Citation Nr: 21004753 Decision Date: 01/28/21 Archive Date: 01/28/21 DOCKET NO. 17-46 813 DATE: January 28, 2021 ORDER Service connection for a lumbosacral spine disability is denied. FINDING OF FACT The preponderance of the evidence is against the finding that the Veteran’s lumbosacral spine disability had its onset in service, manifested to a compensable degree within one year of discharge, or is otherwise causally related to service. CONCLUSION OF LAW The criteria to establish entitlement to service connection for a lumbosacral spine disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Marine Corps from June 1951 to June 1952, and from January 1953 to August 1954. This matter is before the Board of Veterans’ Appeals (the Board) on appeal from the June 2013 and June 2014 Department of Veterans Affairs (VA) Regional Office (RO) rating decisions. The rating decisions, inter alia, denied service connection for a low back injury because the evidence submitted was not new and material. The Veteran’s Notice of Disagreement (NOD) was received in June 2014. The Statement of the Case was issued in August 2017 and the Veteran’s VA Form 9, substantive appeal to the Board was received in September 2017. In a January 2019 decision, the Board reopened the claim and remanded the issue to the agency of original jurisdiction (AOJ) for additional development and adjudication. The Board finds that the RO substantially complied with prior remand directives, to the extent possible, and no further action in this regard is warranted. See Dyment v. West, 13 Vet. App. 141, 146-47 (1999) (concluding that a remand is not required under Stegall v. West, 11 Vet. App. 268 (1998) where there was substantial compliance with the Board's remand instructions). A September 2019 Board decision denied service connection for a lumbosacral spine disability. The Veteran appealed the decision to the United States Court of Appeals for Veterans Claims (the Court). In a July 2020 Order, the Court vacated the Board’s decision and remanded the matter to the Board for development consistent with the parties' Joint Motion for Remand. The case was returned to the Board. Entitlement to service connection for a lumbosacral spine disability. The Veteran seeks service connection for a lumbosacral spine disability. Service connection may be established for a disability resulting from personal injury suffered or disease contracted in the line of duty or for aggravation of preexisting injury suffered or disease contracted in the line of duty. 38 U.S.C. §§ 1110, 1111, 1131, 1137 (2012); 38 C.F.R. § 3.303.   Generally, to establish service connection, there must be lay or medical evidence of (1) a current disability, (2) incurrence or aggravation of a disease or injury in service, and (3) a nexus between the in-service injury or disease and the current disability. See 38 U.S.C. § 1110 (2012); Davidson v. Shinseki, 581 F.3d 1313, 1315-16 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004).   Pursuant to 38 C.F.R. § 3.303(b), where a chronic disease is shown as such in service, subsequent manifestations of the same chronic disease are generally service connected; if a chronic disease is noted in service but chronicity in service is not adequately supported, a showing of continuity of symptomatology after separation is required.  Entitlement to service connection based on chronicity or continuity of symptomatology pursuant to 38 C.F.R. § 3.303(b) applies only when the disability for which the Veteran is claiming compensation is due to a disease enumerated on the list of chronic diseases in 38 U.S.C. § 1101(3) or 38 C.F.R. § 3.309(a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013).  In addition, such chronic diseases are presumed to have been incurred in service if they manifested to a compensable degree within one year of separation from service.  38 U.S.C. §§ 1101(3), 1112(a)(1), 1113; 38 C.F.R. §§ 3.307(a), 3.309(a).   Lay assertions may serve to support a claim for service connection by establishing the occurrence of observable events or the presence of disability or symptoms of disability subject to lay observation. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); see also Buchanan v. Nicholson, 451 F. 3d 1331, 1336 (Fed. Cir. 2006) (addressing lay evidence as potentially competent to support presence of disability even where not corroborated by contemporaneous medical evidence). The United States Court of Appeals for the Federal Circuit (Federal Circuit) has clarified that lay evidence can be competent and sufficient to establish a diagnosis or etiology when (1) a lay person is competent to identify a medical condition; (2) the lay person is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009).   The credibility and weight of all the evidence, including the medical evidence, should be assessed to determine its probative value, and the evidence found to be persuasive or unpersuasive should be accounted for, and reasons should be provided for rejecting any evidence favorable to the claimant. See Masors v. Derwinski, 2 Vet. App. 181 (1992). Equal weight is not accorded to each piece of evidence contained in the record; every item of evidence does not have the same probative value.   It is the Board’s responsibility to determine whether a preponderance of the evidence supports the claim or whether the evidence is in relative equipoise, with the veteran prevailing in either event, or whether there is a preponderance of evidence against the claim, in which case the claim must be denied. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Then, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding service origin, the degree of disability, or any other point, such doubt will be resolved in favor of the claimant. By reasonable doubt is meant one which exists because of an approximate balance of positive and negative evidence which does not satisfactorily prove or disprove the claim. 38 C.F.R. § 3.102.   Veteran’s statements The Veteran submitted several statements regarding his claim. These statements are summarized below. A February 2000 statement from the Veteran indicates that either in late spring or early summer in 1952, he was stationed in Hawaii when a fire started in his bunker. The Veteran indicates that he was driving a jeep when the fire started and that after numerous attempts, he found a fire extinguisher and fought the fire. The Veteran states that during all this driving and getting in and out of his vehicle, he hurt his lower back. The Veteran also states that later he was sent to the Tripler Army Hospital and no information was given to him that he can recall. Then, the Veteran goes on to explain that he was discharged in 1952 and re-entered service in 1953. The Veteran contends that he had problems with his lower back but did not pay attention to it and went into law enforcement from 1968 to 1984 at which point he retired. Following his 1984 retirement from law enforcement, the Veteran reports becoming a barber. He then states that after a while he started noticing his back giving out, aching, and getting worse as time went on. The Veteran asserted that he was treated while he was still a police officer but that the doctor is now deceased. A June 2006 statement from the Veteran indicates that in April 1952, he was stationed in Hawaii and was on the scene of a fire in the bunkers. The Veteran was in a jeep, located a fire extinguisher, was getting in and out of his jeep, and injured his back lower right side, his left hand, and his forearm in handling an extinguisher. The Veteran also indicates that he was treated for his hand and forearm and sent to the Tripler Army Hospital in Honolulu, Hawaii. The Veteran goes on to state that during these treatments, there were no entries made in his medical record. The Veteran added that there was no mention or entries regarding his back injuries in his medical records; however, there are entries on his left hand and forearm. A July 2006 statement from the Veteran states that his claimed in-service injury is noted in his treatment records from April 18, 1952 to April 26, 1952. The Veteran also states that these records show treatment for injuries of his hand and forearm. A July 2012 statement from the Veteran indicates that in April 1952, he was stationed in Hawaii and injured his lower back, left hand and forearm, and his left lower leg. The Veteran also indicates that he was treated for his hand and forearm as he sustained bruises and cuts. The Veteran then goes on to state that his lower back had to be treated at the Tripler Army Hospital in Honolulu, Hawaii. The Veteran states that somehow his military records do not show treatment for his back injury at Tripler Army Hospital. In a July 2013 letter from the Veteran to his fellow soldier, S.M., the Veteran indicates that he injured his back and left leg in service and that he was first treated at the base by the corpsman and then sent to the Tripler Army Hospital in Honolulu, Hawaii. The Veteran also indicates that he was treated there several times and then discharged but there are no records of the treatment. A September 2013 letter from the Veteran indicates that his back injury happened at the same time as his hand and forearm injuries in the timeframe of April 18, 1952 and April 26, 1952. The Veteran indicates that he was sent to Honolulu Tripler Hospital and there is a great deal of medical records missing form his file. A September 2016 VA Form SF 180 submitted by the Veteran indicates that he was treated for his claimed injury at Tripler Army Medical Center in April 1952 and then at Camp Pendleton in January 1953. The Veteran also submitted a July 2020 memorandum with additional legal arguments for consideration by VA. The memorandum appears to be a copy of the arguments that were previously submitted by the Veteran’s attorney to the Court. This memorandum indicates that the Board needs to adequately address the Veteran’s lay statements regarding his in-service injury to the extent that they provide sufficient basis for a finding of service connection; to provide an adequate statement of reasons or bases for any finding that there is no evidence to corroborate the Veteran’s lay statements of an in-service injury; to address favorable evidence of continuity; and to obtain clarification on the Veteran’s submitted private opinions, or at minimum explain why clarification is not needed. The relevant portions of this memorandum will be addressed in the below discussion. Service treatment records At the outset, the Board notes that some of the Veteran’s service treatment records (STRs) are unavailable despite the RO’s multiple attempts to locate the records. Specifically, the RO requested the Veteran’s Tripler Army Medical Center, Hawaii records from the National Personnel Records Center (NPRC) in November 2012. Camp Pendleton, California records were also requested in October 2016. A previous attempt to obtain the Veteran’s complete STRs was made in August 2000. The NPRC responded in December 2012 and August 2017 indicating that these records are not maintained at NPRC. A Formal Finding of Federal Records of Unavailability was issued in December 2012, and the Veteran was notified of the RO’s attempts and unavailability of the records in December 2012, August 2015, and August 2017. When STRs are incomplete as is the case here, the Board has a heightened obligation to explain its findings and conclusions and to consider carefully the benefit-of-the-doubt rule. See O'Hare v. Derwinski, 1 Vet. App. 365, 367 (1991); Russo v. Brown, 9 Vet. App. 46 (1996). There is no presumption, either in favor of the Veteran or against VA, arising from missing records. See Cromer v. Nicholson, 19 Vet. App. 215, 217-18 (2005). Despite the unavailability of the Veteran’s complete STRs, numerous records were obtained and associated with his file. The pertinent records are summarized here. The Veteran’s available STRs are silent with respect to any complaints or treatments for a low back injury. A June 1951 entrance examination indicates that there are no medical problems and that the Veteran was cleared for service. The Veteran’s STRs contain sick call records listing the Veteran’s complaints, treatments, and dispositions. The first sick call record contains entries dated from February 1952 to April 1952. These do not have corresponding physician’s notes from the sick call visits. An April 18, 1952 entry states that the Veteran had a wound, lacerated, back left hand and swelling, left forearm. Under treatment, it was noted that the wound was cleansed and dressed using butterfly bandage. He was released for duty. An April 19, 1952 entry states that the Veteran’s wound was redressed. An April 22, 1952 entry states that the Veteran’s wound was cleansed and redressed. That same day, it was noted that he had pain along his 5th metacarpal finger and x-rays showed no fracture. An April 23, 1952 entry indicates that the Veteran’s finger wound was cleansed and dressed. An April 25, 1952 entry indicates that the Veteran’s finger wound was cleansed and dressed. An April 26, 1952 entry indicates that the Veteran’s finger wound was cleansed and dressed. On each of these days, the Veteran was released for duty. The other sick call record contains complaints dated from October 1953 to February 1954. During this time the Veteran was treated for a sprained wrist, stomach problems, and fungus on his feet. Of note, the Veteran’s STRs contain an April 29, 1952 photofluorographic (x-ray) findings indicating normal chest. The next available record is a June 5, 1952 report of medical examination which cites the April 29, 1952 chest x-ray. The purpose of the examination was noted to be “duplicate health record.” The examining facility is noted to be in Oahu, Territory of Hawaii. The Veteran was not noted to have any medical problems, and his spine and musculoskeletal systems were listed as normal upon examination. There is a corresponding note dated June 5, 1952 from the same physician who completed the June 5, 1952 service examination indicating that duplicate health record made on June 5, 1952 was in lieu of missing health record. A subsequent entry stamped on June 6, 1952 from the physician stated that the Veteran had been examined on that date and found physically qualified for transfer. The available STRs also contain four subsequent medical examinations with similar findings indicating that spine and musculoskeletal systems were normal upon clinical evaluation. A June 24, 1952 report of medical examination from the Naval Station Treasure Island in San Francisco, California indicated that the purpose of the examination was release from active duty. The report indicates that the Veteran did not have any problems and was cleared for discharge. The report states that the Veteran’s spine and other musculoskeletal systems were normal upon clinical evaluation. A January 1953 report of medical examination for reenlistment conducted in Los Angeles, California indicates that the Veteran did not have any problems and was cleared for service. The report also documented that the Veteran’s spine and other musculoskeletal systems were normal upon clinical evaluation. The STRs also contain a February 1953 immunization report and a March 1953 dental report from unknown locations. A March 1953 note within the Veteran’s available STRs indicates that he was in Parris Island, South Carolina and examined and found to be physically qualified for transfer. An August 1953 report of medical examination from Camp Pendleton, California documented that the Veteran’s spine and other musculoskeletal systems were normal upon clinical evaluation. An August 1954 report of medical examination indicates that the Veteran did not have any problems and was cleared for discharge. The Veteran’s spine and other musculoskeletal systems were normal upon clinical evaluation. In the Notes section, it states, "I certify that I have been informed of and understand the BUMED INSTRUCTION 6120.6," with the Veteran’s signature underneath. Thus, the Veteran indicated he was informed he had been found to be fit, and if he felt he had any serious medical problems, he should so inform the examining physician. See Real v. U.S., 906 F.2d 1557, 1559 (Fed. Cir. 1990) (describing the meaning of BUMED INST. 6120). Finally, the Veteran’s STRs contain records of medical care at Camp Pendleton, California, including individual physician summaries for each visit. These are dated from September 1953 to August 1954. An April 1954 treatment note for left otitis media indicates that that the Veteran was in generally good health and listed only a broken fifth talus in 1951 as a previous injury. Post-discharge records After service, an August 1994 private lower back x-ray report from Dr. G.D. indicates degenerative scoliosis, multilevel disc space narrowing at L3-4 and L4-5 with degenerative changes at endplate and facet joints. A March 1996 private bone scan report from Dr. R.M. indicates degenerative-type uptake within the mid to lower lumbar spine and very mild lumbar scoliosis which was unchanged. It was noted that this showed little variation compared with the old study performed in August 1994. The study was ordered by Dr. K.S. A June 1997 medical record indicates that the Veteran is a barber and holds his arms up all the time. The record notes that the Veteran now has neck pain affecting back and lumbar. The Veteran was diagnosed with a cervical strain. A July 1997 private therapy note from Dr. K.S.’s office indicates that the Veteran was seen for a neck sprain which was also described as a whiplash injury which was exacerbated by overuse due to the Veteran’s work as a barber. Onset was noted to be 1997. It was noted that the Veteran’s symptoms resolved after physical therapy. An August 1998 private hospitalization note indicated that the Veteran was admitted as a result of abdominal pain and vomiting. Under musculoskeletal history, it was noted that the Veteran was active and enjoyed a healthy lifestyle. It was also noted that the Veteran worked out in his home gym, did weight lifting, and used a heavy punching bag. A March 1999 private physical therapy note from Dr. K.S. indicates that the Veteran complained of right low back, right posterior thigh, and lateral calf pain. Onset date was listed as July 1998. The Veteran reported having these symptoms for several months. It was noted that there was no apparent cause, although the pain worsened after the Veteran rested in bed for a few weeks after his colon surgery in July 1998. The Veteran reported his symptoms being aggravated by standing at work (he was noted to be a barber), and pain with sitting. The Veteran also reported increased low back pain two weeks ago after he moved the refrigerator. It was noted that the Veteran has not done physical therapy for his back before. The note indicates that the Veteran underwent physical therapy for the duration of the month of March and reported his back feeling much better, with occasional tingling into his right leg. In May 1999, the Veteran was ordered to undergo physical therapy for four to six weeks by Dr. K.S. His diagnosis was listed as right sided low back pain and right lateral knee and thigh pain. An October 1999 private lumbar spine MRI report from Dr. G.D. indicates moderate rotatory degenerative scoliosis with multilevel degenerative annular bulging and facet arthropathies. There was no evidence for dominant central spinal stenosis or lateral recess stenosis. In November 1999, Dr. K.S. wrote a letter indicating that the Veteran has been treated by them in the past and on this date for severe low back pain with radiation. The letter indicates that the pain radiated down to the Veteran’s right leg and that the Veteran was referred to Dr. K.S. for physical therapy for the same condition February 1999, and earlier several years prior to this. Dr. K.S. indicated that the Veteran reported sustaining several injuries to his low back during military service. Specifically, the letter states that the injuries were sustained “Once while stationed at Tripler Army Hospital in Hawaii and also at Camp Pendleton. At Tripler Army Hospital he was assigned to security for the ammunition depot and sustained injury to the low back while fighting a fire. He did not recount to me his experiences at Camp Pendleton and the details of that particular injury.” Dr. K.S. indicated that the Veteran had several imaging studies performed and that an October 1999 MRI of the lumbar spine revealed disc bulging, multilevel degenerative disc disease through the lumbar spine. Dr. K.S. indicated that the Veteran’s lumbar disc disease is the source of his lower back pain with radiation. Dr. K.S. also forwarded the aforementioned May 1999 x-rays of the lumbar spine and the October 1999 MRI of the lumbar spine. A February 2000 letter from Dr. K.S. indicates that the Veteran asked Dr. K.S. to provide a narrative report on his behalf regarding his back and hip condition. Dr. K.S. indicated that the Veteran sustained several injuries to his low back in the military service, and that October 1999 imaging studies revealed multilevel degenerative joint disease and disc bulging. The letter indicates that the Veteran has been a barber for the past 16 years and that prior to that, he retired from a career in law enforcement. The letter also indicates that physical therapy has not improved the Veteran’s condition and that he undergo a neurosurgical evaluation. A May 2000 VA treatment note indicates that the Veteran was seen for a new general medicine appointment. The note states that there is a history of low back pain with right-sided radiculopathy after military trauma per Veteran’s reports. The note goes on to state that a 1999 MRI showed multilevel lumbar DDD and disc herniation. He was noted to be status post physical therapy. The Veteran reported having a flare up of back pain two months ago but doing much better. With respect to low back pain, the Veteran was counseled on rest. Upon examination of the back, there was no costovertebral angle tenderness and no tenderness over the spine. In September 2000, the Veteran underwent a VA examination for his claim. The Veteran was diagnosed with severe lumbar spine DDD involving five joint areas in the lower lumber spine. The Veteran reported that he was hospitalized for a back injury in 1952 at Tripler Army Hospital and was diagnosed with a back strain and has had problems ever since. The VA examiner indicated that he reviewed the Veteran’s records and did not find evidence of a back strain or a hospitalization. The VA examiner noted that the Veteran had chronic pain in his back which was first intermittent and has become constant. The VA examiner noted that the Veteran had chiropractic treatment and injections. The VA examiner also cited the October 1999 private lumbar spine MRI. The VA examiner noted that despite not being able to find any evidence of the Veteran’s injuries, they found him to be credible. A November 2000 VA treatment note indicates that the Veteran has a past medical history of chronic back pain and knee pain with arthritis. A December 2000 letter and private evaluation from Dr. T.M. indicates that the Veteran reported exacerbation of chronic low back pain and knee pain. The Veteran reported his symptoms began while he was in the military in 1952. The letter goes on to state that the symptoms began while extinguishing a fire and climbing into and out of a jeep. It was noted that the Veteran is a barber and that his job requires him to stand, aggravating his symptoms. Under the assessment, Dr. T.M. indicated that the Veteran presented with signs and symptoms consistent with degenerative disc disease and osteoarthritis. A December 2000 letter from Dr. K.S. indicates that the Veteran was Dr. K.S.’s patient from 1997 through 2000. Dr. K.S. states that the Veteran has certain medical conditions that most likely started during the time that he served in the military, though that was before the Veteran was under Dr. K.S.’s care. Dr. K.S. also states that the Veteran has lumbar DDD which is a chronic medical condition that likely started in the military (1950’s). A June 2006 VA treatment note indicates that the Veteran states that he needed to discuss his service connected status and denials with the VA physician. The note indicates that the Veteran reported having chronic back pain ever since service and that he was injured at the same time as his hand injury. The Veteran’s medications were reviewed, refills submitted, and questions answered. The Veteran’s history of back injury in service was noted in new orders and assessments. There was no diagnostic testing or treatment. In April 2007, the Veteran underwent a VA examination for hand, thumb, and fingers. During the examination, the Veteran reported lacerating and bruising his left forearm on metal objects in the military while fighting a fire. The Veteran indicated that there was some treatment including cleansing and dressing but no suturing. The Veteran reported having decreased duty for several days and returning to full status after two or three weeks. The Veteran reported back pain and indicated that he thinks that it started in the military. A September 2011 private lumbar x-ray report indicates that the Veteran has severe scoliosis and lumbar spine DDD, with moderate progression compared to 2005. An October 2011 private treatment note from Dr. S.K. indicates that the Veteran was seen for right lower back pain. It was noted that the Veteran pulled a muscle on his right lower back. Dr. S.K. noted that this happened the prior Saturday after the Veteran was digging weeds. The back pain was in the thoracic region and Dr. S.K. indicated that it seemed to be muscular based on the examination. A January 2013 letter from the Veteran’s private physician, Dr. M.Y. indicates that the Veteran has been under his care since September 2012 and that the letter is being written upon the Veteran’s request. Dr. M.Y. indicates that he performed comprehensive history on the Veteran and medical exams. Dr. M.Y. goes on to state that the Veteran has multiple back and neck problems that are consistent with repetitive wear and tear as well as recurrent trauma which apparently occurred years ago. Dr. M.Y. indicates that given the Veteran’s past history, his medical problems most likely occurred during his military service in the 1950’s. An October 2013 letter and private new patient evaluation from Dr. G.O. indicate that the Veteran is a retired law enforcement officer from the Sheriff’s Department and a Marine Corps Veteran. The letter states that the Veteran presents with a history of chronic low back pain and right-sided neck pain with associated numbness radiating to both hands. The letter also states that the Veteran described an original injury which was service connected, consisting of putting out a fire with injury to the left hand, forearm, and low back. It was noted that the Veteran had difficulty mobilizing and eventually was worked up in Honolulu with all records apparently being lost from the VA. The letter states that the Veteran’s ongoing back pain led to the neck pain. Dr. G.O. reviewed October 2013 MRI of the cervical spine indicating moderate to severe central stenosis C4-5 and C5-6, indicating that the stenosis seems to be more on the right than the left with some widespread facet arthropathy. Under impressions, Dr. G.O. noted status post low back injury which is service connected, resulting in increasing neck pain and restriction, particularly moving towards the left side with herniation and stenosis. Dr. G.O. concluded that the Veteran has a chronic back condition related to his service and that the Veteran’s neck complaints are attributable to this. A May 2014 letter from the Veteran’s friend, S.M. indicates that he served with the Veteran, broke his leg, and spent several weeks at Tripler Army Hospital where he lost track of the Veteran. The letter goes on to state that after S.M. returned to duty, the Veteran was injured while fighting a fire. Further, the letter states “I don’t know any of the details of [the Veteran’s] injuries but he said he was treated at Tripler hospital.” The letter also goes on to state that S.M. ran into the Veteran at Camp Pendleton in mid-1954. A September 2014 letter from the Veteran’s private physician, Dr. M.M. indicates that the Veteran continues to suffer from low back pain. Dr. M.M. states that the Veteran reported believing this problem to be related to service. Dr. M.M. also states that they cannot confirm or deny the Veteran’s contentions but can confirm that these conditions worsened since 2005. Pursuant to the January 2019 Board remand, the Veteran was scheduled for a VA examination for his claim. In essence, the Board acknowledged the opinions of private providers (discussed further below), but explained that the opinions lacked a complete rationale. In each case, the private opinions link the Veteran’s current back disability solely on the Veteran’s self-reported history of an in-service back injury. The Board also noted that even if it conceded that an in-service back injury occurred, none of the medical opinions of record provide any rationale as to why the Veteran’s current back disability is, as likely as not, related to the back injury that occurred in 1952. Accordingly, the Board determined that a VA examination was necessary to obtain a medical opinion based on the totality of the evidence, not just the Veteran’s contradicted self-reported history. As discussed below, the Board herein finds that the Veteran’s reported history is not credible. However, the Veteran failed to report to his examination without good cause shown. Pursuant to 38 C.F.R. § 3.655, when entitlement or continued entitlement to a benefit cannot be established or confirmed without a current VA examination or reexamination and a claimant, without good cause, fails to report for such examination scheduled in conjunction with an original compensation claim, the claim shall be rated based on the evidence. Although the Veteran was scheduled for the VA examinations requested in the January 2019 Board remand, an Exam Scheduling Request Contention Cancellation report received in July 2019 stated that he did report for the examination. The Board acknowledges that the record does not contain a notice letter for the examinations, and there is no published guidance establishing the presumption of regularity in such a situation. See Kyhn v. Shinseki, 716 F.3d 572 (Fed. Cir. 2013). However, the Board finds that the facts of this case are distinguishable from the facts considered in Kyhn as the Veteran has not asserted that he did not receive notice of the examinations. There is also no indication that the Veteran has provided a reason for not reporting to the examination, and he has not requested for the examination to be rescheduled. In a July 2019 supplemental statement of the case (SSOC), the RO explained the provisions of 38 C.F.R. § 3.655(b) and denied the Veteran's claim based on the evidence of record. Thus, the record demonstrates that the Veteran was made aware of the consequences for his failure to report for an examination under 38 C.F.R. § 3.655. Moreover, the Veteran was given an opportunity to respond to the SSOC; and neither the Veteran nor his representative requested that the examination be rescheduled or reported that the Veteran did not receive notice of the examination. The Board notes that "[t]he duty to assist is not always a one-way street," and claimants are expected to comply with reasonable requests. Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). As the Veteran did not report for the July 2020 examination without good cause, the Board will not remand the case to obtain any additional opinion or clarification and will instead adjudicate his original compensation claim for service connection for a lumbosacral disability based on the evidence of record. See 38 C.F.R. § 3.655(b). Analysis After a review of the entire record, the Board finds that a preponderance of the evidence is against the claim. The Veteran’s current lumbosacral disability did not have its onset in service, did not manifest to a compensable degree within one year of discharge, and is not otherwise causally related to service, to include the claimed April 1952 fire extinguisher injury. The Veteran’s lumbosacral disability did not have its onset in service. In essence, the Veteran alleges that he sustained an April 1952 fire extinguisher injury, was treated for his back at Tripler Army Hospital in Hawaii and continued to have back problems following this April 1952 in-service injury. While the Veteran’s STRs are incomplete, the Board finds that the Veteran’s reported medical history is not credible in light of the inconsistencies in the Veteran’s statements and the available findings from the STRs. The Board first notes that the Veteran provided several inconsistent statements with respect to what treatment he received in service, where he received it, and the diagnosis he received. His February 2000 statement indicates that he was treated only at the Tripler Army Hospital in Hawaii following injuries he sustained while fighting a fire, he was discharged in 1952, and then he re-enlisted in 1953. His September 2016 VA Form SF 180 indicates that he was treated at Tripler Army Medical Center in April 1952, and then at Camp Pendleton in January 1953. To further contrast from these contentions, the November 1999 private treatment note from Dr. K.S. indicates that the Veteran reported sustaining several injuries to his low back during military service. The Veteran stated that he sustained one injury to his low back for which he was treated at Tripler Army Hospital and another injury to his low back for which he was treated at Camp Pendleton. Moreover, during the September 2000 VA examination, the Veteran reported being hospitalized at Tripler Army Hospital only, and being diagnosed with a back strain. The Board notes that this report is inconsistent with the Veteran’s prior February 2000 statement indicating that no information was given to him at the Tripler Army Hospital that he can recall. Notwithstanding these inconsistencies, the Veteran’s available STRs contradict all of his contentions regarding his disability having its onset in service. The Veteran alleges that his disability stems from an April 1952 fire extinguishing injury which he sustained in Hawaii. The available STRs contain a sick call outlining all of the injuries for which the Veteran was treated for from February 1952 to April 1952 while stationed in Hawaii. This log concludes with several blank spaces, indicative that these are complete entries for April 1952 treatment rather than suggesting that the entries continued onto another page that may be missing. The April 1952 entries include the injuries that he reportedly sustained from extinguishing a fire, consisting of laceration and swelling of the left arm. The sick call record indicates that on April 18, 1952 the Veteran was treated for a lacerated wound on the back-left hand and for swelling on his forearm and released for light duty the same day without any hospitalizations. The record does not contain complaints or treatments related to his back. Instead, the sick call record contains treatment for the same left hand wound the following day, with follow up care on April 22, 23, 25, and 26, including x-rays of the Veteran’s 5th finger and dressing changes. Each time that the Veteran was treated for his arm injury and released for duty on the same day. There is no indication that the next available April 29, 1952 chest x-ray report was obtained for purposes of treatment. The use of the findings for the subsequent June 1952 service examination report instead indicates that the x-ray was associated that examination. Accordingly, while the records indicate that the Veteran was treated for an injury in April 1952, the available records weigh against finding that the injury involved his back and led to a hospitalization in Hawaii as the Veteran contends. Moreover, the available STRs indicate that the Veteran did not have back problems for the remainder of his active duty and was not subsequently treated for his back at Camp Pendleton. As indicated above, soon after the time of the Veteran’s reported injury, his spine was found to be normal in the June 1952 service examinations. This finding was unchanged in the multiple service examinations that were subsequently conducted. Specifically, the Veteran’s STRs contain January 1953, August 1932, and August 1954 reports of medical examinations indicating that the Veteran’s spine and musculoskeletal systems were normal upon examinations and that he did not have any medical problems. Moreover, the Veteran’s signed certification from the August 1954 service examination indicating that he did not report any medical problems at that time, despite being informed that he had been found fit and should inform the examiner of any serious medical problems; weighs against the Veteran’s report that he had continuing problems following an in-service injury. Thus, there is evidence in the Veteran’s available STRs to contradict his contentions that his symptoms of a lumbosacral disability began and continued following an April 1952 injury. With respect to the Veteran’s contentions that there was continuity of symptomatology between his service and eventual development of his back disability, the contentions have been contradicted by the probative evidence of record. As the evidence in this matter illustrates that the Veteran was not treated for a back injury and was not diagnosed with a back strain in April 1952 or later in service, there can be no continuity of symptomatology. The Veteran’s discharge medical examination confirms that the Veteran’s back symptoms did not begin in service. Thus, the December 2000 notation regarding the Veteran reporting symptoms in 1952 as well as the September 2000 VA examination report that the Veteran was treated for a 1952 back injury and diagnosed with a back strain Tripler Army Hospital, are not afforded probative value as they have been contradicted by the record. The Veteran also alleged that he was treated for back symptoms while he was a police officer. However, this report still does not establish a continuity of chronicity as the Veteran did not become a police officer until years after service. The record shows that the Veteran retired from being in the police force in 1984 after approximately 19 years of service. This means that his service started at least 10 years after discharge. The earliest evidence of the Veteran having a diagnosed lumbosacral disability is the August 1994 private x-ray report showing degenerative scoliosis and multilevel disc space narrowing with degenerative changes. This is approximately forty years after discharge. The passage of many years between discharge from active service and the medical documentation of a claimed disability is a factor that tends to weigh against a claim for service connection. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). While the Veteran contends that his back problems began after his 1952 injury and continued in service and thereafter, these contentions have been contradicted by the record. The Board emphasizes that the Veteran’s statements with respect to his in-service injury and continuity of symptomatology are not rejected solely because there of lack of contemporaneous evidence substantiating his contentions. Although the Veteran is competent to report in-service events and that he experienced observable symptoms since service, his reports are not afforded probative value because they are inconsistent and are contradicted by the other evidence of record, mainly his STRs from April 1952, his in-service medical examinations, and the post-discharge records showing no diagnosis of a lumbosacral disability until August 1994. Consequently, any opinions that were rendered as a result of the Veteran’s self-reported history are not afforded probative value. In other words, the Veteran’s contentions are not lacking in support because of lack of evidence. Instead, the available medical evidence of record illustrates that these contentions are not credible. Based on the foregoing, the Board finds that the most probative evidence of record reflects that the lumbosacral disorder did not manifest until many years after the Veteran's active duty service. As a result, the Veteran is not entitled to service connection for his lumbar spine disorder on a presumptive basis, either as a chronic disease during service or within one year of service. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307(a)(3), 3.309(a); Walker, 708 F.3d 1335 -37. Therefore, chronicity is not established in service or within a year of separation. The remaining question is whether the Veteran’s current lumbosacral disability is otherwise causally related to service. However, the probative evidence of record in this matter additionally indicates that the Veteran’s current lumbosacral disability is not related to service. Although the Board acknowledges the September 2000 VA examiner’s opinion that the Veteran’s reported history of back symptoms present since service was credible despite being unable to locate any evidence of the Veteran’s in-service injury or any other injury to his back, the Board has found otherwise for the reasons explained above. As this opinion was based on the details of the reported history that the Board has found to be not credible, it does not provide probative value in support of the claim. With respect to the letters submitted by the Veteran’s private physicians, the Board also cannot assign these opinions probative value. In summary, the opinions are not afforded probative value as they are based on the Veteran’s self-reported history which the Board has found to be not credible, they are not based on a complete review of the Veteran’s available STRs, and they do not provide any independent medical rationale for the conclusions reached. The individual letters are discussed below. A December 2000 letter from Dr. T.M. indicates that the Veteran was evaluated for reported exacerbation of chronic low back pain and knee pain and that the Veteran reported his symptoms began while he was in the military in 1952. While Dr. T.M. did not provide a full nexus opinion in this case, his conclusion that the Veteran’s symptoms are consistent with DDD and osteoarthritis is suggestive of a nexus, as the letter also states that the symptoms began in 1952. However, this letter is not afforded probative value because the conclusion that the Veteran’s symptoms began in 1952 appears to be based solely on the Veteran’s self-reported history which the Board has found to be not credible. See Reonal v. Brown, 5 Vet. App. 458, 460-61 (1993) (a valid opinion needs to be based on accurate facts). A December 2000 letter from Dr. K.S. indicates that they provided comprehensive care to the Veteran from 1997 to 2000 and that the Veteran has certain conditions that most likely started during that time, though this was before the time that the Veteran was under my care. The letter goes on to state that the Veteran has lumbar spine DDD and that it is a chronic condition that likely started in the military (1950’s). The letter is not afforded probative value due to complete absence of any rationale. A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. Nieves-Rodriquez v. Peake, 22 Vet. App. 295 (2008). Moreover, a medical opinion is considered adequate “where it is based upon consideration of the veteran’s prior medical history and examinations and also describes the disability, if any, in sufficient detail so that the Board’s ‘evaluation of the claimed disability will be a fully informed one.’“ Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007) (quoting Ardison v. Brown, 6 Vet. App. 405, 407 (1994) (quoting Green v. Derwinski, 1 Vet. App. 121, 124 (1991)). The December 2000 letter does not provide any details regarding the information that was used to formulate this conclusion, indicate what records were reviewed, or indicate whether the Veteran’s post-discharge employment and medical history was considered. Although Dr. K.S. submitted prior letter in November 1999 and February 2000, these letters similarly lack probative value as they only described the Veteran’s reports regarding his claimed in-service injuries as well as the Veteran’s current disability and did not suggest that there is a nexus. The Board also finds that the September 2014 letter from Dr. M.M. indicating they the doctor cannot confirm or deny that the Veteran’s current disability is related to service does not provide any positive opinion in support of the Veteran’s claim. A January 2013 letter from M.Y. is also not afforded probative value because Dr. M.Y.’s letter indicates that the conclusion is based on the Veteran’s not credible, self-reported history of trauma during service and relevant medical problems that began at that time. An October 2013 letter from Dr. G.O. is similarly not afforded probative value because it is based on the Veteran’s reports that he had experienced ongoing back pain since a 1952 in-service injury. The Board again notes that these contentions have been found to be not credible. In addition to the aforementioned letters from private treatment records, the Veteran’s VA treatment records contain a May 2000 notation of history of low back pain. However, there is no indication of onset. A September 2000 VA treatment note indicates that the Veteran reported being hospitalized for a back injury in 1952 at Tripler Army Hospital and being diagnosed with a back strain with problems happening since then. A June 2006 VA treatment note indicates that the Veteran requested to speak to a VA physician about his service reported back pain since service following an in-service injury. The September 2000 and June 2006 VA treatment notes contain solely the Veteran’s self-reported history which has been contradicted by the record. The Board acknowledges the Veteran’s contention that his lumbar spine disability was caused by his military service. However, the Veteran is not competent to provide a nexus opinion regarding this issue. The question of the etiology of the Veteran's current lumbar spine disability falls outside the realm of common knowledge of a lay person as it involves a complex medical question not capable of lay observation. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). The Veteran has not been shown to possess the requisite medical training, expertise, or credentials needed to render a competent opinion on medical causation. See King v. Shinseki, 700 F.3d 1339, 1345 (Fed. Cir. 2012). As such, the Veteran’s lay statements cannot serve as the basis for a nexus. (Continued on the next page)   Accordingly, the preponderance of the evidence is against the claim for service connection for a lumbosacral disability, and it is therefore denied. In arriving at the decision to deny the claim, the Board has considered the applicability of the benefit-of-the-doubt rule enunciated in 38 U.S.C. § 5107(b). However, as there is not an approximate balance of evidence, that rule does not apply. See Gilbert v. Derwinski, 1Vet. App. 49 (1990); Ortiz v. Principi, 274 F. 3d 1361 (Fed. Cir. 2001). K.C. SPRAGINS Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Kuksova, Kseniya 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.