Citation Nr: 21004218 Decision Date: 01/26/21 Archive Date: 01/26/21 DOCKET NO. 15-06 091 DATE: January 26, 2021 ORDER Entitlement to service connection for uterine fibroids is denied. Entitlement to service connection for fibromyalgia is denied. Entitlement to service connection for a bilateral hip disability is denied. Entitlement to service connection for a bilateral hand disability, to include frostbite, is denied. Entitlement to service connection for a bilateral foot disability, to include frostbite, is denied. Entitlement to service connection for a low back disability is denied. Entitlement to service connection for a bilateral knee disability is denied. Entitlement to service connection for a headache disability is denied. FINDINGS OF FACT 1. The Veteran is not shown to have a present disability of uterine fibroids. 2. The Veteran is not shown to have a present disability of fibromyalgia. 3. The Veteran is not shown to have a present bilateral hip disability. 4. The claimed bilateral hand disability is not shown to be due to, or etiologically related to, any event, disease, or injury in service. 5. The claimed bilateral foot disability is not shown to be due to, or etiologically related to, any event, disease, or injury in service. 6. The claimed low back disability is not shown to be due to, or etiologically related to, any event, disease, or injury in service. 7. The claimed bilateral knee disability, diagnosed as osteoarthritis, is not shown to be due to, or etiologically related to, any event, disease, or injury in service. 8. The claimed headache disability, diagnosed as migraines, is not shown to be due to, or etiologically related to, any event, disease, or injury in service CONCLUSIONS OF LAW 1. The criteria for service connection for uterine fibroids have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for fibromyalgia have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for service connection for a bilateral hip disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 4. The criteria for service connection for a bilateral hand disability have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 5. The criteria for service connection for a bilateral foot disability have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 6. The criteria for service connection for a back disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 7. he criteria for service connection for a bilateral knee disability have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 8. The criteria for service connection for a headache disability have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1981 to March 1992. She also served in the United States Army Reserves from March 1992 to July 1999. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a September 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In April 2018, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is of record. This matter was previously before the Board in June 2018 at which time the case was remanded for additional development; namely, to obtain missing service treatment records as well as outstanding VA and private treatment records. Regarding private treatment records, the Veteran reported in writing in September 2012 that she tried to obtain her medical records from her private physician, Dr. Roach, who had treated her from 1995 to 2010, but that his office informed her that he had relocated, and it would not provide her with his new address. This report differs from a June 2012 Report of Contact which shows that VA contacted Dr. Roach’s office in June 2012 to obtain the Veteran’s records and was informed that Dr. Roach had retired and that most of his records had been lost. The office also informed VA that there was no record of the Veteran in the system. This report is consistent with the report of a VA examiner in August 2013 who examined the Veteran for her claimed headache disability. The examiner stated that he had attempted to get the Veteran’s medical records from Arthur Roach PA-C by faxing a signed “ROI” to the clinic that the doctor was associated with. The examiner said that the clinic informed him that they had no such patient on record and that he had confirmed with the office the Veteran’s name and date of birth. Regarding service treatment records, records from the Veteran’s active duty service from September 1981 to March 1992 are on file. However, multiple attempts have been made to obtain treatment records from the Veteran’s period of service with the Veteran’s United States Army Reserve from March 1992 to July 1999, including requests to the Defense Personnel Records Information Retrieval System and the Records Management Center. Unfortunately, no medical records have been found. VA informed the Veteran of its attempts to locate these records in letters dated in May 2019, June 2019 and July 2019, and afforded her the opportunity to provide VA with any additional supportive information or records. No additional information or evidence has been received. In consideration of the foregoing, the Board finds that VA has made adequate attempts to obtain the missing private and United States Army Reserve treatment records and that any further attempts to obtain these records would be futile. 38 U.S.C. § 5103A(b), (c). Accordingly, there has been substantial compliance with the Board’s June 2018 remand directives. Stegall v. West, 11 Vet. App. 268 (1998). Service Connection I. Law and Regulations Generally, to prevail on a claim for service connection, there must be competent evidence of (1) current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence or other competent evidence of a nexus between the claimed in-service disease or injury and the present disease or injury. Hickson v. West, 12 Vet. App. 247 (1999). Certain chronic disabilities, such as arthritis and organic diseases of the nervous system, if manifest to a degree of 10 percent or more within one year after separation from active duty, are presumed to have been incurred in active service. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309(a). In adjudicating a claim, the Board must assess the competence and credibility of the claimant. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006); Washington v. Nicholson, 19 Vet. App. 362 (2005). The Board also has a duty to assess the credibility and weight given to evidence and it must provide reasons or bases for favoring one opinion over another. Winsett v. West, 11 Vet. App. 420 (1998). Madden v. Gober, 125 F.3d 1477 (Fed. Cir. 1997); Wensch v. Principi, 15 Vet. App. 362 (2001). Competency of evidence must be distinguished from weight and credibility, which are factual determinations in determining the probative value of the evidence. Rucker v. Brown, 10 Vet. App. 67 (1997). Although interest may affect the credibility of testimony, it does not affect competency to testify. Cartright v. Derwinski, 2 Vet. App. 24 (1991). If all the evidence is in relative equipoise, reasonable doubt shall be resolved in the Veteran’s favor, and the claim should be granted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. If the preponderance of the evidence is against the claim, the claim must be denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). II. Analysis Uterine Fibroids/Fibromyalgia/Bilateral Hip Disability In the absence of proof of present disability there can be no successful claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). See also Degmetich v. Brown, 104 F.3d 1328 (1997) (also interpreting 38 U.S.C. § 1131 as requiring the existence of a present disability for VA compensation purposes). To be present as a current disability, there must be evidence of the condition at some time during the claim period. Gilpin v. West, 155 F. 3d 1353, 1356 (Fed. Cir. 1998); see also McClain v. Nicholson, 21 Vet. App. 319, 321 (2007) (the Gilpin requirement that there be a current disability is satisfied when the disability is shown at the time of the claim or during the pendency of the claim, even though the disability subsequently resolves). The question for the Board is whether the Veteran has current disabilities of fibromyalgia, uterine fibroids and a bilateral hip disability. After considering the evidence in its entirety, the Board finds that the weight of evidence does not show that the Veteran has or has had such disabilities at any time since filing her claim for service connection or prior thereto. Cf. Romanowsky v. Shinseki, 26 Vet. App. 289, 293 (2013) (Board erred in failing to address pre-claim evidence in assessing whether a current disability existed, for purposes of service connection, at the time the claim was filed or during its pendency); McClain, 21 Vet. App. at 321. Regarding uterine fibroids, the Veteran testified that she had digestive problems in service the severity of which depended on what she ate, and that she experienced heavy menstrual bleeding and cramps in service which she had not experienced prior to service. Her service treatment records show that she was seen on a number of occasions for vaginal bleeding in March 1987 related to a miscarriage. There are also records in September 1991 that show that cytology results revealed atypical squamous cell of undetermined significance and that a coloscopy was ordered for a questionable low-grade lesion. A follow up record in January 1992 shows that the Veteran had “just mild atypia” in September 1991, and that the colposcopy was normal. There are no records in service that show or suggest that the Veteran had uterine fibroids. Postservice evidence also does not show that the Veteran has or has had uterine fibroids. The evidence includes a VA primary care visit record from the women’s health clinic in November 2016. This record contains the Veteran’s gynecological history and does not show that she has or had uterine fibroids. There is also the opinion of a VA examiner in September 2020 who stated that no diagnosis of uterine fibroids was identified and, therefore, no diagnosis was warranted. This examiner based her opinion on her examination of the Veteran and on a review of her claims file, and her opinion constitutes probative evidence. Winsett, 11 Vet. App.at 420; Guerrieri v. Brown, 4 Vet. App. 467, 473 (1993) (“The probative value of medical opinion evidence is based on the medical expert’s personal examination of the patient, the physician’s knowledge and skill in analyzing the data, and the medical conclusion the physician reaches”). Moreover, there is no medical evidence to the contrary. Regarding fibromyalgia, this disability is not shown in the Veteran’s service treatment records or in postservice treatment records comprised of VA outpatient records from 2015 to 2019. Some of the VA treatment records include active problem lists and the Veteran’s medical history, but they do not show fibromyalgia. Moreover, the Veteran denied that she was being treated for fibromyalgia at a VA examination performed by a physician on the allergy, immunology and rheumatology staff in August 2013, and this examiner found that she did not have fibromyalgia. Similarly, a Gulf War (GW) general examiner reported in August 2013 that the Veteran did not meet the diagnostic criteria for fibromyalgia. These examiners based their opinions on their examination of the Veteran and on their review of her claims file, and their opinions constitute probative evidence. Winsett, 11 Vet. App.at 420; Guerrieri, 4 Vet. App. at 467. Moreover, there is no medical evidence to the contrary. Turning to the Veteran’s claim for service connection for a bilateral hip disability, the Veteran testified that she injured her hips in service after jumping out of a window in her barracks. She denied seeking immediate treatment for these injuries, but she said that she later sought medical treatment. There are no documented complaints or treatment involving the Veteran’s hips in service and no diagnosis of a bilateral hip disability after service. In fact, an August 2013 VA examiner noted that hip x-rays were negative for arthritis and he opined that the Veteran did not then have nor ever have a hip condition. He based his opinion on his examination of the Veteran and on his review of her claims file and his opinion constitutes probative evidence. Winsett, 11 Vet. App.at 420; Guerrieri, 4 Vet. App. at 467. There is no contrary medical evidence on file. In Saunders v. Wilkie, the United States Court of Appeals for the Federal Circuit held that pain alone, when causing functional impairment, may constitute a “disability” for VA compensation purposes, even if the pain is not with an accompanying diagnosis. 886 F.3d 1356, 1368 (Fed. Cir. 2018). However, in terms of the Veteran’s hip pain, there is no probative evidence of functional impairment caused by such pain. VA outpatient records show that the Veteran is employed as a mail carrier and there is no indication from these records that she is functionally impaired due to hip pain. Moreover, a VA examiner in August 2013 cautioned the “reviewing office” to make any judgments based on his examination findings due to incongruencies and issues with the veracity of the Veteran’s orthopedic reports. The examiner explained that he was concerned about the “truthfulness” of the Veteran and her ability to cooperate with the physical exam. He noted that she was able to demonstrate capable range of motion and strength in several capacities, but when asked to perform these activities for the examination she said that she could not. He said that he was concerned as an examiner that her complaints and the physiologic explanations behind them were incongruent. He went on to opine that the Veteran did not provide a truthful or satisfactory examination. He based his opinion on his examination of the Veteran and on his review of her claims file and his opinion constitutes probative evidence. Winsett, 11 Vet. App.at 420; Guerrieri, 4 Vet. App. at 467. Moreover, there is no contrary medical evidence on file. For these reasons, the Board finds that the Veteran’s bilateral hip pain does not constitute a present disability. In short, the only evidence supporting current diagnoses of uterine fibroids, fibromyalgia and a bilateral hip disability are lay statements from the Veteran. These lay statements have evidentiary value inasmuch as the Veteran is competent to report observable symptomatology. Jandreau v. Nicholson, 492 F.3d 1372 (2007). However, these claimed disabilities are medically complex and require specialized medical education, knowledge of the interaction between multiple systems in the body, and the ability to interpret complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). In this regard, the Veteran is not shown to have the necessary medical expertise. In specific regard to arthritis, this disability is diagnosed primarily on clinical findings such as X-rays or specialized testing, such as MRI, which the Veteran is not competent to conduct or interpret. See 38 C.F.R. § 4.71a, Diagnostic Code 5003 (degenerative arthritis established by X-ray findings), Diagnostic Code 5010 (traumatic arthritis established by X-ray findings), Diagnostic Code 5002 (rheumatoid arthritis must be “objectively confirmed by findings” that show limitation of motion). Cf. 38 C.F.R. § 4.66 (indicating the usual way to diagnose arthritis is by X-ray, which is also required to see arthritic changes). In short, the Board finds that the Veteran is not competent to self-diagnose these disabilities. Inasmuch as the weight of evidence is against an essential element for these claims, i.e., (1) current disability, the claims must be denied. Hickson, supra. In reaching this conclusion the Board has considered the applicability of the benefit of the doubt doctrine; however, as the preponderance of the evidence is against these claims, that doctrine is not applicable. See 38 U.S.C. § 5107(b).   Disabilities of the Hands and Feet 1. Frostbite The Veteran testified that she developed frostbite on her hands and feet in Germany while serving at her post in cold weather. There is no indication in these records of frostbite. This is in fact consistent with her hearing testimony that she did not seek treatment for frostbite in service and self-treated the condition by warming up her extremities after being out in the cold. She also testified that she still experiences the same numbness in her extremities when exposed in cold weather as she did in service. Postservice medical records also do not reflect diagnoses of frostbite or residuals thereof. In fact, a VA examiner in August 2013 relayed the Veteran’s report of having frostbite in service in 1987, and then went on to opine that he could not find any physical examination or x-ray evidence of frostbite. X-rays of the feet and hands in August 2013 showed no abnormalities. A subsequent VA examiner in September 2020 reported that there was no objective evidence of residuals of frostbite therefore, and no diagnosis was warranted. Both examiners based their opinion on their examination of the Veteran and on their review of her claims file and their opinions constitute probative evidence. Winsett, 11 Vet. App.at 420; Guerrieri, 4 Vet. App. at 467. Moreover, there is no contrary medical evidence on file. In short, the only evidence supporting inservice and postservice diagnoses of frostbite are lay statements from the Veteran. These lay statements have evidentiary value inasmuch as the Veteran is competent to report observable symptomatology. Jandreau v. Nicholson, 492 F.3d 1372 (2007). However, this issue is medically complex and requires specialized medical education, knowledge of the interaction between multiple systems in the body, and the ability to interpret complicated diagnostic medical testing which the Veteran has not been shown to have. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Accordingly, the Veteran’s opinion that she has frostbite is not considered probative evidence. Inasmuch as the weight of evidence is against an essential element for this claim, i.e., (1) current disability, the claim must be denied. Hickson, supra. In reaching this conclusion the Board has considered the applicability of the benefit of the doubt doctrine; however, as the preponderance of the evidence is against the claim, that doctrine is not applicable. See 38 U.S.C. § 5107(b). 2. Disabilities of the Feet and Hands Other Than Frostbite The Veteran testified that she injured her feet in service after jumping out of a window. In support of this claim, the Veteran submitted a statement from a fellow serviceman who attested to her having various orthopedic complaints in service. She also submitted a statement from her spouse who said he has observed her “severe and chronic pains” since service. Service treatment records show that she was seen in September 1985 for a soft tissue contusion to her left foot after jumping out of a window. These records also show that she was treated for a soft tissue injury to her right baby toe in August 1982 after hitting a post, and for severe pain to her right great toe after running during physical training. In addition, she was treated for left ankle and lower leg pain in September 1985 with no reported history of trauma. Postservice imaging studies of the Veteran’s feet taken at a VA examination in August 2013 revealed no abnormal findings. The examiner remarked that he could not elicit any disability in the right or left foot. The Veteran was later assessed as having a mucoid cyst to the 4th digit R foot in September 2017, mild pes planus and degenerative joint disease, left foot, in September 2017, congenital pes cavus in December 2018, and hypertrophic arthritic change at the first metatarsophalangeal joint bilaterally by x-ray in September 2019. There is no evidence that relates these postservice diagnoses to service. Moreover, a VA examiner in September 2020 assessed the Veteran’s several complaints of injury to her feet in service as “acute” injuries. He also noted that her complaint of bilateral mid dorsal foot pain in 2013 was unrelated to frostbite and was 21 years after her discharge from service. He went on to state that a nexus had not been established. Regarding the Veteran’s hands, the Veteran testified that she was told that she had arthritis in her hands at the Memphis VA medical center and she thinks that it is related to frostbite that she had in service. As noted above, the Board has denied the Veteran’s claim for service connection for frostbite, and her service treatment records do not show complaints or treatment related to her fingers or hands. The first documentation of hand problems is many years after service. In this regard, VA treatment records show that the Veteran was diagnosed as having left bony mallet finger in 2012. She also reported having bilateral hand pain at a VA examination in August 2013. However, imaging studies taken at that time revealed no abnormal findings and the examiner remarked that the Veteran’s resting posture and examination findings were incongruent. He said that he witnessed the Veteran holding her cane and having full range of motion of all of her fingers, and then would not move them for the formal examination. He said that there was a fair amount of malingering with the examination and he cautioned the reviewers from interpreting the findings as true pathology or disability. Subsequent records show that the Veteran was seen in July 2015 complaining of a three-week history of right finger pain at which time she was diagnosed as having right trigger finger and was given cortisone injections. In short, there is no evidence other than the Veteran’s assertions that relates any of these postservice diagnoses to service. The Board acknowledges the Veteran’s assertions and that of a fellow serviceman and her spouse that she has current bilateral hand and foot disabilities related to service, including arthritis. However, as lay persons, they are not shown to have the competence to provide a diagnosis or etiological opinion for complex disabilities such as osteoarthritis. Layno v. Brown, 6 Vet. App. 465 (1994); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Inasmuch as the weight of evidence is against an essential element for these claims, i.e., (3) medical evidence or other competent evidence of a nexus between a claimed in-service disease or injury and the present disease or injury, the claims must be denied. Hickson, supra. In reaching this conclusion the Board has considered the applicability of the benefit of the doubt doctrine; however, as the preponderance of the evidence is against the claim, that doctrine is not applicable. See 38 U.S.C. § 5107(b). Disabilities of the Low Back and Bilateral Knees The Veteran testified that she injured her low back and knees after jumping out of a window in her barracks. In support of this claim, the Veteran submitted a statement from a fellow serviceman who attested to her having various orthopedic complaints in service. She also submitted a statement from her spouse who said he has observed her “severe and chronic pains” since service. She denied seeking immediate treatment for these injuries, but she said that she did at some point seek medical treatment. While her service treatment records show that she was seen for complaints of pain after jumping out of a window in September 1985, her complaints are limited to the left foot. There are no documented complaints or treatment that pertain to the Veteran’s back or knees in service. The Veteran was afforded a VA examination for her back and knees in August 2013. The examiner diagnosed her as having lumbar strain in the 1980s, and bilateral knee osteoarthritis by x-ray in 2013. He also relayed her complaints of longstanding low back pain and knee pain. However, he negated a nexus between any present low back disability and bilateral knee disability and service by opining that it was “highly unlikely” that any of the Veteran’s current conditions were related or aggravated by service-related activities. First, he noted that there were no service treatment records indicating any diagnoses or conditions incurred while in service and he reported that he could not find any documentation linking the Veteran’s complaints with any service-related activities. He went on to state that, “more importantly”, he was concerned as an examiner with the truthfulness of the Veteran and her ability to cooperate with the physical examination. He noted that she could demonstrate “capable” range of motion and strength in “several capacities”, but when asked to perform these activities for the examination she stated that they could not. He said that he was concerned as an examiner that her complaints and the physiologic explanations behind them were “incongruent”, and he opined that the Veteran did not provide a truthful or satisfactory examination and he cautioned the reviewing office to make any judgment based on the examination findings. He also expressed his concern regarding whether she would be truthful with a second examination or review. There is no other pertinent medical evidence on file regarding the Veteran’s low back and knees other than VA outpatient treatment records beginning in 2015 which reflect low back pain and osteoarthritis. The Board acknowledges the Veteran’s assertions and those of a fellow serviceman and her spouse that she has a current bilateral knee disability, diagnosed as osteoarthritis, and a back disability related to service. However, as lay persons, they are not competent to provide a diagnosis or etiological opinion for complex disabilities involving the Veteran’s back and knees, including the etiology of osteoarthritis. Layno v. Brown, 6 Vet. App. 465 (1994). Rather, the determination must be provided by a medical professional with the proper training, education and experience, in the appropriate fields which they are not shown to have. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). For the foregoing reasons, the weight of evidence is against the Veteran’s claims for service connection for a low back disability and a bilateral knee disability. As the preponderance of the evidence is against these claims, the benefit of the doubt doctrine is not for application and the claims are denied. See 38 U.S.C.A. § 5107(b). Headache Disability The Veteran asserts that she developed migraine headaches in service in 1982 or 1983 after receiving a blow to the head with the butt of an M16 which rendered her unconscious. In support of this claim, the Veteran submitted a statement from a fellow serviceman who attested to her having various migraine headaches in service. She also submitted a statement from her spouse who said he has observed her “debilitating migraines” since service. Her service treatment records do not document a head injury. They do show that she was seen at a medical clinic in July 1985 complaining of headache in the frontal area, muscles aches, malaise and a cough for five days. Notably, she denied at this time sustaining an injury. She also denied blurred or double vision or photophobia. She was assessed as having a tension headache. She was seen again in September 1987 complaining of feeling weak with headaches, dizziness, nausea and feeling tired for about a week. She was assessed as having several nonspecific symptoms that could be related to her use of “bcp”. A VA emergency room record in December 2011 shows that the Veteran reported having a large bump on the back of her head for eight months which began hurting four days earlier. The Veteran reported at a VA headache examination in August 2013 that she was accidentally hit in the head with an M16 in 1981 or 1982 and lost consciousness for about 30 minutes. She said that she developed a cyst on her head where she had been hit. Regarding medical treatment, she said that she had only been treated once by VA for a headache, in March 2013. She went on to report that the headache was determined to be from dehydration related to a gastrointestinal virus. She was diagnosed in August 2013 as having a rebound/tension headache. A VA skin examination in August 2013 revealed a barely visible scar in the left mastoid area behind the right ear. The examiner reported that it was not clear whether the scar was from the head injury in service or from March 2012 when the Veteran had an infected sebaceous cyst incised and debrided. VA treatment records on file from 2015 to 2019 note that the Veteran had chronic headaches and that she was taking ibuprofen for them. A March 2015 record notes that she had a history of migraine headaches, while a June 2016 record from the optometry clinic notes that she denied being diagnosed as having migraine headaches. The June 2016 record also notes that her headaches were of an ocular etiology. A VA examiner in September 2020 opined that the Veteran’s headache disability, diagnosed as migraines, was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. He explained that her headaches during service were “acute only”. He also noted that there was no evidence of chronicity of care and that the Veteran’s symptoms are subjective only. He further noted that after service the Veteran was noted to have multiple headache complaints starting in 2013 and that no continuity of care has been noted immediately following discharge or within one year of discharge. In conclusion, he said that a nexus had not been established. The acute nature of the Veteran’s two documented headache complaints in service renders service connection under 38 C.F.R. § 3.303(a) or based on a chronic headache disability under 38 C.F.R. § 3.303 (b) inapplicable. Regarding establishing service connection under 38 C.F.R. § 3.303(d) based on nexus evidence, the evidence militates against the Veteran’s claim. This is in view of the VA examiner’s September 2020 opinion above. There is no contrary medical evidence on file. The Board acknowledges the Veteran’s assertions that her current headache disability, diagnosed as migraines, is related to service. While she is competent to report having chronic headaches since service, as a lay person, she is not competent to opine as to the diagnosis or etiology of those headaches. That is, she is not competent to opine that her migraine headache disability diagnosed decades after service is related to service. Layno v. Brown, 6 Vet. App. 465 (1994). Rather, the determination must be provided by a medical professional with the proper training, education and experience, in the appropriate fields which the Veteran is not shown to have. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). For the foregoing reasons, the weight of evidence is against the Veteran’s claims for service connection for a headache disability diagnosed as migraine headaches. As the preponderance of the evidence is against this claim, the benefit of the doubt doctrine is not for application and the claim is denied. See 38 U.S.C.A. § 5107(b). Kristin Haddock Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Shawkey, 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.