-service injury to the Veteran’s arm, shoulder and neck as to symptoms in service and continuous symptoms since service are not credible because they are inconsistent with and outweighed by other more contemporaneous evidence of record. This contemporaneous evidence includes the normal clinical evaluation of the neck, spine, and musculoskeletal system at service discharge, as well as the November 1983 medical treatment record showing that the Veteran experienced sudden left shoulder pain after performing overhead lifting; therefore, the Board affords these reports that symptoms had onset during service no probative weight, as the Board finds that they were based upon inaccurate facts reported by the Veteran. Because the November 2013, December 2014, and February 2015 VA treatment records are based on the inaccurate factual assumptions of the Veteran’s left arm (not just his left thumb) being caught in a rope during service, they are afforded no probative value to show that the left shoulder arthritis or neck arthritis were caused by an in-service injury. In this case, the Board is not discounting the recent history of in-service injury and symptoms because of the source of the history, which includes from the Veteran, rather than treatment records; rather, the history of the in-service injury and symptoms is deemed inaccurate because it is inconsistent with, and outweighed by, other lay and medical evidence of record. It is the completeness and accuracy of that history that is important rather than the source of the history. See e.g., Kowalski v. Nicholson, 19 Vet. App. 171, 177 (2005) (holding that VA cannot reject a medical opinion simply because it is based on a history supplied by a veteran, but the strength of the opinion depends rather upon the accuracy of the facts asserted by the veteran). Based on the evidence of record, the weight of the competent and credible evidence demonstrates no relationship between the Veteran’s current left shoulder arthritis, left hip arthritis, or neck arthritis and active service. For these reasons, the Board finds that a preponderance of the evidence is against service connection for left shoulder, left hip, and neck arthritis on a direct, presumptive, or any other basis, and 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. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 5. Service Connection for a Left Arm Disability The Veteran asserts that his left arm disability is related to an injury during service. Specifically, in an August 2008 statement, the Veteran’s counsel asserted that the Veteran injured the left arm while building a fence at Camp Pendleton, California, when he ended up hanging with all of his weight on his left wrist, arm, and left side of his neck in an accident while constructing a fence. At a December 2007 Board hearing, the Veteran testified that, while using equipment to build a fence during service, his left thumb got caught in the mechanism of a machine that lifted him into the air by his thumb. The Veteran testified that he was able to compensate by holding his body up by his right hand until someone disengaged the machine and released his hand, and he was subsequently treated for a dislocated thumb. The Veteran testified that at the time he thought that only his hand was injured as a result of the accident. The Veteran also testified that a car fell on the left side of his body in October 2001, many years after service discharge. Regarding a current disability, the Board finds that the Veteran is currently diagnosed with pain and decreased sensation in the left upper extremity. See July 2000 private treatment record. See also August 2015 VA Rheumatology Outpatient Note. After a review of all the evidence, lay and medical, the Board finds that the weight of the evidence demonstrates no in-service injury, disease, or event to which a left arm disability can be related. A February 1968 treatment record shows that the Veteran required reconstruction of the ulnar collateral ligament of the first metacarpophalangeal joint of the thumb, but that positive physical findings were confined to the left hand, and that the remainder of the physical examination was within normal limits. This tends to show that the Veteran’s current left arm disability is not related to the left thumb injury during service. Service treatment records reflect no injury or disease to the left arm and the May 1968 Report of Medical Examination conducted at service discharge shows a normal clinical evaluation of the Veteran’s musculoskeletal system. The first report of treatment for a left arm disability was many years after service in November 1983, when the Veteran reported that he experienced sudden pain in his left arm while doing overhead lifting. See November 1983 Medical Treatment Record. A July 2000 private physician wrote that the Veteran reported having experienced left upper extremity pain and suffered a work-related injury during service many years prior. To the extent that the Veteran reported that he experienced a left arm injury during service, the Board does not find this reported assertion to be credible, as it is inconsistent with and outweighed by other more contemporaneous evidence of record, including the May 1968 Report of Medical Examination, which shows a normal clinical evaluation of the Veteran’s musculoskeletal system, and the February 1968 treatment record, which shows that findings of physical disability during service were confined to the left hand, and that the remainder of the physical examination was within normal limits. This tends to show that the Veteran’s current left shoulder arthritis and neck arthritis are not related to his left thumb injury during service. Further, the service treatment records show no complaints, symptoms, or diagnosis of a left arm injury during service. Thus, to the extent that the July 2000 physician reported that the Veteran experienced an injury to his left arm during service, the Board affords this report no probative weight, as it finds that this report was based on inaccurate facts reported by the Veteran and recorded by the physician in July 2000. A February 2003 VA examination report shows that the Veteran injured the left upper extremity in 1983 and again injured his left arm years after service in October 2001 when a car fell on the left side of his body. This tends to show that the Veteran’s current left arm disability is related to injuries that occurred many years after service discharge. The weight of the evidence shows that the Veteran did not experience a left arm injury during service, but rather experienced multiple injuries to the left arm many years after discharge from service, in November 1983, October 2001, and May 2017. A May 2019 VA Cardiology Outpatient Note shows that the Veteran was involved in a motorcycle accident in May 2017, over 40 years after service discharge, which resulted in denudation of the left arm. Thus, the weight of the evidence shows that the Veteran did not sustain an in-service injury, disease, or event to which the currentleft arm disability can be related. Rather, the weight of the evidence shows that the Veteran’s left arm disability first had onset in November 1983, over 10 years after service discharge, when he injured his left arm while performing overhead lifting. For this reason, the Board finds that the preponderance of the lay and medical evidence is against service connection for a left arm disability, and the claim must be denied. As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine does not apply. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 6. Service Connection for a Lung Disability The Veteran generally contends that a current lung disorder is the result of service. Specifically, in a June 2014 statement, the Veteran asserts that the current lung disorder is the result of asbestos exposure while repairing the brakes and engines of tanks during service. The Veteran reported that he blew out the engines and hoses of tanks with air and asbestos flew everywhere. The Board finds that the Veteran is currently diagnosed with bilateral pulmonary asbestosis, COPD, and granulomas. See May 2013 private treatment record. See also January 2017 VA examination. After a review of all the evidence, lay and medical, the Board finds that the weight of the evidence demonstrates that the currently diagnosed lung disorder did not have its onset in service, and is not a result of service, including asbestos exposure during service. Rather, the Board finds that the current diagnosis of bilateral pulmonary asbestosis is related to post-service exposure to asbestos while working as a machine tool and dye technician for approximately 33 years after service discharge. A July 1967 chest x-ray eight months prior to service discharge was negative for any abnormal findings, and the May 1968 Report of Medical Examination conducted at service discharge shows that the Veteran’s lungs and chest were evaluated to be clinically normal. This tends to show that the Veteran’s lung disability had onset after service. At an August 2014 VA Pulmonary Consultation, the Veteran reported that after service he was exposed to asbestos in civilian jobs. An April 2016 Care Coordination Home Telehealth Report shows that the Veteran had asbestos exposure for 35 years while working at TVA (his civilian employer). An October 2016 Statement in Support of Claim shows that the Veteran worked at TVA as a machine tool and dye maker for 33 years, wore protective equipment while working there, and felt that exposure to asbestos during service led to his current lung disability. A January 2014 Urology Outpatient Note shows the Veteran’s report that he had “come down with asbestosis from TVA employment for 33 years.” On an August 2014 VA Pulmonary Consultation Report, the physician wrote that pleuroparenchymal changes of the lungs likely represent residua of previous granulomatous process, but could represent some asbestos-related injury. A January 2017 VA examiner wrote that it is less likely than not that the Veteran’s current lung condition is related to service, as COPD that was found on current VA medical records is more likely than not a complication of the Veteran’s history of tobacco use disorder. A June 2018 chest computerized tomography (CT) scan showed multiple small benign-appearing nodules and calcified granulomas of the lungs. The Board has considered the statement on the December 2016 VA examination request that noted relevant evidence to include that the “Veteran’s personnel records received on 2/17/15 confirm probable exposure to asbestos while in service” and the fact that private records show an opinion of possible bilateral pulmonary asbestosis. Regarding this evidence, the Board finds that the Veteran was exposed to asbestos during active service and has a current diagnosis of asbestosis; however, the Board finds that the weight of the evidence, including the Veteran’s own reports for VA treatment purposes, show that the Veteran was exposed to asbestos during his civilian employment after service discharge for over 30 years, while he was exposed to asbestos during service for two years. The record shows that the Veteran was exposed to asbestos after service discharge for 28 years longer than his period of exposure during service. The record also shows that the Veteran’s lungs were evaluated to be clinically normal at service discharge along with a normal chest x-ray several months before service discharge. For these reasons, the Board finds that the lung disability, to include asbestosis, is not related to service, but rather is related to over 30 years of post-service exposure to asbestos. The Board has considered the Veteran’s assertion that the current lung disability is the result of asbestos exposure during service. As a lay person, the Veteran is competent to relate symptoms that may be associated with a lung disorder, such as reduced lung function; however, under the facts of this case that include no lung symptoms for many years after service, he does not have the requisite medical knowledge, training, or experience to be able to diagnose medically complex respiratory disorders. Respiratory disorders can require specialized testing to diagnose, and observable symptomatology can overlap with other disorders. Diagnosing respiratory disorders involves internal and unseen system processes unobservable by the Veteran, not simply observation of observable symptoms. The Veteran has not been shown to have such knowledge, training, or experience. Thus, even though the Veteran may have been exposed to asbestos during active service, the weight of the competent evidence shows that asbestos exposure during service is not the cause of the currently diagnosed lung disorder. Rather, the weight of the evidence shows that the Veteran’s current lung disability is related to over 30 years of asbestos exposure while working as a machine tool and dye maker after service discharge, rather than two years of exposure to asbestos during service. For these reasons, the Board finds that the weight of the evidence is against the claim for service connection for a lung disorder, to include as due to asbestos exposure, and the claim must be denied. As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine does not apply. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 7. Service Connection for a Psychiatric Disorder to include PTSD and Adjustment Disorder with Anxiety and Depression The Veteran claims that he has a current diagnosis of PTSD that is related to active service. See April 2018 Fully Developed Claim. At a June 2018 VA mental health treatment visit, the Veteran asserted that he gets anxious about his medical conditions, including an upcoming heart surgery and the spots on his lungs. After a review of all the lay and medical evidence of record, the Board finds that the Veteran has not been diagnosed with PTSD, but has been diagnosed with unspecified trauma, a stressor related disorder, and adjustment disorder with anxiety and depression. The Board has considered records from mental health treatment visits in March, April, May and June 2018, at which the Veteran expressed feeling depressed and anxious. The medical professional wrote that the Veteran had unspecified trauma and a stressor related disorder and an adjustment disorder with anxiety and depression. August, September, and December 2018 cardiac evaluation notes show no PTSD and no depression. The Board finds that the weight of the evidence is against a finding of an in-service injury, disease, or event related to the current psychiatric disorder. The Board has considered the assertions of the Veteran in a March 2018 VA mental health treatment note that while he did not serve in Vietnam, he had friends who were killed there, including one that he went to school with. The Veteran also reported that his step son was accidentally shot by his friend at his house in 2002, and that he was previously able to put this incident out of his head while working. These assertions tend to show that while the Veteran has experienced stressful and traumatic events to which his current psychiatric disorder may be related, these events did not occur during service. April 2006, October 2007 and October 2008 primary care notes state “No complaints of depression or anxiety.” A December 2009 cardiology note states “No depression.” The Veteran also received screenings for PTSD and depression in June 2010, and May, October, and November 2016, which were negative. This tends to show that the Veteran’s psychiatric disorder had onset many years after service discharge and is not related to service. The Board notes that no diagnosis of PTSD has been added to the record. While the Veteran is competent to report events that happened in service and symptoms that he experienced at any time, he is not competent to diagnose PTSD. See Young v. McDonald, 766 F.3d 1348, 1353 (Fed. Cir. 2014) (holding that “PTSD is not the type of medical condition that lay evidence... is competent and sufficient to identify”); Clemons v. Shinseki, 23 Vet. App. 1, 4-5 (2009) (holding that a claimant without medical expertise cannot be expected to precisely delineate the diagnosis of his mental illness). The Board finds that, while the Veteran has a current diagnosis of adjustment disorder with anxiety and depression, the weight of the evidence is against a finding of an in-service injury, disease, or event to which this psychiatric disorder may be related. The psychiatric disorder had onset many years after service and the Veteran reported that his feelings of anxiety and depression were related to specific medical problems for which he has not received service connection. For this reason, the Board finds that the preponderance of the evidence is against service connection for any psychiatric disorder, to include PTSD and adjustment disorder with anxiety and depression, and the claim must be denied. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. J. PARKER Veterans Law Judge Board of Veterans’ Appeals Department of Veterans Affairs A. Caruso, Attorney for the Board The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.