Citation Nr: 21003170 Decision Date: 01/19/21 Archive Date: 01/19/21 DOCKET NO. 13-20 046 DATE: January 19, 2021 ORDER 1. Entitlement to service connection for right total knee replacement is denied. 2. Entitlement to service connection for a left shoulder disability is denied. 3. Entitlement to service connection for a lumbar spine disability is denied. 4. Entitlement to service connection for a left leg disability, to include radiculopathy, is denied. 5. Entitlement to service connection for a right leg disability, to include radiculopathy, is denied. FINDINGS OF FACT 1. A right knee disability causing a subsequent knee replacement did not have its onset during active service or within one year of service discharge and is not otherwise related to active service. 2. A left shoulder disability did not have its onset during active service or within one year of service discharge and is not otherwise related to active service. 3. A lumbar spine disability did not clearly and unmistakably exist prior to active service, did not have its onset during active service or within one year of service discharge, and is not otherwise related to active service. 4. A right leg disability, to include radiculopathy, did not have its onset during active service or within one year of service discharge and is not otherwise related to active service, to include as secondary to a service-connected disability. 5. A left leg disability, to include radiculopathy, did not have its onset during active service or within one year of service discharge and is not otherwise related to active service, to include as secondary to a service-connected disability. CONCLUSIONS OF LAW 1. The criteria for service connection for right total knee replacement have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2019). 2. The criteria for service connection for a left shoulder disability have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2019). 3. The criteria for service connection for a lumbar spine disability have not been met. 38 U.S.C. §§ 1101, 1110, 1111, 1112, 1113, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309 (2019). 4. The criteria for service connection for a right leg disability, to include radiculopathy have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310 (2019). 5. The criteria for service connection for a left leg disability, to include radiculopathy have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from July 1970 to October 1970. The Veteran testified before the undersigned Veterans Law Judge (VLJ) at a December 2018 Travel Board hearing at the Houston Regional Office (RO), and a transcript of the hearing has been associated with the claims file. In a June 2019 decision, the Board denied the Veteran’s claims on appeal, after which the Veteran appealed the matters to the United States Court of Appeals for Veterans Claims (Court). In June 2020, the Veteran and the Secretary of VA (parties) agreed to a Joint Motion for Partial Remand (JMPR), after which the Court issued an Order granting the JMPR later that same month. As discussed further below, the deficiencies identified within the June 2020 JMPR have been addressed herein. Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. To establish a right to compensation for a 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. For certain chronic disorders, including arthritis and other organic diseases of the nervous system, service connection may be granted on a presumptive basis if the disease manifests within one year following service discharge. Even where service connection cannot be presumed, service connection may still be established on a direct basis. Veterans are presumed 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 the injury or disease in question existed prior to service and was not aggravated by such service. 38 U.S.C. §§ 1111 (2012). Only such conditions as are recorded in entrance examination reports are to be considered as “noted.” 38 C.F.R. § 3.304(b) (2019). 1. Entitlement to service connection for right total knee replacement. The Veteran claims entitlement to service connection for right total knee replacement, which he asserts is a result of marching during military training. The Board has carefully reviewed the evidence of record and finds that the preponderance of the evidence is against the claim for service connection for a right knee disability causing a right total knee replacement. The reasons follow. As to the first element of a service-connection claim, evidence of a current disability, the Board finds that post-service private treatment records document relevant diagnoses including right knee osteoarthritis and right knee degenerative joint disease (DJD), which have required right knee total replacement surgery. Thus, this first criterion is met. Regarding the in-service element of a service-connection claim, the Board finds that service treatment records do not document complaints, treatment, or diagnosis of a right knee disease or injury. The Veteran’s January 1970 pre-induction physical examination documents normal clinical evaluations of the Veteran’s lower extremities and musculoskeletal system without any notation of a right knee defect or diagnosis. Although a subsequent September 1970 Medical Board physical examination documents a finding of abnormal lower extremities, the Board is mindful that an accompanying narrative report and concurrent physical profile each document the relevant finding refers to the Veteran’s residuals of a pre-existing right femoral fracture, which was incurred in a January 1968 school bus accident. Significantly, there is no documented notation within such records of a relevant right knee disease or injury. Additionally, in October 1970, the Veteran reported that there had been no change in his medical condition since his separation examination. Within the June 2020 JMPR, the parties found that the Board’s June 2019 decision did not adequately address lay statements of an in-service knee injury when determining that the preponderance of the evidence is against a finding of in-service incurrence of a disease or injury. Therefore, the Board acknowledges that the Veteran has reported, including within his testimony at the December 2018 Travel Board hearing, that he believed his right knee problems were related to physical activity such as marching and training during active service, as well as injuries from being knocked to the ground by a rifle in his back and being hit in the head with a club. While the Veteran is competent as a layperson to report observable symptoms and occurrences, to the extent that he asserts that such in-service injuries led to a chronic right knee disability resulting in a right total knee replacement, the Board affords more probative value to the service treatment records, which, as discussed above, do not document reports or treatment of a right knee disease or injury during active service. The fact that the Veteran freely reported other conditions during active service leads the Board to reasonably presume that had he experienced right knee problems as a result of physical activity or trauma, he would have reported as much. Additionally, the Board finds that physical activity and marching are not diseases or injuries. To the extent that the Veteran has alleged some sort of injury to his right knee in service, the Board finds such allegation not credible. When being treated in October 2009 for knee pain, the Veteran specifically denied “previous injuries” to his right knee. Statements made while seeking medical treatment tend to be highly reliable. Thus, the Board finds as fact that there was no right knee disease or injury in service. Given the above, the Board finds that the preponderance of the evidence is against a finding that a right knee disability had its onset during active service, and as such, service connection is not warranted on a direct basis. Moreover, there is no competent evidence that right knee arthritis first had its onset within the one-year period following the Veteran’s October 1970 discharge from active service; as such, presumptive service connection is not warranted. Additionally, regarding the third element of a service connection claim, the Board also finds that the preponderance of the evidence is also against a finding of a nexus between the Veteran’s current right knee disability and his active service. For example, of record are treatment records from 2003 and 2004, which document complaints related to the Veteran’s lower back with left leg pain and left shoulder pain. At that time, the Veteran was not reporting right knee pain. At this point, it had been more than 30 years following service discharge, and the Veteran was not reporting right knee pain. There are hundreds of pages of medical treatment records going back to 1979, and they do not show the Veteran complaining of right knee pain but show multiple other medical complaints, which tends to show that the Veteran was not experiencing right knee pain in the years following service discharge. This does not lend to a finding that a right knee disability had its onset in service or is otherwise related to service. Post-service treatment records from February 2006 first document the Veteran’s complaints of occasional swelling and cramps in his right lower extremity generally. Thereafter, in April 2007, he reported specific right knee pain and swelling, and a subsequent January 2008 x-ray revealed mild tricompartmental osteoarthritis of the right knee. A February 2008 private medical record shows that the examiner wrote that the Veteran presented “with pain to his right knee that he has had for several years.” Diagnostic MRIs in May 2009 and August 2009 further documented a degenerative tear in the medial meniscus, osteoarthritis of the medial femorotibial joint, mild to moderate patellofemoral joint chondromalacia, and joint effusion. In October 2009, the Veteran underwent right knee arthroscopic surgery to repair his right knee medial meniscus tear and was treated with right knee physical therapy. At that time, the Veteran reported “no previous injuries or surgeries to [the] right knee.” Thereafter, in April 2010, the Veteran was scheduled for right knee total replacement surgery. The above-described facts show that the Veteran started complaining of right knee pain decades following service discharge and specifically denied any specific injury, which does not support his assertion that he experienced a right knee disease or injury in service or that his right knee was aggravated during service. Additionally, there is no competent evidence that the Veteran’s post-service right knee complaints, including right knee DJD, arthritis, meniscus tear, and ultimate right total knee replacement surgery, had their onset in service. As stated above, the Veteran specifically denied any previous injuries when seen in October 2009. Additionally, the Board is mindful that the Veteran’s February 2006 complaints of right lower extremity pain and subsequent right knee complaints occurred over 35 years after service discharge. Such a lengthy time interval between service and the earliest post-service clinical documentation of the disability is a factor for consideration against a finding that the disability is related to service. As above, while the Veteran’s lay statements of observable symptomatology are probative evidence, to the extent that the Veteran has asserted that a current right knee disability is related to his active service, such statements are not probative, as the Veteran has not been shown to possess medical or orthopedic expertise to render a nexus opinion regarding a complex and internal disease process such as arthritis or another right knee disability. Similarly, while the Veteran testified at the December 2018 Travel Board hearing that he believed his right knee problems were related to physical activity such as marching and training during active service, as well as injuries from being knocked to the ground by a rifle in his back and being hit in the head with a club, his lay assertions in this regard also lack probative value for the same reasons. VA has not provided the Veteran with an examination or opinion in connection with the claim for service connection for a right knee disability. VA must provide a medical examination when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, (2) evidence establishing that an event, injury, or disease occurred in service, or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran’s service, but (4) there is insufficient competent medical evidence on file for the Secretary to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79 (2006). In this case, the evidence does not show that an event, injury, or disease occurred in service or that the right knee disability may be related to service. For a VA examination and/or medical opinion to be warranted, all the McLendon criteria have to be met, and at least one element is not met. Therefore, entitlement to a VA examination and/or medical opinion is not warranted for this service-connection claim. For all the reasons laid out above, the Board finds that the preponderance of evidence weighs against the Veteran’s claim of entitlement to service connection for a right knee disability. As such, there is no reasonable doubt to be resolved, and the claim for service connection for a right knee disability is denied. 2. Entitlement to service connection for a left shoulder disability. The Veteran also claims entitlement to service connection for a left shoulder disability, which he believes is a result of carrying a pack while marching during service and getting knocked down and hit with a pole during training. The Board has carefully reviewed the evidence of record and finds that the preponderance of the evidence is against the claim for service connection for a left shoulder disability. The reasons follow. As to the first element of a service connection claim, evidence of a current disability, the Board finds that post-service private treatment records document relevant diagnoses including left shoulder impingement syndrome and left shoulder rotator cuff tear, with related surgery. Thus, this first criterion is met. Regarding the in-service element of the Veteran’s service-connection claim, the Board initially notes that within the June 2020 JMPR, the parties found that the Board should address whether the Veteran is entitled to the presumption of soundness. The parties agreed that based upon evidence within the record showing that the Veteran fractured his left clavicle in a pre-service vehicle accident and the Veteran’s statements (including within his June 2013 VA Form 9 and his December 2018 Board hearing testimony) asserting that his pre-existing injuries were aggravated by service. As noted above, veterans are presumed 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. The Board concedes that the evidence of record prior to active service, specifically an April 1968 medical report, documents that the Veteran was involved in a school bus accident on January 19, 1968, after which he was admitted to hospital with a laceration of the scalp and closed fractures of the right femur, right clavicle, and left clavicle. However, a subsequent treatment record documents that the Veteran was seen for follow up on March 29, 1968, at which time x-rays revealed good alignment of both clavicular fractures with moderate callus and almost complete healing of both clavicular fractures. Additionally, the Board finds it significant that the Veteran’s January 1970 pre-induction physical examination documents normal clinical evaluations of the Veteran’s upper extremities and musculoskeletal system, without any notation of a left clavicle or left shoulder defect or diagnosis. As such, the Board finds that a left shoulder disability was not noted at the Veteran’s entrance to active service, and he is entitled to the presumption of soundness. Moreover, the Board is mindful that a subsequent September 1970 Medical Board physical examination similarly does not document any notation of a left clavicle or left shoulder defect or diagnosis (other than to relate his medical history of a bilateral clavicle fracture prior to service), and in October 1970, the Veteran reported that there had been no change in his medical condition since his separation examination. As such, the Board finds that the Veteran’s service treatment records do not document complaints, treatment, or diagnosis of a left clavicle or left shoulder disability during active service. Given the above, the Board finds that the preponderance of the evidence is against a finding that a left shoulder disability had its onset during active service, and as such, service connection is not warranted on a direct basis. Moreover, there is no competent evidence that left shoulder arthritis first had its onset within the one-year period following the Veteran’s October 1970 discharge from active service; as such, presumptive service connection for a chronic disease is not warranted. Further, regarding the third element of a service connection claim, the Board finds that the preponderance of the evidence is also against a finding of a nexus between the Veteran’s current left shoulder disability and his active service. For example, as noted above, there are hundreds of pages of medical treatment records going back to 1979, and they do not show the Veteran complaining of left shoulder pain but show multiple other medical complaints, which tends to show that the Veteran was not experiencing left shoulder pain in the years following service discharge. This does not lend to a finding that a left shoulder disability had its onset in service or is otherwise related to service. Post-service treatment records include an August 2001 Workers’ Compensation Report of Medical Evaluation, which documents the Veteran’s left shoulder impingement syndrome and left shoulder acromioplasty following a March 25, 1997 work injury. Additional subsequent treatment records confirm the Veteran’s complaints of left shoulder pain following a 1997 work-related injury to his left shoulder when he was struck by another employee. This was subsequently treated with surgery for left shoulder impingement syndrome. The Veteran was still complaining of left shoulder pain in April 2003, which pain he attributed to the on-the-job injury when he was struck by another employee. In other words, when he discussed the onset of the left shoulder pain, he attributed it to an injury he sustained six years before, which also does not lend to a finding that a left shoulder disability had its onset in service or is otherwise related to service. The above-described facts show that the Veteran started complaining of left shoulder pain more than 25 years after service discharge, which does not support his assertion that he developed a left shoulder disability in service or that his left shoulder was aggravated during service. Notably, there is no competent evidence of record that the Veteran’s post-service left shoulder disability is related to his active service. While the Veteran’s lay statements of observable symptomatology are probative evidence, to the extent that the Veteran has asserted that a current left shoulder disability is related to his active service, such statements lack probative value, as the Veteran has not been shown to possess medical or orthopedic expertise to render a nexus opinion regarding a complex and internal disease process such as arthritis or another left shoulder disability. Similarly, to the extent that such statements, including the Veteran’s December 2018 Travel Board hearing testimony, are inconsistent with additional evidence of record, which documents that his left shoulder complaints are the result of a March 25, 1997 work-related injury, they are afforded no probative value. VA has not provided the Veteran with an examination or opinion in connection with the claim for service connection for a left shoulder disability. VA must provide a medical examination when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, (2) evidence establishing that an event, injury, or disease occurred in service, or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran’s service, but (4) there is insufficient competent medical evidence on file for the Secretary to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79 (2006). In this case, the evidence does not show that an event, injury, or disease occurred in service or that the left shoulder disability may be related to service. For a VA examination and/or medical opinion to be warranted, all the McLendon criteria have to be met, and at least one element is not met. Therefore, entitlement to a VA examination and/or medical opinion is not warranted for this service-connection claim. In conclusion, the Board finds that the preponderance of evidence weighs against the Veteran’s claim of entitlement to service connection for a left shoulder disability. As such, there is no reasonable doubt to be resolved, and the claim for service connection for a left shoulder disability is denied. 3. Entitlement to service connection for a lumbar spine disability. The Veteran also claims entitlement to service connection for a lumbar spine disability. He asserts that his claimed back disability is a result of physical activity and rigorous training during active service, as well as due to in-service injuries when he was struck with a rifle butt while marching during training and later struck in the head with a pole and knocked unconscious. In the June 2020 JMPR, the parties agreed that the Board failed to properly address the presumption of soundness with respect to the Veteran’s lumbar spine service-connection claim; therefore, the Board will first address this issue before proceeding to consider the merits of the Veteran’s claim. Significantly, the Veteran’s January 1970 pre-induction physical examination documents a normal clinical evaluation of the Veteran’s spine and other musculoskeletal system, without any notation of a lumbar spine defect or diagnosis; therefore, with respect to his claimed lumbar spine disability, the presumption of soundness attaches. 38 U.S.C. §§ 1111; 38 C.F.R. § 3.304(b). In order to rebut the presumption of soundness with respect to the claimed lumbar spine disability, there must be clear and unmistakable evidence that the disorder both pre-existed service and was not aggravated in service. The Board acknowledges the evidence of record discussed within the June 2020 JMPR, including a pre-service July 1970 treatment record which documents that he was seen in June 1970 with complaints to his dorsal spine that were treated with physical therapy measures, after which he cancelled two appointments and was discharged from active follow-up care of such complaints. Additionally, after his entrance to active service, an August 1970 lumbar spine x-ray documents a “wedge-shaped fragment off the anterior superior aspect of L-4” which was found to represent “either a congenital lumbus vertebra or possibly an old ununited wedge fracture;” however, the “bony structures [were] otherwise normal.” Thereafter, a September 1970 Medical Board narrative medical summary documents that the Veteran reported non-radiating low back pain since September 1968, brought on by prolonged standing, marching, bending, and relieved by rest. He reported that he had seen a private doctor for this on one occasion, and used a vibrator and analgesic balm to help relieve his low back pain, without further treatment or hospitalization. A physical examination of the back revealed no significant tenderness, spasm, or deformity, and range of motion was within normal limits, and x-ray studies of the lumbosacral spine showed an old anterior-superior compression fracture of L4 body. The Board finds that while the evidence discussed immediately above and reviewed within the June 2020 JMPR documents some probative evidence of a pre-existing back injury prior to service, it does not establish clear and unmistakable evidence of the presence of a lumbar spine disability at the time the Veteran was examined at service entrance, as required to rebut the first prong for the presumption of soundness. Notably, the Veteran’s lay reports of back pain prior to service are not sufficient to establish clear and unmistakable evidence of a pre-existing lumbar spine disability, as he did not report ongoing complaints at his physical examination at service entrance in July 1970. While the September 1970 narrative summary stated that there was x-ray evidence of “an old anterior-superior compression fracture of L4 body,” the prior August 1970 record states that the x-ray result documented “either a congenital lumbus vertebra or possibly an old ununited wedge fracture;” however, the “bony structures [were] otherwise normal.” As such, the Board reasonably concludes there was at least some variability in the interpretation of the lumbar spine x-ray results, which the Board finds as fact cannot meet the stringent standard of clear and unmistakable evidence of a pre-existing lumbar spine disability. Therefore, the Board disregards the findings of the RO when it determined that the Veteran’s lumbar spine disability pre-existed service and was not aggravated by service. Rather, the Board will adjudicate the appeal as one for a claimed lumbar spine disability incurred in or caused by active service, as discussed further below. The Board has carefully reviewed the evidence of record and finds that the preponderance of the evidence is against the grant of service connection for a lumbar spine disability. The reasons follow. As to the first element of a service connection claim, evidence of a current disability, the Board finds that post-service private treatment records document relevant diagnoses including lumbosacral strain, lumbar spine degenerative changes, and lumbar spine spondylosis. Thus, this first criterion is met. Regarding the in-service element of a service connection claim, the Board finds that service treatment records do not document complaints, treatment, or diagnosis of a lumbar spine disability. As noted above, the Veteran’s January 1970 pre-induction physical examination documents a normal clinical evaluation of the Veteran’s spine and other musculoskeletal system, without any notation of a lumbar spine defect or diagnosis. Additionally, while a subsequent September 1970 Medical Board narrative summary documents that the Veteran’s report of non-radiating low back pain since September 1968, which was treated by a private doctor on one occasion, a concurrent physical examination of the back revealed no significant tenderness, spasm, or deformity, and range of motion was within normal limits. Moreover, an x-ray study of the lumbosacral spine was variously interpreted to show “an old anterior-superior compression fracture of L4 body,” and “either a congenital lumbus vertebra or possibly an old ununited wedge fracture;” with “bony structures [that were] otherwise normal.” Given the above, the Board finds that the preponderance of the evidence is against a finding that a current lumbar spine disability had its onset during active service, and as such, service connection is not warranted on a direct basis. Moreover, there is no competent evidence that lumbar spine arthritis first had onset within the one-year period following the Veteran’s October 1970 discharge from active service; as such, presumptive service connection based on a chronic disease is not warranted. Additionally, regarding the third element of a service-connection claim, the Board finds that the preponderance of the evidence is also against a finding of a nexus between the Veteran’s lumbar spine disability and his active service. For example, post-service treatment records document the Veteran’s January 1979 complaint of severe pain in his lower back after bending over to pick up materials at work. Concurrent records specify that his back pain, diagnosed as acute lumbosacral strain, started on January 2, 1979 at 2:45 pm. In February 1979, the Veteran was noted to have sacroiliac strain and a left leg that was longer than his right, due to a previous right femur fracture at age 17. In November 1980, the Veteran was again diagnosed with acute lumbosacral strain after he reported low back pain from changing a light fixture at home the previous month. When discussing the Veteran’s past history, the examiner wrote, “Reveals the patient injur[]ed his back at work at the US Post Office in 1979.” In other words, when discussing the onset of his lumbar spine pain, the Veteran attributed it to a post-service injury and not an injury from service, which is evidence that refutes the Veteran’s allegation of chronic low back pain that started in service. The records from 1979 and 1980 are consistent with each other in that the onset of the Veteran’s lumbar spine pain started in January 1979 while at work and does not lend to a finding that a lumbar spine disability had its onset in service or is otherwise related to service. In January 1986, the Veteran was assessed with sacroiliac strain after he again reported low back pain beginning on December 31, 1985 due to an accident at work. Thereafter, in July 1995, he was noted to have recurrent herniated discs of the lumbar spine, which required discectomy surgery. In March 1997, he was noted to have post-laminectomy syndrome. In April 2003, he reported ongoing back and left leg complaints due to his previous work-related injury; in March 2004, he again reported lower back pain, left leg tingling, and left leg throbbing, all unchanged from his previous complaints going back to the 1990s. A May 2004 Workers’ Compensation Information Sheet documents a confirmed workplace injury to his back and legs at the U.S. Postal Service, and in August 2004, the Office of Personnel Management (OPM) approved his request for disability retirement. A December 2004 Social Security Administration (SSA) Disability Determination and Transmittal found that he was not disabled through the date of the current determination, though it also noted his primary disorders of the back (discogenic and degenerative) and secondary disorders of muscle, ligament, and fascia. Private treatment records from October 2006 document that a previous EMG in 2004 suggested L5 radiculopathy, which was certainly related to his back. A repeat EMG in December 2006 confirmed true radiculopathy in both lower extremities that was certainly related to his old back injuries and surgery. Similarly, September 2009 treatment records document his history of lumbar spondylosis and radiculopathy. The post service treatment records addressing the Veteran’s lumbar spine show the Veteran consistently attributed his lumbar spine pain/disability to work-related injuries he experienced in 1979, 1985, and 1997, which does not support the allegation that he developed a lumbar spine disability in service. Notably, however, there is no competent evidence of record that the Veteran’s post-service lumbar spine disability is related to his active service. Additionally, the Board is mindful that the Veteran’s post-service January 1979 complaints of lower back pain and subsequent back and bilateral radiculopathy complaints occurred years after his service discharge in 1970. Such a period of time between service and the earliest post-service clinical documentation of the disability is of itself a factor for consideration against a finding that the disability is related to service. While the Veteran’s lay statements of observable symptomatology are probative evidence, to the extent that the Veteran has asserted that a current lumbar spine disability is related to his active service, such statements lack probative value as the Veteran has not been shown to possess medical or orthopedic expertise to render a nexus opinion regarding a complex and internal disease process such as arthritis. Similarly, to the extent that such statements, including the Veteran’s December 2018 Travel Board hearing testimony, are inconsistent with additional evidence of record, which documents that his lumbar spine complaints are the result of a 1979 work injury, with subsequent additional work-related injuries, they are likewise afforded little probative value. VA has not provided the Veteran with an examination or opinion in connection with the claim for service connection for a lumbar spine disability. VA must provide a medical examination when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, (2) evidence establishing that an event, injury, or disease occurred in service, or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran’s service, but (4) there is insufficient competent medical evidence on file for the Secretary to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79 (2006). In this case, the evidence does not show that an event, injury, or disease occurred in service or that the lumbar spine disability may be related to service. For a VA examination and/or medical opinion to be warranted, all the McLendon criteria have to be met, and at least one element is not met. Therefore, entitlement to a VA examination and/or medical opinion is not warranted for this service-connection claim. In conclusion, the Board finds that the preponderance of evidence weighs against the Veteran’s claim of entitlement to service connection for a lumbar spine disability. As such, there is no reasonable doubt to be resolved, and the claim for service connection for a lumbar spine disability is denied. 4. Entitlement to service connection for a left leg disability, to include radiculopathy. 5. Entitlement to service connection for a right leg disability, to include radiculopathy. The Veteran also claims service connection for bilateral leg disabilities, to include radiculopathy, as secondary to his claimed lumbar spine disability. Therefore, as noted within the June 2020 JMPR, these claims are intertwined with the Veteran’s claim for service connection for a lumbar spine disability. In order to warrant entitlement to service connection under a secondary theory, the Veteran would need to be in receipt of service connection for his lumbar spine disability. However, as the Board herein denies such claim, secondary service connection is not warranted for any related bilateral lower extremity radiculopathy as a matter of law. Nevertheless, the Board will consider the Veteran’s claims in a direct basis below. As to the first element of a service connection claim, evidence of a current disability, the Board finds that post-service private treatment records document relevant diagnoses including lumbosacral strain, lumbar spine degenerative changes, and lumbar spine spondylosis, with bilateral lower extremity radiculopathy. Thus, this first criterion is met. Regarding the in-service element of a service-connection claim, the Board finds that service treatment records do not document complaints, treatment, or diagnosis of bilateral lower extremity radiculopathy. As noted above, the Veteran’s January 1970 pre-induction physical examination documents a normal clinical evaluation of the Veteran’s spine and lower extremities, without any notation of a bilateral lower extremity defect or diagnosis. Additionally, a subsequent September 1970 Medical Board narrative summary does not document any indication or finding of a bilateral lower extremity disability, including radiculopathy. Given the above, the Board finds that the preponderance of the evidence is against a finding that a current bilateral lower extremity disability, including radiculopathy, had its onset during active service, and as such, service connection is not warranted on a direct basis. Moreover, there is no competent evidence that bilateral lower extremity radiculopathy (an organic disease of the nervous system) first had its onset within the one-year period following the Veteran’s October 1970 discharge from active service; as such, presumptive service connection based on a chronic disease is not warranted for such disabilities. Additionally, regarding the third element of a service-connection claim, the Board finds that the preponderance of the evidence is also against a finding of a nexus between the Veteran’s current bilateral leg radiculopathy and his active service. For example, post-service treatment records document the Veteran’s January 1979 complaint of severe pain in his lower back after bending over to pick up materials at work. Concurrent records specify that his back pain, diagnosed as acute lumbosacral strain, started on January 2, 1979 at 2:45 pm. In February 1979, the Veteran was noted to have sacroiliac strain and a left leg that was longer than his right, due to a previous right femur fracture at age 17. In November 1980, the Veteran was again diagnosed with acute lumbosacral strain after he reported low back pain from changing a light fixture at home the previous month. He reported his past history including a prior work injury in 1979, with intermittent back pain since that time. In January 1986, the Veteran was assessed with sacroiliac strain after he again reported low back pain beginning on December 31, 1985 due to an accident at work. Thereafter, in July 1995, he was noted to have recurrent herniated discs of the lumbar spine, which required discectomy surgery. In March 1997, he was noted to have post-laminectomy syndrome. In April 2003, the Veteran reported ongoing back and left leg complaints due to his previous work-related injury; in March 2004, he again reported lower back pain, left leg tingling, and left leg throbbing, all unchanged from his previous complaints going back to the 1990s. A May 2004 Workers’ Compensation Information Sheet documents a confirmed workplace injury to his back and legs at the U.S. Postal Service, and in August 2004, the Office of Personnel Management (OPM) approved his request for disability retirement. A December 2004 Social Security Administration (SSA) Disability Determination and Transmittal found that he was not disabled through the date of the current determination, though it also noted his primary disorders of the back (discogenic and degenerative) and secondary disorders of muscle, ligament, and fascia. Private treatment records from October 2006 document that a previous EMG in 2004 suggested L5 radiculopathy, which was certainly related to his back. A repeat EMG in December 2006 confirmed true radiculopathy in both lower extremities that was certainly related to his old back injuries and surgery. Similarly, September 2009 treatment records document his history of lumbar spondylosis and radiculopathy. Notably, however, there is no competent evidence of record that the Veteran’s post-service bilateral leg radiculopathy is related to his active service. Additionally, the Board is mindful that the Veteran’s post-service bilateral radiculopathy complaints occurred subsequent to his January 1979 complaints of lower back pain following a work injury, and years after his service discharge in 1970. Such a period of time between service and the earliest post-service clinical documentation of the bilateral lower extremity disability is of itself a factor for consideration against a finding that the disability is related to service. While the Veteran’s lay statements of observable symptomatology are probative evidence, to the extent that the Veteran has asserted that a current bilateral leg disability, to include radiculopathy, is related to his active service, such statements lack probative value as the Veteran has not been shown to possess medical or orthopedic expertise to render a nexus opinion regarding a complex and internal disease process such as a neurological disability. Similarly, to the extent that such statements, including the Veteran’s December 2018 Travel Board hearing testimony, are inconsistent with additional evidence of record, which documents that his lumbar spine complaints, with subsequent additional work-related injuries including radiculopathy, are the result of a 1979 work injury, they are likewise afforded little probative value. VA has not provided the Veteran with an examination or opinion in connection with the claim for service connection for a bilateral leg disability. VA must provide a medical examination when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, (2) evidence establishing that an event, injury, or disease occurred in service, or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran’s service, but (4) there is insufficient competent medical evidence on file for the Secretary to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79 (2006). In this case, the evidence does not show that an event, injury, or disease occurred in service or that the bilateral leg disability may be related to service. For a VA examination and/or medical opinion to be warranted, all the McLendon criteria have to be met, and at least one element is not met. Therefore, entitlement to a VA examination and/or medical opinion is not warranted for these service-connection claims. In conclusion, the Board finds that the preponderance of evidence weighs against the Veteran’s claims of entitlement to service connection for a bilateral leg disability, to include radiculopathy. As noted above, secondary service connection is not warranted for bilateral lower extremity radiculopathy as secondary to a lumbar spine disability a matter of law. As such, there is no reasonable doubt to be resolved, and the claims for service connection for a bilateral leg disability, to include radiculopathy, are denied. A. P. SIMPSON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Chad Johnson, Counsel 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.