Citation Nr: 21001937 Decision Date: 01/12/21 Archive Date: 01/12/21 DOCKET NO. 16-43 027 DATE: January 12, 2021 ORDER Entitlement to service connection for an abdominal disability is denied. Entitlement to service connection for a right knee traumatic arthritis is granted. Entitlement to service connection for a left knee disability is granted. Entitlement to service connection for a right hip disability is granted. Entitlement to service connection for a left hip disability is granted. Entitlement to service connection for migraine headaches is denied. Entitlement to service connection for a vision disability, to include left eye ptosis and Horner’s Syndrome is denied. Entitlement to service connection for a right wrist disability, to include carpal tunnel syndrome (CTS) is denied. Entitlement to service connection for a left wrist disability, to include CTS is denied. Entitlement to service connection for allergies is denied. Entitlement to service connection for a gynecological disability, to include fibroids is denied. Entitlement to service connection for a right shoulder disability is denied. Entitlement to service connection for a left shoulder disability is denied. Entitlement to service connection for a skin disability of the face or feet is denied. Entitlement to service connection for a right hand disability is denied. Entitlement to service connection for a left hand disability is denied. Entitlement to service connection for a right foot disability is denied. Entitlement to service connection for a left foot disability is denied. Entitlement to service connection for a breast lump disability is denied. Entitlement to service connection for a back disability is denied. FINDINGS OF FACT 1. The Veteran does not have a current abdominal disability. 2. Right knee disability of arthritis (traumatic arthritis) has been related to marching and overuse in service by a competent medical source. 3. Left knee disability of arthritis (traumatic arthritis) has been related to marching and overuse in service by a competent medical source. 4. Right hip disability of arthritis (traumatic arthritis)has been related to marching and overuse in service by a competent medical source. 5. Left hip disability of arthritis (traumatic arthritis) has been related to marching and overuse in service by a competent medical source. 6. Right shoulder disability was not manifest in service and is not otherwise related to service. 7. Left shoulder disability was not manifest in service and is not otherwise related to service. 8. Right foot disability was not manifest in service and is not otherwise related to service. 9. Left foot disability was not manifest in service and is not otherwise related to service. 10. The Veteran’s back disability did not manifest in service and degenerative disc disease of the back did not manifest within one year of separation from a qualified period of service. The disability is not otherwise related to service. 11. The Veteran does not have migraines; acute intermittent tension headaches were not manifest in service and are not otherwise related to service. 12. A vision disability, to include left eye ptosis and Horner’s Syndrome was not manifest in service and the disorder is not related to service. 13. Allergies were not manifest in service and the disorder is not related to service. 14. A right wrist disability, to include CTS did not manifest in service and right CTS did not manifest within one year of separation from a qualified period of service. The disability is not otherwise related to service. 15. A left wrist disability, to include CTS did not manifest in service and right CTS did not manifest within one year of separation from a qualified period of service. The disability is not otherwise related to service. 16. Right hand disability was not manifest in service and is not otherwise related to service. 17. Left hand 5th finger fracture preexisted the Veteran’s active service and was noted on entrance to service in 1988. 18. There was no increase in the Veteran’s preexisting left hand 5th finger fracture during service; current left hand disability is unrelated to the fracture, was not manifest in service and is not otherwise related to service. 19. A skin disability of the face or feet was not manifest in service and is not otherwise related to service. 20. A breast lump disability was not manifest in service and is not otherwise related to service. 21. A gynecological disability, to include fibroids was not manifest in service and is not otherwise related to service. CONCLUSIONS OF LAW 1. The criteria for service connection for an abdominal disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. Right knee disability of traumatic arthritis was incurred in wartime service. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303. 3. Left knee disability of traumatic arthritis was incurred in wartime service. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303. 4. Right hip disability of traumatic arthritis was incurred in wartime service. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303. 5. Left hip disability of traumatic arthritis was incurred in wartime service. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303. 6. The criteria for service connection for right shoulder disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 7. The criteria for service connection for left shoulder disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 8. The criteria for service connection for right foot disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 9. The criteria for service connection for left foot disability are not met. 38 U.S.C. §§ 1110, 1131, 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 10. The criteria for service connection for a back disability are not met. 38 U.S.C. §§ 1101, 1110, 1131, 1112, 1113; 38 C.F.R. §§ 3.102, 3.303(a)-(b), (d), 3.307, 3.309(a). 11. The criteria for service connection for breast lump disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 12. The criteria for service connection for a gynecological disability to include fibroids are not met. 38 U.S.C. §§ 1110, 1131, 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 13. The criteria for service connection for a skin disability of the face or feet are not met. 38 U.S.C. §§ 1110, 1131, 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 14. The criteria for service connection for headaches to include migraines are not met. 38 U.S.C. §§ 1101, 1110, 1131, 1112, 1113; 38 C.F.R. §§ 3.102, 3.303(a)-(b), (d), 3.307, 3.309(a). 15. The criteria for service connection for allergies are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 16. The criteria for service connection for vision disability, to include left eye ptosis and Horner’s Syndrome are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 17. The criteria for service connection for a right wrist disability to include CTS are not met. 38 U.S.C. §§ 1101, 1110, 1131, 1112, 1113; 38 C.F.R. §§ 3.102, 3.303(a)-(b), (d), 3.307, 3.309(a). 18. The criteria for service connection for a left wrist disability to include CTS are not met. 38 U.S.C. §§ 1101, 1110, 1131, 1112, 1113; 38 C.F.R. §§ 3.102, 3.303(a)-(b), (d), 3.307, 3.309(a). 19. The criteria for service connection for a right hand disability are not met. 38 U.S.C. §§ 1110, 1131, 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 20. Preexisting left hand 5th finger fracture was not aggravated during service. The presumption of soundness at entry does not attach. 38 U.S.C. §§ 1110, 1111, 1131, 1153; 38 C.F.R. §§ 3.303, 3.304, 3.306. 21. The criteria for service connection for a left hand disability are not met. 38 U.S.C. §§ 1110, 1131, 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had service from November 29, 1988 to February 21, 1989 and from February 10, 1991 to May 22, 1991. See DD 214 reflecting honorable service with the Air Force – USAFR, with completion of initial active duty training (ACDUTRA) in February 1989 and DD 214 reflecting release from active duty due to demobilization, with honorable service, in May 1991. These matters come to the Board of Veterans’ Appeals (Board) on appeal from an August 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Philadelphia, Pennsylvania. The matters were remanded by the Board to the Agency of Original Jurisdiction (AOJ) in April 2018 for development to include obtaining treatment records and ordering some examinations. The matters have been returned to the Board. Service Connection Service connection may be established for disability resulting from personal injury suffered or disease contracted in the line of duty in the active military, naval, or air service or for aggravation of a preexisting injury suffered or disease contracted in line of duty. 38 U.S.C. § 1110 (wartime), 1131 (peacetime). In the context of Reserve or National Guard service, the term “active military, naval, or air service” includes active duty, any period of active duty for training (ACDUTRA) during which the individual concerned was disabled or died from a disease or injury incurred or aggravated in line of duty, and any period of inactive duty training (INACDUTRA) during which the individual concerned was disabled or died from an injury incurred or aggravated in line of duty. 38 U.S.C. § 101 (21), (24); see also 38 C.F.R. § 3.6. Diseases or injuries incurred or aggravated while performing ACDUTRA are eligible for service connection. 38 U.S.C. §§ 101 (24), 106, 1110. In other words, when a claim is based on a period of Reserve or National Guard service, it must be shown that the individual concerned became disabled (or died) as a result of a disease or injury incurred or aggravated in the line of duty on Reserve ACDUTRA/INACDUTRA or during Federalized National Guard service. In general, to establish a right to compensation for a present disability, a Veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service - the so-called “nexus” requirement. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009). Service connection may be granted for any disease initially diagnosed after service when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). For veterans who have served 90 days or more of active service during a war period or after December 31, 1946, certain chronic diseases such as arthritis and organic diseases of the nervous system will be presumed related to service if they were noted as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if continuity of the same symptomatology has existed since service, with no intervening cause. 38 U.S.C. §§ 1101, 1112, 1113, 1137; Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2012); Fountain v. McDonald, 27 Vet. App. 258 (2015); 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a). A Veteran is considered to have been in sound condition when examined, accepted and enrolled for service, except as to defects, infirmities, or disorders noted at entrance into service, or where clear and unmistakable evidence demonstrates that an injury or a disease existed before acceptance and enrollment and was not aggravated by such service. 38 U.S.C. § 1111; 38 C.F.R. § 3.304. The United States Court of Appeals for the Federal Circuit has distinguished between those cases in which the preexisting condition is noted upon entry into service, and those cases in which the preexistence of the condition must otherwise be established. Wagner v. Principi, 370 F.3d 1089, 1096 (Fed. Cir. 2004); Davis v. Principi, 276 F.3d 1341, 1345 (Fed. Cir. 2002); Horn v. Shinseki, 25 Vet. App. 231, 234 (2012); see also 38 U.S.C. § 1111. Regarding the existence of a preexisting condition, to be "noted" within the meaning of the presumption of soundness statute, the condition must be recorded in the entrance examination report. 38 C.F.R. § 3.304 (b); 38 U.S.C. § 1111. This presumption attaches only where there has been an induction examination in which the later complained-of disability was not detected. Bagby v. Derwinski, 1 Vet. App. 225, 227 (1991). A history of conditions existing prior to service recorded at the time of the entrance examination does not constitute a notation of such conditions for the purpose of establishing whether the Veteran was of sound condition at enlistment. 38 C.F.R. § 3.304 (b)(1). However, the recording of such a history during the entrance examination will be considered together with all other material evidence in determinations as to inception of the disability at issue. Id. If a pre-existing disability is noted upon entry into service, then the Veteran cannot bring a claim for service connection for that disability, only a claim for service-connected aggravation of that disability. In that case, 38 U.S.C. § 1153 applies and the burden falls on him, not VA, to establish aggravation. Wagner, 370 F.3d at 1096; Jensen v. Brown, 19 F.3d 1413 (Fed. Cir. 1994); 38 C.F.R. § 3.306. In evaluating a claim, the Board must determine the value of all evidence submitted, including lay and medical evidence. Buchanan v. Nicholson, 451 F.3d 1331, 1335 (2006). The evaluation of evidence generally involves a three-step inquiry. First, the Board must determine whether the evidence comes from a "competent" source. Competent lay evidence means any evidence not requiring that the proponent have specialized education, training, or experience. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159 (a); Layno v. Brown, 6 Vet. App. 465, 470 (1994). Lay evidence can also be competent and sufficient evidence of a diagnosis if (1) the medical issue is within the competence of a layperson, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Kahana v. Shinseki, 24 Vet. App. 428, 433 (2011); Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). If the evidence is competent, the Board must then determine if the evidence is credible, or worthy of belief. Barr v. Nicholson, 21 Vet. App. 303, 308 (2007). (observing that once evidence is determined to be competent, the Board must determine whether such evidence is also credible). After determining the competency and credibility of evidence, the Board must then weigh its probative value. In this regard, the Board may properly consider internal inconsistency, facial plausibility, and consistency with other evidence submitted on behalf of the claimant. Caluza v. Brown, 7 Vet. App. 498, 511-12 (1995). A claimant is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence. See 38 C.F.R. § 3.102. The preponderance of the evidence must be against the claim for benefits to be denied. See Alemany v. Brown, 9 Vet. App. 518 (1996). The Board notes that the Veteran has not been afforded VA examination in connection with the claims of service connection for abdominal disability, right and left hip, shoulder, feet disabilities, skin, breast, back and gynecological disabilities. VA’s duty to assist includes providing a medical examination or obtaining a medical opinion when one is necessary to render a decision on the claim. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). Development is considered necessary if the information and evidence of record does not contain sufficient competent medical evidence to decide the claim, but contains: (1) competent evidence of diagnosed disability or symptoms of disability, (2) establishes that the veteran had an event, injury or disease in service, or has a presumptive disease during the pertinent presumptive period, and (3) indicates that the claimed disability may be associated with the in-service event, injury, or disease, or with another service-connected disability. 38 C.F.R. § 3.159 (c) (4). The Board observes that there are no diagnoses pertaining to abdominal disability or symptoms of disability, and no evidence that the claimed disability may be related to any event in service or a service-connected disease or injury. Although there is competent evidence of diagnosed disability or symptoms of disability as to the other listed claims, there is no evidence that the claimed disabilities may be related to any event in service or a service-connected disease or injury. Service treatment records are negative and there is no evidence of disability for years following service, nor is there indication that the claimed disabilities may be associated with service. Therefore, no examination is required for any of these claims. The factual foundation to support the claims is not demonstrated. The Board thus finds that the evidence on file is adequate to render a decision on these claims. 1. Entitlement to service connection for an abdominal disability is denied. The preponderance of the evidence is against the claim; there is no current disability. The Veteran does not have an abdominal disability and has not had any such disability at any time during the pendency of the claim or recent to the filing of the claim. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); 38 C.F.R. § 3.303(a), (d). The record does not show any findings of abdominal disability in service. Service treatment records (STRs) include her August 1988 enlistment examination reflecting normal clinical evaluation of all systems to include the abdomen and viscera, as well as her April 1991 separation report of medical history wherein she reported excellent health, with denying all signs and symptoms to include frequent indigestions and stomach, liver or intestinal trouble. VA and non-VA post service treatment notes reflect no diagnosis or finding of abdominal disability. There were minimal abdominal pain complaints associated with a 2015 car accident and a 2012 uterine surgery, but these appear to have resolved as they are not indicated on a continued basis. The Veteran reports that an abdominal disability is related to service. There is no actual substantive argument. See, e.g., August 2016 substantive appeal, October 2015 NOD and December 2014 VA form 21-526. There is no competent evidence of current abdominal disability. Due to the absence of proof of a present disability, there is no valid claim for service connection. Congress has specifically limited entitlement to service connection to cases where such incidents have resulted in a disability at any point during the claim or appeal period. Brammer v. Derwinski, 3 Vet. App. 223 (1992). Here, we lack competent evidence of disease, injury and disability. To the extent that she urges abdominal disability since service, her assertion is considered not credible in light of the lack of indication of any such condition in the treatment record. We find negative medical record, in view of the many other current complaints and findings, probative as to the fact that she does not have abdominal disability. The preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine does not apply, and the claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 2. Entitlement to service connection for a right knee disability is granted. 3. Entitlement to service connection for a left knee disability is granted. 4. Entitlement to service connection for a right hip disability is granted. 5. Entitlement to service connection for a left hip disability is granted. The Veteran maintains that chronic bilateral knee and hip disability began when she was in service, due to marching in her estimation, and has been present since then. Here, there is current disability inasmuch as there is diagnosis of bilateral knee arthritis by T. M.-P., DO., of Penn Medicine, in May 2016, as well as a diagnosis of bilateral hip and knee arthritis in April 2018. Dr. M.-P.’s treatment records were obtained as directed in the Board remand. They show this osteopath is the Veteran’s treating doctor for bilateral knee problems, specifically arthritis of the knees, and hip pain. There are also complaints and findings in the VA treatment records during the appeal period. Dr. M.-P. opined in May 2016 that the Veteran’s knee arthritis is most likely due to overuse from prolonged marching in the military. In April 2018, Dr. M.-P. stated that the Veteran was under her care for bilateral knee and hip pain (osteoarthritis) more likely than not due to previous overuse related to her military duties (including marching on concrete grounds, intense exercise regimens, prolonged standing). However, there is also evidence against the claim. STRs are negative for knee problems and include the aforementioned denial of all symptoms at separation to include no arthritis or “trick” or locked knee at that time. The records from Penn Medicine showing arthritis of the knees dates from many years following service separation, in 2015. The Veteran submitted multiple pieces of medical literature in support of her theory that her knee and hip disorders are due to the physical rigors of her service. We conclude that the evidence is ultimately in equipoise as to whether the knee and hip conditions currently present, which were initially diagnosed after service, were incurred in service. 38 C.F.R. § 3.303 (d). There is no other medical opinion contrary to Dr. M.-P.’s opinions. The Board saw fit to only obtain this doctor’s treatment records on remand. We have reviewed these treatment records and cannot ultimately conclude that, in this case, the opinions lack merit. We of course note that the nexus opinion as to both the knees and hips is minimally supported but we reasonably infer the doctor’s meaning that there was overuse injury of the hips and knees causing current disability and accept that the rationale as adequate in this case. The evidence is evenly balanced based on the 2016 and 2018 favorable opinions in conjunction with the medical literature. Service connection for right and left knee disability and right and left hip disability is thus warranted. See 38 C.F.R. § 3.303(d). Since she had wartime and peacetime service, we will conclude the disorders are related to wartime service. This is the most favorable result for the Veteran. Since the disorders have been attributed to use and overuse, such is a traumatic process . The decision to not obtain a VA opinion rests with the AOJ. 6. Entitlement to service connection for a right shoulder disability is denied. 7. Entitlement to service connection for a left shoulder disability is denied. 8. Entitlement to service connection for a right foot disability is denied. 9. Entitlement to service connection for a left foot disability is denied. 10. Entitlement to service connection for a back disability is denied. 11. Entitlement to service connection for a gynecological disability, to include fibroids is denied. 12. Entitlement to service connection for a skin disability of the face or feet is denied. 13. Entitlement to service connection for a breast lump disability is denied. As to each of these claims, there is current disability. However, none of the conditions manifested in service or within a year of service separation. To the extent that presumptions for veterans who have served 90 days or more of active service may apply in cases of arthritis and degenerative disc disease and thus are for consideration with regard to the shoulder, back and feet claims, service connection is not warranted on a presumptive basis. Here, we note the negative STRs with the Veteran’s denial of problems with joints, legs, shoulder, back, feet, skin, tumor, growth, cyst, cancer and any ‘female disorder’ at separation. We also note the lack of treatment records for many years after service, to approximately January 1999 at the earliest. Lumbar spondylosis and degenerative changes were noted from December 2009. The question for the Board is thus whether the current shoulder, foot or back disability, skin disability, gynecological disability to include fibroids or breast lump disability, manifested in service or whether any such condition is otherwise related to service. We find for the following reasons that the preponderance of the evidence is against each of these claims on any such basis. First, we note again that there was nothing but denials of symptoms in service with regard to each of these conditions. VA and private treatment records dating from not prior to 1999 include foot pain since October 2002, bilateral shoulder pain since March 2001, breast mass dating from May 2011 and also from October 2011 with a negative mammogram after breast lump reported in October 2005, acne from April 2004, epidermal cyst from December 2011 and cyst on chest from March 1999 with rash related to perfume use, mastitis from July 2011, premenopausal menorrhagia from November 2013, leiomyoma from January 2013, tinea from April 2008, athlete’s foot from March 2005, uterine fibroids diagnosed in July 2009 with benign biopsy in 2010 and uterine artery embolization (UAE) in December 2012 and December 2013, bacterial vaginitis from February 2007 and galactorrhea from March 2006. She reported back pain after an automobile crash in September 2004 and also an accident in 2015. Lumbar spondylosis and degenerative changes are documented from December 2009. The preponderance of the evidence is against finding that a nexus exists between the Veteran’s shoulder, foot or low back disability, skin disability, gynecological disability to include fibroids or breast lump disability and any in-service event or injury. 38 U.S.C. §§ 1110, 1131; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303 (a), (d). Here, the Board notes that the conditions are first reported in the record years after service and have not been attributed by any competent evidence to service. 38 C.F.R. § 3.303. The Veteran’s report of pain and symptoms since service is vague and not credible in light of the denials of symptoms at separation and the lack of complaints or findings for many years following service. No health care provider has opined that any of these conditions was present since service or is otherwise related to service. The multi-year gap between discharge from active duty and the first evidence of problems is viewed as a factor weighing against the claims on a direct basis. See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). The medical literature submitted by the Veteran as to musculoskeletal injury and the rigors of service is informative yet, alone, not specific to this Veteran. It is not persuasive in view of the denial of symptoms at separation and lack of other competent evidence suggesting a connection between the conditions which first manifested years following service and this Veteran’s service. To the extent that the Veteran argues in support of these claims, her contentions pale in comparison to the negative medical record and the lack of any probative evidence suggesting a link between service and the current conditions. The preponderance of the evidence is against the claims, the benefit-of-the-doubt doctrine does not apply, and the claims of service connection for shoulder, foot and low back disability, skin disability, gynecological disability and breast lump disability must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 14. Entitlement to service connection for migraine headaches is denied. 15. Entitlement to service connection for a vision disability, to include left eye ptosis and Horner’s Syndrome is denied. 16. Entitlement to service connection for allergies is denied. There is current disability as to headache (but not migraines), vision and allergies as demonstrated in August/September 2020 VA examinations ordered by the Board in the prior remand. However, to the extent that the Veteran asserts these problems are related to a qualifying period of service, the documented record is contrary to this assertion and the preponderance of the evidence is against finding that service connection on any available basis is warranted. First, we note that the aforementioned reported history at the April 1991 service separation examination was negative as to migraines, vision disability and allergies. She denied frequent or severe headaches, eye trouble, nose trouble, frequent or chronic colds. She did not wear glasses and she had vision in both eyes. She stated she was in excellent health and on no medications. She did seek primary care treatment earlier that month for what was assessed as URI with sinusitis. Also, an earlier, February 1991, eye exam indicates Horner's Syndrome, myopia. At that time, she had complaints of blurred vision, occasional headaches, and squinting constantly. Of note there was no glaucoma and she denied sinus problems or hay fever/allergies. She was asked to return to the clinic with baby pictures to evaluate for ptosis, but there is record of that. She had one notation of being allergic to penicillin with no observed problem. Additionally, no private or VA treatment records, to include within a year of service separation, show any indication of these conditions for years following service. Indeed, there are no current migraines, only acute tension headaches. As such, we conclude that there were no migraines, or chronic conditions with respect to eye disorders present in service or for years following service. Service connection on a presumptive basis is not warranted. 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a). Moreover, the preponderance of the evidence is against finding that a nexus exists between the current eye disorder, headaches or allergies and an in-service injury or disease. 38 U.S.C. § 1110; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). As to migraines, the 2020 VA examiner found no migraines. Rather, the diagnosis was acute intermittent tension headaches with a date of diagnosis of 1991. The Veteran reported the onset of headaches while in service which she attributed to outdoor PT and exercise. The VA examiner found that the claimed condition of headaches, migraine, was less likely not (less than 50 percent probability) incurred in or caused by service. The examiner acknowledged that the Veteran claimed she has migraines due to working in an administrative position during service from November 29, 1988 to February 21, 1989 and from February 10, 1991 to May 22, 1991 but found no evidence of a headaches, migraine condition, during active service or at discharge from service in 1991. They also noted there is no record of treatment for headaches or migraine condition in 1992. They explained that headaches, migraines, is not diagnosed by record and no diagnosis is made for headaches, migraine. They noted that the August 2020 VA examination was objectively and physically normal. Symptoms were subjective only. The Veteran was diagnosed with Acute/Intermittent Tension Headache, not chronic. There is no evidence of chronicity of care. The examiner concluded that a nexus was not established. As to allergies, the August 2020 VA examiner diagnosed allergic rhinitis with a reported onset date of 2000. They concluded however that the allergic rhinitis was likely not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. They noted that she alleged to have allergic rhinitis during service from November 29, 1988 to February 21, 1989 and from February 10, 1991 to May 22, 1991. However, STR noted no evidence of allergic rhinitis during active service or at discharge from service in 1991. During service, the STR's note of an allergic reaction to medication in January 1989 was a one-time event that was acute and resolved and it is medically unrelated to current her diagnosis of allergic rhinitis. There is no record at the VA medical center for any medical treatment or medical records for the Veteran for allergic rhinitis in 1992. The Veteran's diagnosis of allergic rhinitis was documented in April 2000 VA treatment records. The Veteran was prescribed antihistamines for allergies in April 2000 through 2019. The examiner concluded that there is no evidence of chronicity of care and found that a nexus has not been established. As to eye disorder, the August 2020 VA examiner diagnosed left upper lid ptosis, secondary to Horner's Syndrome, dating from 2016. Onset was noted as mild ptosis and the current symptoms were ‘none’. They concluded that the current eye disability was less likely than not (less than 50 percent probability) incurred in or caused by service. It was noted that the Veteran was discharged in 1992 per her history. Symptoms of Horner's Syndrome apparently appeared between 2014 and 2016 per our conversation and previous exams. Horner's Syndrome is typically idiopathic. There does not appear to be any connection between her time in service and the presence of Horner's Syndrome. An updated opinion as to the eye in September 2020 included that the Veteran stated her roll in the service was to be in front of a computer daily. The examiner explained that looking at a computer does not cause a Horner's syndrome. Based on date of occurrence, it is less than 50% probability that the condition occurred or was caused by service. Further, the examiner stated that the Veteran left military in 1991 and her claim was made in 2015, 24 years later. Finally, there are no supporting documents to show condition was present prior to 2015. The Board notes that post-service treatment records are consistent with the history as assessed by the VA examiners. We conclude that the preponderance of the evidence is against finding that a nexus exists between the current disorders and an in-service injury or disease. 38 U.S.C. § 1110; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). Here, service treatment records reflect the aforementioned findings, but each examiner has provided well-supported conclusions that the current conditions are not related to service. No other medical evidence provides a nexus between the current tension headaches, allergy or eye condition and service. We note that she denied eye, headache and allergy-type problems at service separation and there is no treatment in the initial years following service. The medical opinion evidence is wholly against the claims. To the extent that she asserts these disorders have been present since service, the suggestion is inconsistent with the above-discussed record and not credible. There is no credible evidence linking the present allergic rhinitis, tension headaches or eye condition to an in-service disease or injury. The multi-year gap between discharge from active duty service in 1991 and evidence of the disorders years later is viewed as a factor weighing against the claims. Also, the examiners’ opinions clearly explain why, medically, there is no relationship between current eye, headache or allergy issues and service. The opinions of the VA examiners are uncontroverted by any other medical opinion. Consequently, the Board gives more probative weight to the competent medical evidence, which shows that these disorders first manifested years after service. There is no significantly probative evidence that any of these three current conditions is otherwise related to service, and the weight of the evidence is against so concluding. 38 C.F.R. § 3.303 (d). The 2020 VA opinions are highly probative, because they are based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The opinions are not supportive of the claims. While Veteran believes current eye and headache disorders and allergies are related to service, and is competent to report pain and such symptoms, the medical evidence identifying no disorder for years following service is far more extensive, reliable and credible than statements from a lay informant. We note that the article she submitted on prolonged computer use affecting the eyes is not specific to this Veteran. Indeed, the VA examiner considered this theory and explained why it was not sufficiently persuasive in this case. It is outweighed by the medical opinion as to etiology in this case. The preponderance of the evidence weighs against finding that any current headache disorder, eye disability or allergy occurred in or is otherwise related to service. There is no reasonable doubt to resolve. 17. Entitlement to service connection for a right wrist disability, to include carpal tunnel syndrome (CTS) is denied. 18. Entitlement to service connection for a left wrist disability, to include CTS is denied. 19. Entitlement to service connection for a right hand disability is denied. 20. Entitlement to service connection for a left hand disability is denied. The Veteran urges that she has hand and wrist problems that are related to overuse in service while working with computers and during excessive PT training. However, the preponderance of the evidence is against her theory as to each current disability. VA hand examination in August 2020 reflects that she claims bilateral hand pain, right thumb index and ring finger, left index and ring finger. Current diagnoses include right trigger finger, diagnosed 2014-2017, ganglion cyst right side, diagnosed in September 2010, and left hand contusion, diagnosed in April 1991. Corresponding wrist examination reflects the ganglion cyst diagnosed in December 2015, right wrist degenerative arthritis, diagnosed in December 2014, and left CTS, diagnosed in January 2009. Thus, there are current disabilities of the hands and wrists. We note that at enlistment she reported having broken her pinky finger at age 10. At her enlistment physical examination in August 1988, fracture of the fifth phalanx, left hand, was noted. The upper extremities were normal bilaterally on clinical evaluation. In early April 1991 she sought treatment after she hit her left hand on a table. The assessment was contusion left hand. Later that month, at separation, she reported no arthritis, bone or joint deformity or loss of finger. At her April 2020 VA hand examination, she reported that increased pain to bilateral hands and fingers began at McGuire AFB with pain shooting up the forearms. Veteran stated she was diagnosed with right thumb trigger finger in 1992 at VA and advised with a treatment plan to include possible surgery. Veteran stated she had an EMG at VA in the 1990’s and has had treatment at VA since 1992. She reported worsening since 2015 with pain in the fingers and hands due upon lifting objects, dropping things and a decreased range of motion where she cannot button clothing or zip a garment. She complained of left index and ring finger and right thumb, index, and ring finger loss of function. She denied any related decompensation or service connection contention to the left pinky finger of the left hand. The VA examiner opined that all of these conditions were less likely than not (less than 50 percent probability) incurred in or caused by service. The examiner explained that, during service, the left hand condition, contusion to the dorsal aspect of the left hand, was acute only. The current CTS disability is unrelated to preexisting left fifth phalanx fracture noted on the entrance examination into service. There is no evidence of chronicity of care. A nexus has not been established. The rationale continued as to the other aspects of these claims. The examiner found that a diagnosis of a left hand disability is less likely not (less than 50 percent probability) incurred in or caused by the Veteran’s active service. Relevant to the Veteran's hand claims, the Veteran asserts to have hand conditions due to working in an administrative position during service. The hand contusion noted in STR's was a separate acute-only injury that incurred and resulted was an acute condition in 1991 with no follow up care noted in records for that contusion versus the preexisting left hand 5th finger fracture noted on the entrance exam in 1988. The left hand contusion incident in 1991 shows no causal relationship of record in the STR's to the pre-existing fracture of the 5th finger of the left hand noted on entrance exam in 1988, therefore, theses hand conditions are the separate and unrelated. The Veteran's other current claimed conditions to the hand are right hand Ganglion cyst and right-thumb /ring finger trigger condition are medically unrelated and separate condition. Bilateral carpal tunnel syndrome is an unrelated and separate medical condition. A nexus has not been established. The examiner further explained that the claimed bilateral CTS was less likely not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. The Veteran had no complaints related to CTS during active duty dates per record. The Veteran did have a pre-existing left hand 5th finger fracture noted upon entrance in 1988 and also was treated for a left hand contusion in 1991 while in service. However, the left hand contusion was acute only and per records Veteran was not treated for the contusion after the initial progress note confirms diagnosis and treatment. There is lack of any chronic condition related to that acute left hand contusion as well as the pre-existing left hand 5th finger fracture. The reported symptoms of CTS and diagnosis are medically unrelated and first note of such in records came well after discharge from active duty in 2014. Therefore, the CTS being unrelated to active duty and the left hand contusion and left hand 5th finger fracture being acute and resolved, there is no evidence of any hand disability having had its onset during the Veteran's active service or was caused by her active service. A nexus is not established. Finally, the examiner found that the pre-existing left fifth phalanx fracture was less likely not (less than 50 percent probability) related to service. Veteran had clear and unmistakable evidence of the pre-existing diagnosed fracture of the fifth finger on the left hand; resolved at entrance in 1988. The current diagnosis of the left hand, left hand contusion, resolved, and CTS, and are medically unrelated to that preexisting left hand 5th finger condition. There are no service treatment records during active duty dates that show the Veteran complained of that left hand fifth finger to support aggravation of the pre-existing condition existed. No evidence to support a nexus has been established. We note that, historically, the post service VA and non-VA treatment record are consistent with the examination reports as to the hands and wrists. Here, the left hand 5th finger fracture preexisted the Veteran’s active service as it was noted on entrance to service in 1988. The presumption of soundness does not attach. Significantly, there was no increase in the Veteran’s preexisting left hand 5th finger fracture during service. We find that the VA examiner’s opinion as to this matter is uncontroverted and well-explained. We conclude that any current left hand disability is unrelated to the fracture. Additionally, no private or VA treatment records, to include within a year of service separation, show any indication of these conditions for years following service. Specifically, arthritis and CTS were not noted for years following service. Service connection on a presumptive basis is not warranted. 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a). Moreover, the preponderance of the evidence is against finding that a nexus exists between any current hand or wrist disorder and an in-service injury or disease. 38 U.S.C. § 1110; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). The VA examiner has provided well-supported, uncontroverted conclusions that the current conditions are not related to service. No other medical evidence provides a nexus between a current wrist and hand disorder and service. The medical opinion evidence is wholly against the claims. To the extent that the Veteran asserts these disorders have been present since service, the suggestion is inconsistent with the above-discussed record and is not credible. The examiner’s opinions clearly explain why, medically, there is no relationship. Consequently, the Board gives the most probative weight to the competent medical evidence, which shows that the hand and wrist disorders are unrelated to service. There is no significantly probative evidence that any of the current conditions is otherwise related to service, and the weight of the evidence is against so concluding. 38 C.F.R. § 3.303 (d). The 2020 VA opinions are highly probative, because they are based on an accurate medical history and provide an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The opinions are not supportive of the claims. While Veteran believes current wrist and hand disorders are related to overuse in service, and is competent to report pain and such symptoms, the medical evidence identifying no relationship between the current disorders and service is far more extensive, reliable and credible than statements from a lay informant. We note that the article she submitted on prolonged sitting/computer use and CTS is not specific to this Veteran. It is outweighed by the VA medical opinion as to etiology in this case. The preponderance of the evidence weighs against finding that any current hand or wrist disorder occurred in or is otherwise related to service. There is no reasonable doubt to resolve. H. N. SCHWARTZ Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board N. RIPPEL 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.