Citation Nr: 21000345 Decision Date: 01/05/21 Archive Date: 01/05/21 DOCKET NO. 19-00 640 DATE: January 5, 2021 ORDER 1. Reopening of service connection for residuals of a tonsillectomy based on the receipt of new and material evidence is granted. 2. Service connection for residuals of a tonsillectomy is denied. 3. Service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), major depressive disorder, and an unspecified anxiety disorder, is denied. 4. Service connection for a lumbar spine disability is denied. 5. Service connection for a left hip disability is denied. FINDINGS OF FACT 1. A March 2013 rating decision denied service connection for residuals of a tonsillectomy due to the lack of a currently diagnosed disability. 2. The Veteran did not enter a timely Notice of Disagreement to the March 2013 rating decision to deny service connection for residuals of a tonsillectomy. 3. Evidence received since the March 2013 rating decision, including November 2013 private treatment records, pertains to the previously unestablished fact of a currently diagnosed disability. 4. The currently diagnosed laryngitis is unrelated to the tonsillectomy during service. 5. The Veteran does not have a current diagnosis of PTSD. 6. The Veteran has a current diagnosis of major depressive disorder in full remission and an unspecified anxiety disorder. 7. The Veteran did not experience an in-service event related to the major depressive disorder (in full remission) or the unspecified anxiety disorder. 8. The current diagnoses of major depressive disorder in full remission and an unspecified anxiety disorder did not have onset during service and are not otherwise related to service. 9. The Veteran has a current diagnosis of sacroiliac dysfunction of the lumbar spine. 10. The Veteran does not have a current diagnosis of arthritis of the lumbar spine. 11. The Veteran experienced back pain during active service. 12. The current diagnosis of sacroiliac dysfunction of the lumbar spine is unrelated to the back pain that the Veteran experienced during active service. 13. The sacroiliac dysfunction of the lumbar spine did not have onset during service and is not otherwise related to service. 14. The Veteran has a current diagnosis of left hip piriformis syndrome and a left hip strain. 15. The Veteran does not have a current diagnosis of arthritis of the left hip. 16. The Veteran did not experience an in-service left hip injury. 17. The current left hip injury did not have onset during service and is not otherwise related to service. CONCLUSIONS OF LAW 1. The March 2013 rating decision denying service connection for residuals of a tonsillectomy became final. 38 U.S.C. § 7105; 38 C.F.R. §§ 20.302, 20.1103. 2. Evidence received since the March 2013 rating decision is new and material to reopen service connection for residuals of a tonsillectomy. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 3. The criteria for service connection for residuals of a tonsillectomy have not been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303. 4. The criteria for service connection for an acquired psychiatric disorder, to include major depressive disorder and an unspecified anxiety disorder, have not been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303. 5. The criteria for service connection for a lumbar spine disability have not been met. 38 U.S.C. §§ 1101, 1112, 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 3.102, 3.303, 3.307, 3.309. 6. The criteria for service connection for a left hip disability have not been met. 38 U.S.C. §§ 1101, 1112, 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from March 2002 to March 2007. The Veteran did not request a Board of Veterans Appeals (Board) hearing on the December 2018 VA Form 9, Appeal to the Board. In August 2019, the Board denied reopening of service connection for residuals of a tonsillectomy, reopened and remanded the claim for service connection for an acquired psychiatric disorder to include PTSD, reopened and remanded the claim for service connection for a left hip disability, and remanded the claim for service connection for a low back disability. The issues were remanded where further development was required. Development has been completed, and these issues are again before the Board. In August 2020, the United States Court of Appeals for Veterans Claims adopted a joint motion for partial remand for the Board to provide an adequate statement of reasons and bases explaining whether new and material evidence had been received regarding the claim to reopen service connection for residuals of a tonsillectomy. The Board herein finds that new and material evidence has been received, and the claim for service connection for tonsillectomy residuals is reopened, and will be adjudicated on the merits. Reopening for 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 injury 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 injury and the current disability. Where the evidence shows a “chronic disease” such as arthritis in service (which the Veteran has alleged in this case) 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 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). The Veterans’ Claims Assistance Act of 2000 (VCAA) enhanced VA’s duty to notify and assist claimants in substantiating their claims for VA benefits. 38 U.S.C. §§ 5100, 5102, 5103, 5103A, 5107, 5126; 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a). The Board finds that in this case VA met the duties under the VCAA to notify and assist. In this case, neither the Veteran nor the representative has raised specific contentions regarding VCAA duties. 1. Reopening Service Connection for Residuals of a Tonsillectomy In this case, a March 2013 rating decision denied service connection for residuals of a tonsillectomy the grounds that there was no currently diagnosed disability. The Veteran did not file a timely Notice of Disagreement. As such, the March 2013 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 March 2013 rating decision denying service connection for residuals of a tonsillectomy, VA has received additional lay and medical evidence that pertains to a currently diagnosed disability. For example, November 2013 private treatment records show diagnoses of thrush of the mouth and esophagus, chronic laryngitis, and vocal cord dysfunction, which tends to show the presence of a current disability that could be related to residuals of a tonsillectomy, a fact not previously established at the time of the March 2013 rating decision. The credibility of new evidence is presumed for the purposes of reopening the claim. This evidence relates to the unestablished fact of a current residual disability so could reasonably substantiate the claim for service connection for residuals of a tonsillectomy. For this reason, the Board finds that the additional evidence is new and material to reopen service connection for residuals of a tonsillectomy. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). 2. Service Connection for Residuals of a Tonsillectomy The Veteran asserts that service connection is warranted for residuals of a tonsillectomy. See August 2020 Memorandum. Specifically, the Veteran asserts that she had a normal voice prior to a tonsillectomy, now has very aggressive laryngitis, and that she believes that the tonsillectomy caused the current laryngitis. See August 2020 Memorandum. The weight of the evidence shows that the identified current disorders are not residuals of the tonsillectomy. A January 2013 VA examination shows no current diagnosis of residuals of a tonsillectomy, while the weight of the evidence shows that other disorders of chronic laryngitis, thrush, and vocal cord dysfunction are not related to the tonsillectomy. The Board has carefully considered the November 2013 private treatment records, which show a chronic laryngitis, thrush, and vocal cord dysfunction. The Veteran reported a history of a tonsillectomy a few years earlier after which she completely lost her voice, and afterwards experienced very squeaky laryngitis. The private examiner noted that the Veteran was adamant about the fact, that prior to her tonsillectomy, her voice was completely normal, and that, after the tonsillectomy, her voice was distinctly abnormal. The physician recommended that the Veteran receive further evaluation for the possibility of recurrent laryngeal nerve/traumatic injury to the vocal cord based on the reported symptomatology. The Board has carefully considered this opinion by the private physician, but notes that it does not constitute a nexus opinion with any tendency to relate the disorders to service or the tonsillectomy. The assessment and plan offered by the physician was “thrush with chronic laryngitis after tonsillectomy,” and the recommendation was further evaluation to evaluate the possibility of laryngeal injury. The diagnosis of “chronic laryngitis after tonsillectomy” does not constitute a nexus opinion with any tendency to make a causative link between the tonsillectomy and laryngitis; rather, the statement simply asserts a chronological fact that the chronic laryngitis appeared after the tonsillectomy. The private examiner in November 2013 also wrote that he did not examine the vocal cords because he did not have the equipment to perform this examination. The private examiner noted the Veteran’s adamant assertion that her voice was completely normal prior to tonsillectomy and completely abnormal after the tonsillectomy; however, the Board does not find this assertion credible because it is inconsistent with and outweighed by other evidence of record. This evidence includes the fact that the Veteran first complained of hoarseness in April 2012, over six years after the tonsillectomy in 2005, when she ran out of albuterol inhaler. This medical history provided by the Veteran for treatment purposes that shows onset of symptoms in 2012 is more highly probative because it was made earlier in time and was made for treatment purposes. One would be expected to provide and accurate medical history when seeking treatment in order to receive efficacious medical care. The Board affords the statement of the November 2013 private examiner no probative value because it is based on factually inaccurate assumptions that the Board finds not to be credible, namely, that chronic laryngitis has existed since the tonsillectomy during service. The weight of the evidence shows that the Veteran did not experience chronic laryngitis ever since the tonsillectomy in 2005 during service. Regarding the question of whether the laryngitis is a residual of tonsillectomy, the private examiner in November 2013 reported the adamant assertion of the Veteran that the current hoarseness of voice was related to the tonsillectomy in service, but ultimately recommended further evaluation to check for an injury that may have caused the hoarseness of voice. The Board finds that the private examiner’s note of chronic laryngitis after tonsillectomy does not constitute a nexus opinion linking the chronic laryngitis to the tonsillectomy, but merely establishes that the laryngitis occurred years after the performance of the tonsillectomy. To the extent that the Veteran attempts to assert a nexus between the current hoarseness of voice and the tonsillectomy during service, the Board finds that, under the specific facts of this case that show laryngitis several years after the tonsillectomy, the Veteran is not competent to make this assertion. Determining the etiology of hoarseness of voice, especially when several diagnoses including sinusitis (as the Veteran has been shown to have), laryngitis, and asthma are present, is a complex medical question involving multiple possible etiologies that requires advanced medical knowledge and training to answer, which the Veteran has not been shown to possess. A February 2016 VA treatment record indicates that the Veteran was sniffling frequently, and that her voice sounded hoarse and “sinusy.” The medical provider documented the hoarseness of voice that the Veteran experienced, and wrote that the Veteran had diagnoses of sinusitis, environmental allergies, and asthma. This tends to show that, while the Veteran may experience hoarseness of voice and/or laryngitis, these conditions have been associated with sinusitis, environmental allergies, and asthma, rather than the tonsillectomy during service in 2005. The January 2013 VA examiner also considered the Veteran’s assertion that the chronic laryngitis was caused by the tonsillectomy, and opined that the chronic laryngitis and hoarseness of voice is less likely than not incurred in or caused by the in-service tonsillectomy. The VA examiner reasoned that a physical examination of the oral pharyngeal airway was normal, and mirrored function of vocal cords, and that the medical records available for review showed no documented complaints of “hoarseness” nor “voice breaking” after the tonsillectomy in 2005, citing a physical history taken in October 2006. The VA examiner wrote that, for the claimed condition of residuals of a tonsillectomy, there was no diagnosis because there was no pathology to render a diagnosis. The Board affords the opinion of the VA January 2013 VA examiner great probative weight, as the VA examiner examined the Veteran’s oral pharyngeal airway, reviewed the Veteran’s past medical history, considered the Veteran’s assertions, and offered an opinion supported by a well-reasoned rationale. As the preponderance of the evidence is against the claim for service connection for residuals of a tonsillectomy, the appeal must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 3. Service Connection for an Acquired Psychiatric Disorder The Veteran claims that she has a current diagnosis of PTSD that is related to active service. See November 2016 Notice of Disagreement. After a review of all the evidence of record, lay and medical, the Board finds that the Veteran has not been diagnosed with PTSD, but has been diagnosed with major depressive disorder, and an unspecified anxiety disorder. See November 2014 private examination. 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. An October 2006 Report of Medical History conducted a few months prior to separation from service shows that the Veteran answered “No” to the question “Have you ever had or have you now nervous trouble of any sort, depression, or excessive worry?” The Veteran indicated that she was in poor health at the time of this Report of Medical History and provided an extensive list of many other medical problems that she was experiencing at that time. This tends to show that the Veteran provided a complete medical history at the time of his Report of Medical History while specifically denying relevant psychiatric symptoms. A January 2020 VA examiner assessed that the Veteran did not have a current diagnosis of PTSD and had a current diagnosis of major depressive disorder that was in full remission. The VA examiner noted that the Veteran experiences worrying about health issues, but that this is normal worrying, as the Veteran does have multiple health concerns. The VA examiner opined that the current diagnosis of major depressive disorder in full remission was not related to service or anything reported to have occurred during service. The VA examiner was aware of the reports of an in-service event, and opined that no diagnosed mental disorder was due to any in-service event. A November 2014 private psychiatric examiner indicated diagnoses of major depressive disorder and an unspecified anxiety disorder. The private examiner wrote under the “Mental Health History” section of the examination that PTSD was previously diagnosed from one single psychological session in Missouri, but opined that the Veteran did not have a current diagnosis of PTSD. This reported history of a diagnosis of PTSD does not indicate that what criteria might have been used to renders such diagnosis. Additionally, the weight of the evidence shows that the same symptoms have been diagnosed as other disorders, and not PTSD. This private examiner November 2014 also did not opine that the current (non-PTSD) diagnoses were related to active service. The Board notes that no diagnosis of PTSD has been added to the record, and any history of a past diagnosis of PTSD is outweighed by other more thorough examinations that show the Veteran does not have PTSD. While the Veteran is competent to report events that happened in service and symptoms experienced at any time, she 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). While the Veteran has a current diagnosis of major depressive disorder in full remission and an unspecified anxiety disorder, the weight of the evidence is against a finding that the Veteran has a current diagnosis of PTSD. The Board also finds that the weight of the evidence is against a finding that the currently diagnosed major depressive disorder or unspecified anxiety disorder are related to service; indeed, there are no in-service events to which the current diagnoses could be related. For this reason, the Board finds that the preponderance of the evidence is against service connection for any psychiatric disorder, to include PTSD, major depressive disorder, or an unspecified anxiety disorder, and the claim for service connection must be denied. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 4. Service Connection for a Lumbar Spine Disability The Veteran asserts that service connection is warranted for a lumbar spine disability. Specifically, the Veteran asserts that the currently diagnosed sacroiliac dysfunction of the lumbar spine was caused by performing sit ups in basic training. See January 2020 VA examination. The evidence shows a currently diagnosed lumbar spine disability of sacroiliac dysfunction that was first diagnosed in March 2014. See January 2020 VA examination. The evidence does not show a diagnosis of arthritis of the lumbar spine. While the Veteran has included osteoarthritis of the lumbar spine in the claim for service connection for a lumbar spine disability, the evidence of record does not show a current diagnosis of osteoarthritis of the lumbar spine. A January 2020 VA examination report indicates that imaging studies of the thoracolumbar spine have been performed and that arthritis has not been documented. The Board has carefully considered a July 2016 assertion by the Veteran at a physical medicine rehabilitation consultation that x-rays were taken which show “arthritis in the lower back.” However, the Board does not find this statement credible, as it is inconsistent with and outweighed by other more probative evidence of record, including both an x-ray and an MRI taken in June 2016 and the December 2014 MRI (discussed below) – all of which do not show arthritis of the lumbar spine. The Board has also considered a March 2015 note made during a podiatry consultation that the Veteran experiences “alleged lower back arthritis.” The Board likewise affords this statement no probative value, as it is inconsistent with and outweighed by other more probative evidence of record, including the June 2016 x-ray and MRI and the December 2014 MRI, all which do not show arthritis of the lumbar spine. Regarding assertions of an in-service injury, an October 2006 Report of Medical History shows that the Veteran answered “Yes” to the question “Have you ever had or do you now have recurrent back pain or any back problem” and specified that she had experienced back pain associated with her hip, and that “doctors ‘believed’ it to be arthritis.” The Board notes that to date the Veteran has not been diagnosed with arthritis of the lumbar spine; rather, multiple imaging studies confirm the absence of arthritis of the lumbar spine. For example, June 2016 x-rays show that an MRI of the lumbosacral spine was negative, and that x-rays of the lumbsacral spine showed only mild disc space narrowing at the L5-S1 level. Further, a December 2014 MRI of the lumbar spine showed a normal lumbar spine, and a March 2014 VA treatment record shows that a March 2014 MRI of the lumbar spine was within normal limits, showing minimal discogenic disc changes and no cause for radicular pain. The Board has also considered a March 2015 Social Security Administration Examination report, which states that an MRI performed in March 2014 showed minimal discogenic degenerative changes in the spine, and a radiologic examination of the spine showed a normal bony lumbar spine. The Board has considered the statement that a March 2014 imaging study found minimal discogenic degenerative changes of the spine, but finds that this was a typographical error, as the March 2014 MRI report cited in the March 2014 VA treatment records states that the March 2014 MRI showed “minimal discogenic disk changes and no cause for radicular pain.” The Medical Dictionary of Health Terms published by Harvard Health Publishing and Harvard Medical School defines degenerative disk disease as “normal, sometimes painful, deteriorations in the disks of the spine that occur with age” (emphasis added). This same dictionary defines degenerative joint disease as “arthritis that occurs when the cartilage in joints breaks down over time, also called osteoarthritis” (emphasis added). The Board notes that degenerative disk disease does not affect the joints of the spine, but rather affects the disks of the spine, which are located near the joints of the spine, but are not joints themselves. The Board notes that “arthritis” is defined as inflammation of a joint. DORLAND’S ILLUSTRATED MEDICAL DICTIONARY 152 (31st ed. 2007). Degenerative joint disease (DJD) is arthritis, but it is distinguished from degenerative disc disease (DDD), which is not arthritis and therefore not a chronic condition. 38 C.F.R. §§ 3.307, 3.309(a). For these reasons, the Board finds that the Veteran does not have a current diagnosis of arthritis of the lumbar spine. The Board finds that the preponderance of the evidence is against a finding that a nexus exists between the current sacroiliac dysfunction and an in-service injury, disease, or event. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a), (d). While the October 2006 Report of Medical History at service separation shows that the Veteran reported experiencing back pain during service associated with the hip, it does not show that the Veteran experienced sacroiliac dysfunction of the lumbar spine during service, with which she is currently diagnosed, or that the Veteran experienced any lumbar spine injury or disease during service. The weight of the evidence shows that a current lumbar spine disability is not related to service. A January 2020 VA examiner opined that the current lumbar spine disability was less likely than not related to service. The VA examiner reasoned that during service the Veteran experienced only an acute back condition. The VA examiner further reasoned that there was no evidence of chronicity of care, and that the current lumbar spine disability was, therefore, not related to service. The evidence of record shows that, while the Veteran reported having experienced back pain associated with her hip at discharge from service, the Veteran did not again complain of or seek treatment for back pain until over six years after service, which was diagnosed as the current sacroiliac dysfunction of the lumbar spine. This tends to show that the currently diagnosed lumbar spine disability did not have onset during service and that symptoms were not continuous since service discharge. While the Veteran now asserts that the current sacroiliac dysfunction of the lumbar spine is related to service, she is a lay person and, while competent to relate symptoms that may be associated with sacroiliac dysfunction of the lumbar spine such as pain, under the facts of this case that include no in-service injury or disease and post-service onset of symptoms, she does not have the requisite medical knowledge, training, or experience to be able to opine as to the etiology of a medically complex orthopedic disorder such as sacroiliac dysfunction. Orthopedic disorders can require specialized testing to diagnose, and observable symptomatology can overlap with other disorders. Determining the etiology of orthopedic disorders such as disc disease and arthritis involves some internal and unseen system processes unobservable by the Veteran, not simply observation of observable symptoms such as pain, and requires specialized testing such as by X-rays. The Veteran has not been shown to have such knowledge, training, or experience. See Kahana v. Shinseki, 24 Vet. App. 428, 438 (2011) (holding that ACL injury is too “medically complex” for lay diagnosis); King v. Shinseki, 700 F.3d 1339, 1345 (Fed. Cir. 2009) (holding that it was not erroneous for the Board to find that a lay veteran claiming service connection for a back disorder and his wife lacked the “requisite medical training, expertise, or credentials needed to render a diagnosis” and that their testimony “could not establish medical causation nor was it a competent opinion as to medical causation”); Clyburn v. West, 12 Vet. App. 296, 301 (1999) (holding that a veteran is not competent to relate currently diagnosed chondromalacia patellae or degenerative joint disease to the continuous post-service knee symptoms); Savage v. Gober, 10 Vet. App. 488, 496-97 (1997) (requiring that a veteran present medical nexus evidence relating currently diagnosed arthritis to in-service back injury). To the extent that the Veteran now asserts that the current sacroiliac dysfunction of the lumbar spine had onset during service and has been continuous since service discharge, the Board finds this statement not credible because it is inconsistent with and outweighed by other evidence of record more contemporaneous with service. For example, the first complaints of back pain after discharge from service were in March 2014, when the Veteran was diagnosed with sacroiliac dysfunction, over six years after discharge from service. For these reasons, the Board finds that the preponderance of the evidence is against a finding that the current sacroiliac dysfunction of the lumbar spine had onset during service or is otherwise related to service, and that the criteria for service connection for sacroiliac dysfunction of the lumbar spine have not been met. As the preponderance of the evidence is against the claim, the appeal for service connection for a lumbar spine disability must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 5. Service Connection for a Left Hip Disability The Veteran asserts that service connection is warranted for a left hip disability. Specifically, the Veteran asserts that the current left hip piriformis syndrome was caused by performing physical training exercises during service. See January 2020 VA examination. The evidence shows a current diagnosis of left hip piriformis syndrome. See January 2020 VA examination. Regarding an in-service injury, the evidence of record, including service treatment records, does not reflect that the Veteran sustained a left hip injury during service. The October 2006 Report of Medical History at service separation shows that the Veteran specifically answered “No” to the question “Have you ever had or have you now swollen or painful joints or a bone, joint, or other deformity?” The Board has considered the fact that the Veteran wrote “Back pain associated with hip” on the October 2006 Report of Medical History but finds that this report does not constitute a documentation of an in-service injury to the left hip, in light of the fact that the Veteran complained of and sought treatment for a right hip disability, but not a left hip disability, during service on multiple occasions (for which service connection has been granted). March 2005 service treatment records show that the Veteran specifically reported a long history of pain in the right hip but did not similarly report pain in the left hip. The Board finds that the preponderance of the evidence is against finding that a nexus exists between the current left hip disability and an in-service injury, disease, or event. The evidence of record does not contain a competent medical opinion establishing a medical nexus between the current left hip disability and an injury, disease, or event during service, and the competent medical opinion that is of record weighs against finding such nexus. A January 2020 VA examiner opined that the current left hip disability was less likely than not related to service. The VA examiner reasoned that that there was no evidence of chronicity of care, and that the current left hip condition was not related to service. The VA examiner further reasoned that the separation examination did not indicate a left hip disability. An April 2017 VA examination shows a current diagnosis of a left hip strain with a leg length discrepancy. The VA examiner considered the Veteran’s statement that she had been diagnosed with degenerative joint disease and that her treatment required x-ray guided injections, but nevertheless assessed that the Veteran did not have a current diagnosis of arthritis of the left hip. The Veteran is a layperson, and has not been shown to possess the specialized medical knowledge or training to diagnose arthritis. Orthopedic disorders can require specialized testing to diagnose, and observable symptomatology can overlap with other disorders. Determining the etiology of orthopedic disorders involves some internal and unseen system processes unobservable by the Veteran, not simply observation of observable symptoms such as pain, and requires specialized testing such as by X-rays. The Veteran has not been shown to have such knowledge, training, or experience. The competent and credible evidence of record does not establish that the current left hip disability had onset during service. The Board has carefully considered the Veteran’s assertion on the June 2016 Application for Disability Compensation that while she was recently diagnosed with piriformis syndrome of the left hip, this condition has been present since service. The Board does not find this statement to be credible because it is inconsistent with and outweighed by other evidence of record that is more contemporaneous with service, including numerous medical records during service, which specifically document complaints of and treatment for right hip pain only and not left hip injury, disease, or even complaints or symptoms. See March 2005 service treatment records. For these reasons, the Board finds that the preponderance of the evidence is against a finding that the current left hip disability had onset during service or is otherwise related to service, and that the criteria for service connection for a left hip disability have not been met. As the preponderance of the evidence is against the claim, the appeal for service connection for a left hip disability must be denied. 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.