Citation Nr: 21003252 Decision Date: 01/21/21 Archive Date: 01/21/21 DOCKET NO. 15-02 290 DATE: January 21, 2021 ORDER Service connection for a back disability is denied. Service connection for a neck disability is denied. Service connection for a foot disability is denied. Service connection for a knot on the chest is denied. Service connection for a sinus or throat disability is denied. FINDINGS OF FACT 1. Current disabilities of the back and neck, foot (to include right toe or left ankle), knot on the chest (post-surgical excision), and sinuses or throat did not have their onset during service and are not otherwise related to injury or disease in service. 2. A preexisting foot disability and sinus disability were not aggravated by service. CONCLUSIONS OF LAW 1. The criteria for service connection for a back disability are not met. 38 U.S.C. §§ 101(24), 1101, 1110, 1131, 5107; 38 C.F.R. §§ 3.6, 3.102, 3.303, 3.304. 2. The criteria for service connection for a neck disability are not met. 38 U.S.C. §§ 101(24), 1101, 1110, 1131, 5107; 38 C.F.R. §§ 3.6, 3.102, 3.303, 3.304. 3. The criteria for service connection for a right foot or toe and left foot or ankle disability are not met. 38 U.S.C. §§ 101(24), 1101, 1110, 1111, 1131, 1153, 5107; 38 C.F.R. §§ 3.6, 3.102, 3.303, 3.304, 3.306. 4. The criteria for service connection for a knot on the chest are not met. 38 U.S.C. §§ 101(24), 1101, 1110, 1131, 5107; 38 C.F.R. §§ 3.6, 3.102, 3.303, 3.304. 5. The criteria for service connection for a sinus or throat disability are not met. 38 U.S.C. §§ 101(24), 1101, 1110, 1111, 1131, 1153, 5107; 38 C.F.R. §§ 3.6, 3.102, 3.303, 3.304, 3.306. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty for training from August 1977 to January 1978 and subsequent service with the U.S. Army Reserves until his honorable discharge effective May 1996. He had no active duty periods, but Veteran status has been established based on an award of service connection for posttraumatic stress disorder (PTSD) related to his basic training in a June 2016 rating decision. This matter came before the Board of Veterans’ Appeals (Board) on appeal from an August 2014 rating decision. In June 2018, the Board remanded the issues addressed in this decision for additional development, which was substantially completed. There is no argument or indication that another remand is needed. Although prior adjudications characterized the claimed sinus condition as for sinusitis, the Veteran has also described throat problems in connection with this claim. Therefore, this claim is recharacterized to reflect his asserted complaints. After the June 2020 supplemental statement of the case (SSOC), the Veteran submitted additional evidence for his appeal in July 2020. No waiver of initial review of such evidence by the agency of original jurisdiction (AOJ) is needed because the Veteran’s substantive appeal (VA Form 9) was received after February 2, 2013, and such review has not been requested. See 38 U.S.C. § 7105(e). The Veteran has also submitted a VA Form 9 for the issue of an increased rating for PTSD; however, he requested a Board hearing for that issue and that request is still pending. Therefore, that issue will be addressed in a separate decision when ready. Service Connection The Veteran asserts that each of his claimed conditions began or occurred during his initial period of boot camp or subsequent training for Reserve service. See, e.g., January 2015 correspondence; August 2020 appellate brief from representative. Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active service, even if first diagnosed after service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.304. The three-element test for service connection requires: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Presumptions apply for certain conditions, which are discussed below as relevant. For Reserve or National Guard service, service connection may only be granted for a disability resulting from disease or injury incurred or aggravated while on active duty for training (ACDUTRA or ADT), or for an injury incurred or aggravated during inactive duty training (INACDUTRA or IDT), but not for a disease during inactive duty training, except from an acute myocardial infarction, a cardiac arrest, or a cerebrovascular accident. 38 U.S.C. §§ 101(24), 106; 38 C.F.R. § 3.6. For some of the claimed conditions, there are suggestions of a preexisting condition. There is a presumption of sound condition upon entrance into active duty unless a defect is “noted” on the entrance examination; and a presumption of aggravation of a preexisting condition if the underlying condition worsens in severity during service. Clear and unmistakable evidence is required to show a preexisting condition if it is not noted, as well as to rebut the presumption of aggravation, to include a specific finding that the increase is due to the natural progress of the disease. See 38 U.S.C. §§ 1111, 1153; 38 C.F.R. §§ 3.304, 3.306. If soundness is presumed, the Veteran has the burden of showing a worsening in service to trigger a presumption of aggravation. Horn v. Shinseki, 25 Vet. App. 231 (2012); Wagner v. Principi, 370 F.3d 1089 (Fed. Cir. 2004). There must be more than temporary flare-ups or a recurrence of the condition. Davis v. Principi, 276 F.3d 1341 (Fed. Cir. 2002); Hunt v. Derwinski, 1 Vet. App. 292 (1991). These presumptions generally do not apply to cases with only ACDUTRA, and no active duty, with limited exceptions. See Smith v. Shinseki, 24 Vet. App. 40 (2010) (discussing presumption of soundness where there is an entrance examination for ACDUTRA or IDT); Hill v. McDonald, 28 Vet. App. 243 (2016) (discussing presumption of aggravation where veteran status has been established for an ACDUTRA period and other disabilities were aggravated during the same period). In adjudicating such claims, reasonable doubt that exists because of an approximate balance of positive and negative evidence concerning any point will be resolved in favor of the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Findings Applicable to All Issues The prior Board remand directed that the AOJ verify each of the Veteran’s periods of active duty for training and obtain his complete service treatment records. Service personnel records reflect that the Veteran had his initial training period from September 1977 to January 1978 and continued in the Reserve until he was discharged in May 1996. The Veteran clarified in July 2019 that he was on inactive status, or Inactive Ready Reserve (IRR), for the last five years from June 1991 through May 1996. Thus, treatment records after June 1991 would not be expected, and it appears that all service treatment records have been obtained. There is no argument or indication of outstanding medical records relating to service. The AOJ requested information as to the Veteran’s ACDUTRA periods and received a response referencing previously provided info. Nevertheless, the available evidence from the Veteran and service personnel records is sufficient to show relevant periods of ACDUTRA and IDT. In June 2014, VA received service personnel records reflecting assignments, performance evaluations, and several requests from the Veteran for correction of his points for service. He requested correction of points from 1977 to 1987, including 122 active points from 1977 to 1978 (his initial ACDUTRA training period), and 15 membership points for each year thereafter, but other active points. The Veteran also identified specific dates each month from 1978 to 1982 and requested points inactive duty training (IDT). A points summary for August 1988 to August 1989 reflects 17 active points and 34 inactive points. Consistent with these records, during a November 2017 VA examination, the Veteran reported 17 to 32 days of duty per year (which would include both ACDUTRA and IDT), except for 120 days from 1977 to 1978 (which was his initial training period reflected on his DD Form 214). In June 2019 and July 2019, the Veteran identified addresses for his assigned units. In July 2020, he submitted orders for annual training dated March 28, 1982, to April 19, 1982. As explained below, it is clear from the available evidence whether the Veteran had ACDUTRA or IDT for the identified dates of his claimed injuries, diseases, or symptoms. Otherwise, he asserts generally that he had symptoms related to service. Additionally, the Board finds the Veteran not credible as to having ongoing problems for his claimed conditions with an onset during active service. Therefore, another remand to identify other specific ACDUTRA or IDT dates is unnecessary because it would not have a reasonable likelihood of aiding in substantiating his claims. No prejudice results from not obtaining additional information in this regard, and there was substantial compliance with this directive. 1. and 2. Service connection for a back disability; service connection for a neck disability The Veteran asserts that his back and neck disabilities began or occurred during his initial period of boot camp or subsequent training for Reserve service. See, e.g., January 2015 correspondence; August 2020 appellate brief from representative. The evidence establishes current back and neck disabilities. During the period since the Veteran’s June 2013 claim for service connection, VA treatment records in 2016 noted a history of a T9 fracture for the back or thoracic spine, and prior records from 1990 through 2001 also noted a compression fracture at T9. In August 2019, x-rays of the lumbar and thoracic spine showed a chronic appearing T9 compression fracture and no significant degenerative disease of lumbar spine. For the neck, imaging in June 2019 showed irregularities at C2-C3 and C3-C4 and degenerative changes or osteoarthritis of the cervical spine, but a July 2019 MRI found no explanation for upper extremity radiculopathy symptoms. In July 2019, a rheumatologist explained why he doubted that the Veteran had rheumatoid arthritis. The evidence does not establish a specific back or neck injury or disease during active service or chronic or persistent and recurring back or neck symptoms with an onset in active service. To the extent the Veteran’s contention that his current disabilities are related to training periods for his Reserve is an assertion that he had pain or other symptoms during those periods, those reports are competent but not credible because they are inconsistent with the more probative evidence. Specifically, service treatment records from 1977 through 1989 do not reflect any back or neck complaints or treatment. During his August 1977 enlistment examination, January 1978 examination for release from active duty training (REFRADT), April 1982 retention examinations, the Veteran denied recurrent back pain, arthritis, rheumatism, or bursitis, bone or joint or other deformity, and lameness in Reports of Medical History. He was found clinically normal for these evaluations for all areas, including the spine, except for head and shoulder scars. At the 1982 examination, the Veteran reported being treated for back and neck injuries, which were noted as a sprained neck and back, but denied recurrent back pain and the other conditions. The examiner noted testing and physical examination findings found his spine clinically normal, noting no evidence of spinal deformity, full active range of motion and 4+ (out of 5) strength. At an August 1989 retention examination, the Veteran again denied recurrent back pain and other arthritis or bone-related complaints and was found clinically normal. This is not an absence of complaints; instead, the Veteran expressly denied relevant symptoms or injuries and had no objective abnormalities for the back and neck. This is true even though the Veteran did report other symptoms or conditions at those times. The Veteran reported a history of ear, nose, or throat (ENT) trouble and sinusitis with surgery as a child, broken bones of a broken left ankle in 1974, “don’t know” for foot trouble in service, and a tumor of having a “knot” or benign mass removed from his chest in 1989. Particularly because the Veteran reported other musculoskeletal orthopedic problems, it is reasonable to expect that he would have reported back or neck problems if they also existed at those times. Although the Veteran reported back and neck sprains in 1982, he denied recurrent or current symptoms and had no objective abnormalities on testing, and he again denied recurrent symptoms in 1989. Thus, the absence of current back and neck complaints and abnormalities points to them not existing at those times, and to there being no lasting back or neck complaints in 1982 or later. Thereafter, a November 19, 1990, service treatment record noted that the Veteran had a back injury and was treated by a private provider on November 18, 1990. The evidence also includes medical evaluations from the Social Security Administration (SSA), private records from 1989 through 2001, and VA records from January 2015 through January 2020. In August 2013, the Veteran identified private treatment from Dr. B since 1990. In May 2018 and May 2019 letters, Dr. B stated that the Veteran had been his patient since 1995 and he had several medical problems including chronic back pain. Treatment records from Dr. B from 1995 to 2013 were obtained, which reflect consistent complaints of chronic back pain. A July 1995 record from Dr. B noted that the Veteran was followed by Dr. M for a compression fracture at T10 since November 1990. Records received from the SSA include private treatment records from Dr. B and Dr. M, as well as other providers, and reflect that the Veteran was treated in November 1990 for back pain with an onset of November 15, 1990, due to a work injury while lifting cases of drinks. He worked as a soft drink delivery driver from 1983 through 1990, and previously in a factory from 1978 to 1979 and in various construction jobs from 1979 to 1983. A November 1991 MRI for the thoracic spine showed a compression fracture of T9, loss of disc space and disc space disease at T8-11 and 7-8, slight increase in thoracic kyphosis at the fracture point, and a slight scoliotic component. The area below the compression fracture throughout the lumbar spine was normal. In December 1992, x-rays of the back showed degenerative disc disease at L4-L5. The Veteran underwent surgery, and a December 1992 operative report noted a post-operative diagnosis of multiple fragments of hemorrhagic intervertebral disc following herniated nucleus pulposus with anterior column collapse at L4-L5. Private records in June 1993 and July 1993 noted back pain and neck pain or a pulled muscle related to the November 15, 1990, work injury. The Veteran described being injured when he was pulling a hand truck loaded with eight cases of two-liter sodas and onset of pain at that time. He worked again the next day and was lifting a case overhead and had an onset of pain, and he was off work at the time of treatment. The Veteran was diagnosed with a compression fracture based on x-rays, and a July 1993 also showed a compression fracture. An October 1993 record from Dr. M noted that the Veteran’s T9 compression fracture had healed with a lot of fibrous tissue or a small tumor as confirmed by an MRI. A July 1996 SSA decision found the Veteran disabled due to his back since November 15, 1990. A March 1998 record again noted a back injury at work in November 1990 and that the Veteran also had associated neck pain plus bilateral upper extremity symptoms. A March 1998 x-ray of the thoracic spine showed focal levoscoliosis, spondylosis, and a T9 compression fracture. A March 1998 SSA evaluation noted significant neck and back pain and loss of strength in the right arm and hands and legs. A September 2001 SSA evaluation again noted the T9 fracture in 1990 with bilateral upper extremity problems and pain after walking or standing for 15 to 20 minutes. The Veteran described the work injury and reported that he quit working in 1993. VA treatment records from January 2015 through January 2020 reflect chronic back and neck pain, but no indication as to the date of onset or opinion as to cause. The records during service and for treatment after service, particularly prior to his claim for VA benefits in June 2013, are more probative than the Veteran’s more recent statements because they were contemporaneous in time to the events and symptoms when his recollection was fresh. The Veteran’s reports for treatment were also made under circumstances when he had an incentive to give an accurate history as to the nature and timing of his symptoms in order to receive proper medical care. As summarized above, the Veteran first complained of back and neck problems or injury in November 1990, and he repeatedly identified those injuries and symptoms as related to a civilian work injury. If the Veteran had experienced chronic or persistent and recurrent back or neck symptoms prior to the November 1990 injury, it is reasonable to expect that he would have identified prior symptoms when he sought treatment related to the accident. Instead, the only time the Veteran asserted that his back and neck disability were related to training in service was in connection with his 2013 VA claim, when he had an incentive to attempt to link the conditions to service. Potential bias may be considered in determining credibility. For all of these reasons, any assertion that the Veteran’s back or neck symptoms, or an injury or disease, began during a period of Reserve training are not credible. Arthritis is considered a chronic disease, which generally may be eligible for presumptive service connection. See 38 U.S.C. §§ 1101, 1112, 1113, 1137; Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013); Fountain v. McDonald, 27 Vet. App. 258 (2015); 38 C.F.R. §§ 3.303, 3.307(a)(3), 3.309(a). However, the chronic disease presumption requires 90 days of continuous active duty. 38 C.F.R. § 3.307 (a)(3); Grose v. Brown, 4 Vet. App. 144, 148 (1993). Similarly, the chronic disease presumption does not apply to claims based on a period of ACDUTRA. Smith v. Shinseki, 24 Vet. App. 40, 47 (2010). Therefore, this presumption does not apply to the claimed back and neck disabilities. The Veteran is not competent to provide an opinion as to the cause of his back and neck disabilities. This is a medically complex question that requires knowledge of the musculoskeletal system, and interpretation of his medical history and testing, particularly in light of the Board’s findings as to the timing of his symptoms. There is no medical evidence indicating that a back or neck disability may be related to active service. Instead, the medical records attribute these conditions to his November 1990 civilian work injury. The prior Board remand directed the AOJ to obtain a VA examination or other necessary development for each issue if such was found to be needed based on any additional information obtained upon remand. No VA examination or opinion was obtained. However, the Veteran’s broad conclusory statements as to the cause of his current disabilities are insufficient to trigger the need for a VA examination or medical opinion. See McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006); Waters v. Shinseki, 601 F.3d 1274, 1276-77 (Fed. Cir. 2010). Therefore, this directive was satisfied. In summary, the preponderance of the evidence is against service connection for the current back or neck disabilities under any reasonably raised theory. There is no reasonable doubt to resolve in his favor, and the Veteran’s appeals are denied. 3. Service connection for a foot disability, to include right toe or left ankle The Veteran asserts that his foot disability began or occurred during his initial period of boot camp in August 1977 from wearing the wrong sized boots for three weeks. He states that he “roughed up” the bone in his right big toe and was limping. Although he was provided correct boots, he states that the bone in his toe has always given him trouble since then. The Veteran states that he went to VA about his right toe and left ankle while in the Reserve but was told he could not get VA benefits. Years later, he sought treatment and had his right toe broken and put a pin in it, but he still had trouble walking. See, e.g., January 2015 correspondence; August 2020 appellate brief from representative. The evidence establishes a current foot disability. A November 2019 VA treatment record noted the Veteran’s report of a history of right foot bunion surgery and diagnosed hallux limitus of the right foot and a 1st digit (or great toe) bunion. The Veteran also reported that his left ankle swells at times, and the provider diagnosed traumatic arthropathy of the left ankle. Similarly, a September 2019 VA examination (with a December 2019 report) diagnosed a right first toe fracture status post-surgery in the 1990s and noted that November 2019 x-rays showed left ankle vascular calcifications and right foot mild joint space narrowing at the metatarsophalangeal (MTP) joint. An August 2019 VA treatment record also noted intermittent numbness in both feet, which the Veteran related to his known T-6 spinal fracture. Because service connection is denied for a back disability, this condition cannot be service-connected. However, the Veteran’s claim does not reference these symptoms. The evidence does not establish a foot injury or disease, to include for the right toe or left ankle, during active service or chronic or persistent and recurring symptoms with an onset in active service. The Veteran’s report of injury and symptoms during service, and particularly ongoing symptoms related to training, is competent but not credible because it is inconsistent with the more probative evidence. In June 2020, the Veteran also submitted a lay statement from one of his brothers, L.S., who also served in the military. L.S. recalled that when the Veteran came back from basic training in January 1978 he had been given the wrong sized boots and his right foot had been damaged, and he continued in the Reserve. This is essentially a recollection of what the Veteran told him. Although it is competent to this extent, it is also not credible and does not establish ongoing symptoms. Specifically, service treatment records do not reflect any specific foot, toe, or ankle complaints or treatment during basic training or otherwise. In a Report of Medical History for his August 1977 enlistment examination, the Veteran reported foot trouble and broken bones, and the examiner noted that he had broken his left ankle with no sequelae. He was found clinically normal except for head and shoulder scars, including for the feet and lower extremities. During a January 1978 examination for release from active duty training, the Veteran again reported broken bones but checked “don’t know” for foot trouble. The examiner noted that he reported prior treatment for a broken foot, identified as broken bones of a left ankle fracture in 1974 that was treated with no residuals. He was found clinically normal. In June 1978, the Veteran reported no change since that examination. During April 1982 and August 1989 retention examinations, the Veteran again reported broken bones, but he expressly denied foot trouble, arthritis, rheumatism, or bursitis, bone or joint or other deformity, and lameness, as in prior examinations. The examiner noted that the Veteran reported being treated for back and neck injuries and his prior broken left ankle at age 15 or 16, and that he had no significant change in his health since the last physical examination except for his back and neck. The Veteran was found clinically normal except for his prior scars. This is not an absence of complaints; instead, the Veteran expressly denied relevant symptoms or injuries and had no objective abnormalities for the feet. This is true even though the Veteran did report other symptoms or conditions at those times. Particularly because the Veteran reported other musculoskeletal or orthopedic problems, it is reasonable to expect that he would have reported foot problems, to include the right toe or left ankle, if they also existed at those times. Instead, he checked “don’t know” for foot trouble in January 1978, and referenced only his prior left ankle fracture, not any right toe, left ankle, or other foot problems related to his basic training, to include wearing improperly fitting boots. The Veteran also expressly denied foot trouble in subsequent examinations. Thus, the absence of foot, toe, or ankle complaints, and the Veteran’s express denial of foot problems several times, points to them not existing at those times or being related to training. In August 2013, the Veteran identified private treatment from Dr. B since 1990. In May 2018 and May 2019 letters, Dr. B stated that the Veteran had been his patient since 1995 and he had several medical problems including chronic back pain, but he did not mention a foot problem, to include the right toe or left ankle. Treatment records from Dr. B from 1995 to 2013 were obtained. A July 1995 record notes a history of foot surgery in 1993 by podiatry, and a July 2003 record notes right 4th toenail discoloration and a diagnosis of paronychia. There were no other foot, toe, or ankle complaints, and no mention of problems related to training in the Reserve. Private treatment records from 1989 to 2001 do not reflect foot, toe, or ankle complaints. SSA evaluations in March 1998 and September 2001 noted back and neck pain and related symptoms in the upper and lower extremities, among other physical and mental health complaints. The Veteran described problems standing, walking, or climbing stairs due to his back and related extremity pain or numbness. However, he did not report any foot-specific complaints, to include of the right toe or left ankle. In 2001, he expressly denied problems with the ankles and feet. VA treatment records from January 2015 through January 2020 reflect a history of right foot bunion surgery and traumatic arthropathy of the left ankle with swelling. The Veteran did not mention any foot, toe, or ankle symptoms as related to service. The records during service and for treatment after service, particularly prior to the June 2013 claim for VA benefits, are more probative than the more recent statements by the Veteran and his brother because they were contemporaneous in time to the events and symptoms when his recollection was fresh. The Veteran’s reports for treatment were also made under circumstances when he had an incentive to give an accurate history as to the nature and timing of his symptoms in order to receive proper medical care. As summarized above, those records reflect that the Veteran had surgery for a right foot or toe bunion in 1991 or 1993, which appears to have been during his inactive status for the Reserve from 1991 to 1996. The first medical notations of left ankle complaints or a diagnosis other than the fracture prior to service were in 2019, when he was noted to have vascular calcifications and traumatic arthropathy. Notably, the Veteran did not mention his right toe or left ankle complaints as being related to Reserve service except in connection with his VA claim, when he had an incentive to attempt to link the conditions to service. Potential bias may be considered in determining credibility. The Veteran has not identified a specific injury other than due to wearing improper boots for a few weeks during basic training from 1977 to 1978, and his contemporaneous records contradict any ongoing symptoms from any such injury. In contrast, SSA records reflect that the Veteran worked in a factory from 1978 to 1979, in construction jobs from 1979 to 1983, and as a soft drink delivery driver from 1983 through 1990. He quit his job in 1993 after a work injury to the back and neck in November 1990. It is common knowledge and reasonable to expect that these positions likely included significant time on the feet and strenuous activities, including lifting heavy items as noted in the back and neck analysis. The Veteran clearly spent more time in his civilian work positions than in his Reserve training periods of approximately 15 to 30 days of ACDUTRA or IDT per year. If the Veteran had experienced chronic or persistent and recurrent foot symptoms, to include in the right toe or left ankle, or these conditions were affected by his Reserve training periods, it is reasonable to expect that he would have identified those symptoms at some point for his Reserve evaluations. For all of these reasons, the assertion that the Veteran’s ongoing foot symptoms, to include of the right toe or left ankle, began or were related to period of Reserve training is not credible. To the extent the Veteran has arthritis of the right foot or toe or left foot or ankle, although this is considered a chronic disease, that presumption requires 90 days of continuous active duty and does not apply to claims based on a period of ACDUTRA. Therefore, this presumption does not apply to a foot disability. The Veteran is not competent to provide an opinion as to the cause of his foot disability. This is a medically complex question that requires knowledge of the musculoskeletal system, and interpretation of his medical history and testing, particularly in light of the Board’s findings as to the timing of his symptoms. There is no medical evidence linking a foot disability to active service. Instead, the December 2019 VA examiner provided negative nexus opinions. The examiner noted the Veteran’s report of having a right first toe fracture and surgery in 1991 due to his boots during service and that he denied a foot condition prior to service. He reported current pain in the right MTP joint with walking and weightbearing, and the examiner noted the November 2019 x-rays results for the left ankle and right toe, as noted above. The examiner opined that a foot disorder clearly and unmistakably existed prior to service and was clearly and unmistakably not aggravated beyond its natural progression by service. The examiner noted that the January 1978 separation examination noted the left ankle fracture prior to service and no residuals (or current complaints). The examiner stated there was no nexus to service for the right toe because there were no right first toe complaints prior to or during service. These opinions are highly probative because they applied medical expertise to the Veteran’s current complaints and medical history, consistent with the Board’s credibility findings as to the timing of his right toe and left ankle symptoms. There is no argument of inadequacy. Together with the medical opinions, application of the presumptions of soundness or aggravation do not establish entitlement to service connection. As noted above, Veteran status has been established for PTSD due to the Veteran’s initial basic training through January 1978. The Veteran seeks service connection based on a right toe injury during the same period of initial ACDUTRA. Although he has not specified a left ankle injury, he generally asserts that his conditions are related to Reserve training over time. The Veteran’s enlistment examination in 1977 reflected a prior left ankle fracture. Although it was described has having no sequelae or being asymptomatic, it was still a prior disability, i.e., status-post fracture. See Verdon v. Brown, 8 Vet. App. 529, 530 (1996). Moreover, the Hill exception for aggravation is not triggered because the Veteran has not asserted that there was a left ankle injury or symptoms during this period, and there were no complaints or treatment for the left ankle noted. Additionally, the Board finds him not credible as to having a right toe injury and symptoms during this period. There were subsequent retention examinations, but no entrance examinations prior to specific periods of ACDUTRA or IDT, and the Veteran has not identified a specific injury during any such training period. Therefore, the Smith exception for the presumption of soundness for those periods also does not apply. Similarly, to the extent there may have been undocumented injuries from required activities for physical qualifying tests after basic training through January 1978, those would not be in the same ACDUTRA period and would not be subject to the presumptions. In summary, the preponderance of the evidence is against service connection for the current foot disability under any reasonably raised theory. There is no reasonable doubt to resolve in his favor, and the Veteran’s appeal is denied. 4. Service connection for a knot on the chest In his June 2013 claim, the Veteran sought service connection for a large knot on the right side of his chest. He asserts generally that his conditions began during Reserve training. See, e.g., January 2015 correspondence; August 2020 appellate brief. In 2017 and 2019 VA examinations, he reported treatment in 1978 and/or 1986 for right chest pain and a mass that was removed by a private doctor. The evidence establishes current disability. A May 2016 VA treatment record noted a history of a “knot” removed from the chest. A November 2017 VA examination noted a scar near the right breast and pain in the right chest area with pressure, and a history of removal of a benign mass from the right breast area in 1989. A September 2019 VA examination noted no visible scar in the right chest area, but that the area was very sensitive, with slight pain when he wears a tight shirt. The evidence also reflects treatment for left and right chest or breast conditions during the Veteran’s range of dates for his Reserve service. However, there was no indicated injury, and a disease was not present during an ACDUTRA period. Specifically, during his August 1977 enlistment examination and January 10, 1978 examination for release from active duty training, the Veteran denied having a tumor, growth, cyst, cancer, or skin disease. He was found clinically normal for relevant areas. A January 25, 1978, service treatment record noted complaints of a cyst on the with pain or swelling in the left nipple area which was diagnosed as mastitis. The Veteran’s DD Form 214 reflects that he was released from ACDUTRA for basic training on January 31, 1978. Therefore, this condition was diagnosed and treated during ACDUTRA. However, there is no indication that the Veteran had complaints involving the right chest at this time, and there was no indication of a mass or “knot,” only a disease or infection of mastitis. Several years later, in his April 1982 retention examination, the Veteran denied a tumor, growth, cyst, cancer, or skin disease. During an August 1989 retention examination, he reported having a tumor, growth, cyst, or cancer and stated that he had a “knot” taken out of his chest in May 1989 by a private doctor in Richmond. The examiner noted that a benign mass was excised from the right breast area. The evidence also includes medical evaluations from the SSA, private records from several providers from 1989 through 2013, and VA records from January 2015 through January 2020. Private treatment records in October 1993 and January 1994 noted back pain with referred pain to the right chest wall related to the Veteran’s T9 compression fracture from his November 1990 work injury that appeared to have healed with a lot of fibrous tumor or a small tumor. During a November 2017 VA examination, the Veteran reported being treated for pain in the right chest and diagnosed with a knot in the chest in 1978 and having surgery in Richmond to remove it. During a September 2019 VA examination, the Veteran reported having a growth of the size of a walnut under his right nipple in 1986 that was surgically removed in 1986. The records during service and for treatment after service, particularly prior to his claim for VA benefits in June 2013, are more probative than the Veteran’s more recent statements because they were contemporaneous in time to the events and symptoms when his recollection was fresh. The Veteran’s reports for treatment were also made under circumstances when he had an incentive to give an accurate history as to the nature and timing of his symptoms in order to receive proper medical care. As summarized above, the Veteran’s treatment in 1978 was for the left chest area, not the right chest, and his right chest mass was removed in 1989 (not 1986). The Veteran’s recall of having right chest problems in 1978 is inaccurate, and there is no indication of right chest complaints prior to the 1989 benign mass. Additionally, there is no indication that the 1989 diagnosis or treatment was during a period of Reserve training. Moreover, the only time the Veteran asserted that his right chest mass is related to service was in connection with his 2013 VA claim, when he had an incentive to attempt to link the condition to service. Potential bias may be considered in determining credibility. Although the Veteran’s right chest condition occurred during his overall range of Reserve service from 1977 to 1996 (with inactive status since 1991), this is not sufficient for service connection. For all of these reasons, the assertion that his right chest mass or “knot” began during a period of Reserve training is not credible. The Veteran is not competent to provide an opinion as to the cause of right chest condition. This is a medically complex question that requires knowledge of the dermatologic and musculoskeletal systems, and interpretation of his medical history and testing, particularly in light of the Board’s findings as to the nature and timing of his symptoms. There is no medical evidence linking the right chest mass or knot to active service. Instead, the November 2017 VA examiner opined that the current condition was less likely than not incurred or caused by service. The examiner summarized relevant notations in service records. The examiner emphasized that the 1978 condition was in active service but involved in the left breast, whereas the claimed knot was from the right breast in 1989, noted the denial of symptoms in 1982, and found no indication of a chronic condition related to the 1978 service findings. The examiner also explained that mastitis is an inflammation due to a bacterial infection and generally resolves within days with appropriate treatment. Similarly, the September 2019 VA examiner noted the Veteran’s ACDUTRA service from 1977 to 1978 and his report of a right chess growth and removal in the 1980s. The examiner stated that because the right chest mass was after active service, it was less likely than not incurred or caused by events in service. The 2017 and 2019 medical opinions are highly probative because they applied medical expertise to the Veteran’s current complaints and medical history, consistent with the Board’s credibility findings as to the nature and timing of his symptoms and illnesses. Although the 2019 examiner inaccurately noted removal in 1986, as opposed to 1989, there is still no indication that it was during active service, so this was not prejudicial. There is no argument of inadequacy. In summary, the preponderance of the evidence is against service connection for a knot on the chest, status-post removal, under any reasonably raised theory. There is no reasonable doubt to resolve in the Veteran’s favor, and the appeal is denied. 5. Service connection for a sinus or throat disability The Veteran asserts that his current sinusitis disability, to include problems breathing and coughing, began or occurred during Reserve training. He describes sinus problems related to sleeping in cold and hot barracks generally. The Veteran also reports that between September 1977 and November 1977 (during basic training) he was sent to a nuclear biological chemical or gas chamber. He would leave his mask off when a gas container was opened and feeling his skin burning, then he had difficulty breathing and a bleeding nose after putting the mask back on. Additionally, the Veteran states that on August 24, 1979, he flew from Fort Bragg to Fort Jackson and had problems with sinusitis and his throat, and he went to the dispensary at Fort Bragg but was told nothing could be done because he was leaving the next week. A few years later, he had his tonsils taken out at a private hospital, and he still has sinusitis and throat trouble with problems breathing and coughing. See, e.g., January 2015 correspondence; August 2020 appellate brief. The evidence establishes a current sinus or throat disability. VA treatment records reflect that a June 2019 CT scan of the cervical spine noted a small mucous retention cyst in the right maxillary sinus and asymmetry involving the left tonsillar region and oropharynx and hypopharynx. A July 2019 record noted that the Veteran had pharyngeal asymmetry, and he reported having a difficult tonsillectomy in 1983. A December 2019 VA examination diagnosed chronic sinusitis and allergic rhinitis, a deviated ulna, and a right maxillary sinus cyst. Although the Veteran was treated for a throat condition during service, the evidence does not establish chronic or recurring sinus or throat symptoms, or other injury or disease during active service. The Veteran’s reports of injury and symptoms in 1977 and on a persistent basis since 1979 are competent but not credible because they are inconsistent with the more probative evidence. In June 2020, the Veteran also submitted a lay statement from one of his brothers, R.S., who stated that he was on a cold flight with the Veteran from Fort Bragg to Fort Jackson during service in August 1979. He recalled that the Veteran became sick due to that flight and his throat “never got right.” He had his tonsils removed at a private hospital in the 1980s, there was a problem with the operation, and the Veteran still has problems with his throat and sinusitis. This statement is competent as to observing the cold flight and the Veteran’s noticeable symptoms such as coughing over time. Otherwise, it is essentially a recollection of what the Veteran told him about his symptoms and treatment. Although the lay statement is competent to this extent, it does not establish ongoing symptoms related to service. In his June 2013 claim, the Veteran identified his claimed sinusitis as having an onset in 1990. This onset date conflicts with his other assertions and his brother’s report that he had frequently recurring throat problems and sinusitis since 1979. Additionally, in his August 1977 enlistment examination Report of Medical History, the Veteran denied ear, nose, or throat (ENT) trouble, sinusitis, chronic or frequent colds, hay fever, and chronic cough. He was found clinically normal for the head, neck, nose, sinuses, mouth and throat. However, during a January 1978 examination for release from active duty training, the Veteran reported ENT trouble and sinusitis, but again denied the other relevant conditions. The examiner noted for ENT trouble and sinusitis that the Veteran surgery at 4 to 5 years of age with no residuals. No recent symptoms or symptoms during training were mentioned, and he was again found clinically normal for the relevant areas. In August 1979, the Veteran was treated at Fort Bragg for strep throat diagnosed on August 25, 1979, which progressing well with all signs diminished. He was advised to continue medications, drink fluids, and return to the clinic as needed. This record is consistent with the report by the Veteran and his brother that he was treated for a throat condition in August 1979. The Veteran’s service personnel records include the Veteran’s request for correction of his points for inactive duty training (or IDT) for multiple dates for one to three points per month, including for August 25, 1979. Therefore, this condition occurred during IDT, not ACDUTRA. There was no injury, only an illness or disease, which is not eligible for service connection based on a period of IDT. See 38 C.F.R. § 3.6. Moreover, there is no indication of follow-up treatment in 1979, suggesting that his strep throat healed. During an April 1982 retention examination, the Veteran reported ENT trouble and sinusitis, and the examiner noted occasional tonsillitis with swelling. He was found clinically normal for relevant areas. A February 22, 1983, private operative report reflects a tonsillectomy for recurrent tonsillitis. The Veteran reported that “over the past years he has had extremely frequent episodes of tonsillitis with flareups almost on a bimonthly basis.” Both of these records were several years after the August 1979 treatment for strep throat, and there was no indication of tonsillitis in that treatment record. There is also no argument or suggestion that the reported episodes of tonsillitis (a disease) or swelling occurred during ACDUTRA. There were no subsequent notation of sinus or throat complaints, to include strep throat or tonsillitis, in service treatment records. During an August 1989 retention examination, the Veteran expressly denied ENT trouble, chronic or frequent colds, sinusitis, and chronic cough. He again reported treatment for sinusitis prior to service, stating that he was hospitalized for a sinus infection at age 7, but he did not mention recent symptoms or symptoms related to service. This points against him having frequently recurring symptoms or disability since either 1977 or 1979. In addition to an absence of contemporaneous throat or sinus-related complaints other than in August 1979 (on IDT) and February 1983 (for private treatment), the Veteran expressly denied relevant symptoms or conditions for service evaluations in 1978 and 1989. This is true even though he did report other symptoms or conditions at those times, as well as a history of ENT trouble or sinusitis that required surgery in childhood. It is reasonable to expect that the Veteran would have reported sinus or throat problems, including difficulty breathing, coughing, or bleeding from the nose as asserted for his VA claim, if they existed at those times. Instead, he reported only a history of problems prior to service or expressly denied all relevant conditions or symptoms. Additionally, the Veteran’s denial of relevant problems in his 1989 service examination, several years after his 1983 surgery, is generally consistent with his report in his June 2013 claim that his chronic sinusitis began in 1990. However, it is not consistent with his assertion for his claim in 2015 (and by his brother in 2020) of having symptoms since 1979. This evidence points to ongoing symptoms not existing at those times or being related to training. In August 2013, the Veteran identified private treatment from Dr. B since 1990. In May 2018 and May 2019 letters, Dr. B stated that the Veteran had been his patient since 1995 and he had several medical problems, but he did not identify a sinus or throat problem. Treatment records from Dr. B from 1995 to 2013 were obtained. A July 1995 record notes a history of tonsillectomy. A March 2000 record notes congestion, itchy eyes, runny nose, and cough, with a diagnosis of upper respiratory infection versus allergies. A February 2013 record notes a sore throat and earache for four days that was diagnosed as pharyngitis. Other private records from 1989 to 2001 do not reflect sinus or throat complaints. SSA evaluations in March 1998 and September 2001 noted multiple physical and mental health complaints. The 2001 evaluation noted some sinus pressure and stuffiness in the first part of the year, but no cough and allergies, and that the Veteran quit smoking in 1985 and he used to smoke 20 cigarettes in three days. VA treatment records from January 2015 through January 2020 do not mention sinus or throat problems until 2019. In July 2019, the provider asked the Veteran about pharyngeal asymmetry, and he reported that during service he was diagnosed with tonsillitis in 1979, and in February 1983 he had a difficulty tonsillectomy. The provider noted that the Veteran presented the private operative report that indicated that the snare broke four times, which led to some maceration and tearing of the muscle on the posterior pillar on the right side. The Veteran reported a sensation of something coming from his sinuses out of his mouth since that time. The records during service and for treatment after service, particularly prior to the June 2013 claim for VA benefits, are more probative than the more recent statements by the Veteran and his brother because they were contemporaneous in time to the events and symptoms when his recollection was fresh. The Veteran’s reports for treatment were also made under circumstances when he had an incentive to give an accurate history as to the nature and timing of his symptoms in order to receive proper medical care. As summarized above, those records reflect that the Veteran was treated for strep throat in August 1979, which was incurred during IDT and noted to be progressing well, with no followup treatment. Therefore, he had an inaccurate understanding or recall of his history as being treated for tonsillitis in 1979. The Veteran reported occasional tonsillitis and swelling in 1982 and had private surgery for recurring tonsillitis in 1983, but he denied relevant symptoms in 1989. Additionally, for VA treatment in 2019, the Veteran reported having ongoing sinus and throat problems since the 1983 surgery, not since the 1979 illness or another period of Reserve training. Moreover, as noted above, the 1979 throat illness was during IDT and is not an eligible service date because it is not an injury. For all of these reasons, the assertion that the Veteran’s ongoing sinus and throat symptoms began during active service is not credible. The Veteran is not competent to provide an opinion as to the cause of his sinus or throat disability. This is a medically complex question that requires knowledge of the respiratory system, and interpretation of his medical history and testing, particularly in light of the Board’s findings as to the timing of his symptoms. There is no medical evidence linking a sinus or throat disability to active service. Instead, the September 2019 VA examiner’s report and a May 2020 addendum provided negative nexus opinions. During the 2019 VA examination, the Veteran reported being in service from 1977 to 1991 and having sinus problems during service and seasonal allergies. He described having pressure in the at sinus area all the time, needing to constantly clean his nose, and having hairs inside his nose move up to his nose with irritation and come out his mouth. The examiner noted the June 2019 CT scan results as summarized above. The examiner opined that the Veteran’s sinusitis was not caused or incurred in service. In a May 2020 addendum, the examiner further opined that the Veteran’s current condition clearly and unmistakably preexisted service and was clearly and unmistakably not aggravated beyond its natural progression by service. The examiner summarized relevant notations in the Veteran’s service records, including the service examinations as noted above and the 2019 examination report. For both opinions, the examiner explained that the reports of prior ENT trouble an surgery for sinusitis in service evaluations showed a preexisting condition, and there were no complaints during the period from 1977 to 1978 such that no aggravation was shown. The examiner noted that a 1982 record noted occasional tonsillitis and swelling and findings in the June 2019 CT scan indicated chronic sinusitis and a deviated uvula. The examiner stated that the deviated uvula was likely related to the tonsillectomy, so there was no aggravation during service. Although the examiner referenced a tonsillectomy in childhood, as opposed to the documented 1983 tonsillectomy, that tonsillectomy was not during active service, as explained above. Additionally, although the examiner did not expressly mention the Veteran’s 1979 treatment for strep throat, that occurred during IDT, as noted above, not active service. Accordingly, these opinions are highly probative because they applied medical expertise to the Veteran’s current complaints and medical history, consistent with the Board’s credibility findings as to the nature and timing of his symptoms and illnesses. There is no argument of inadequacy. Together with the medical opinions, application of the presumptions of soundness or aggravation do not establish entitlement to service connection. As noted above, the Veteran seeks service connection based in part on coughing or breathing problems during exposure in a gas chamber in 1977 during the same period of initial ACDUTRA for which Veteran status was established. The Veteran’s enlistment examination in 1977 did not reflect a prior throat or sinus condition. Instead, the Veteran first reported this condition at his 1978 separation examination. Therefore, he was presumed sound for his period of basic training for these conditions. However, the Hill exception for aggravation is not triggered because there were no complaints or treatment for a sinus or throat condition during basic training, and he did not report current complaints at his 1978 examination, only the sinus surgery prior to service. Additionally, the Board finds him not credible as to having symptoms since this period, as explained above. The Veteran primarily asserts that he had ongoing problems related to getting sick after a cold flight in August 1979, and generally cold and hot barracks during Reserve training. These episodes were not during the same period of ACDUTRA for basic training. There were subsequent retention examinations, but no entrance examinations prior to specific periods of ACDUTRA or IDT. Therefore, the Smith exception for the presumption of soundness for those periods does not apply. Additionally, although the Veteran was treated for a throat condition in August 1979, it was during IDT and was not an injury, and the Board also finds him not credible as to having ongoing sinus or throat symptoms during or since this period. In summary, the preponderance of the evidence is against service connection for a sinus or throat disability under any reasonably raised theory. There is no reasonable doubt to resolve in his favor, and the Veteran’s appeal is denied. Bethany L. Buck Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Wheatley 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.