Citation Nr: 21061598 Decision Date: 10/04/21 Archive Date: 10/04/21 DOCKET NO. 16-43 999 DATE: October 4, 2021 ORDER Entitlement to service connection for a right hip disability, to include as secondary to service-connected left ankle disability, is denied. Entitlement to service connection for a lumbar back disability, to include as secondary to service-connected left ankle disability, is denied. Entitlement to service connection for a right shoulder disability is denied. FINDINGS OF FACT 1. A right hip disability was not manifest during active service, or until many years after service, and is not shown to be causally or etiologically related to an in-service event, injury, or disease. 2. A right hip disability was not caused or aggravated by other service-connected disability. 3. A lumbar spine disability was not manifest during active service, or until many years after service, and is not shown to be causally or etiologically related to an in-service event, injury, or disease. 4. A lumbar spine disability was not caused or aggravated by other service-connected disability. 5. A right shoulder disability was not manifest during active service, or until many years after service, and is not shown to be causally or etiologically related to an in-service event, injury, or disease. CONCLUSIONS OF LAW 1. The criteria for service connection for a right hip disability have not been met. 38 U.S.C. §§ 1131, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.310 (2020). 2. The criteria for service connection for a lumbar back disability have not been met. 38 U.S.C. §§ 1131, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.310 (2020). 3. The criteria for service connection for a right shoulder disability have not been met. 38 U.S.C. §§ 1131, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from January 2002 to April 2006. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an October 2014 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida. By way of background, the Veteran originally filed a claim for service connection for a right shoulder disability and a lumbar back disability in November 2007, and that claim was denied in an October 2008 rating decision. That decision was not appealed within one year, and thus became final. The Veteran filed to reopen his right shoulder service connection claim in August 2011, but that was denied in a February 2012 rating decision. Again, the Veteran did not appeal that rating decision, and thus it became final. In April 2013, the Veteran filed a claim to reopen the right shoulder and lumbar back disabilities, an original service connection claim for his right hip, and this is the appeal stream now active before the Board. The Board remanded the issues on appeal for additional development in February 2020. The directives having been substantially complied with, the matter again is before the Board. D'Aries v. Peake, 22 Vet. App. 97, 105 (2008); Stegall v. West, 11 Vet. App. 268 (1998). The Veteran testified at a travel Board hearing before the undersigned Veterans Law Judge (VLJ) in January 2020; a transcript of that hearing is associated with the claims file. Veterans Claims Assistance Act of 2000 (VCAA) The Veterans Claims Assistance Act of 2000 (VCAA) and implementing regulations impose obligations on VA to provide claimants with notice and assistance. 38 U.S.C. §§ 5100, 5102, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2020). The Veteran in this case has not referred to any deficiencies in either the duties to notify or assist; therefore, the Board may proceed to the merits of the claim. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015, cert. denied, U.S.C. Oct. 3, 2016) (holding that "the Board's obligation to read filings in a liberal manner does not require the Board....to search the record and address procedural arguments when the [appellant] fails to raise them before the Board"); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to an appellant's failure to raise a duty to assist argument before the Board). The Board has reviewed all of the evidence in the Veteran's claims file. Although the Board has an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that the evidence submitted by the Veteran or obtained on his behalf be discussed in detail. Rather, the Board's analysis below will focus specifically on what evidence is needed to substantiate the claim and what the evidence in the claims file shows, or fails to show, with respect to the claim. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) and Timberlake v. Gober, 14 Vet. App. 122, 128-130 (2000). Service Connection for Right Hip, Lumbar Spine, and Right Shoulder Disabilities Legal Criteria for Service Connection - General Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). To establish entitlement to service-connected compensation benefits, a Veteran must show: "(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service-the so-called "nexus" requirement." Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Service connection may also be granted for disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303(d). For secondary service connection, it must be shown that the disability for which the claim is made is proximately due to or aggravated by a service-connected disability. See 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439 (1995) (en banc). Service connection may also be established for a current disability on the basis of a presumption that certain chronic diseases, to include arthritis, manifesting themselves to a certain degree within a certain time after service must have had their onset in service. 38 U.S.C. §§ 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309(a). For arthritis, the disease must have manifested to a degree of 10 percent or more within one year of service. 38 C.F.R. § 3.307(a)(3). Service connection can also be established through continuity of symptomatology. Walker v. Shinseki, 708 F.3d 1331 (2013); 38 C.F.R. §§ 3.303(b), 3.309. For chronic diseases shown as such in service or within the applicable presumptive period, subsequent manifestations of the same chronic disease at any later date are service-connected unless attributable to an intercurrent cause. 38 C.F.R. § 3.303(b). For a chronic disease to be considered to have been "shown in service," there must be a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings. Id. When the condition noted in service or within the presumptive period is not a chronic disease, a showing of continuity of symptomatology after discharge is required. Id. VA is required to give due consideration to all pertinent medical and lay evidence in evaluating a claim for disability benefits. 38 U.S.C. § 1154(a). Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Lay evidence cannot be determined to be not credible merely because it is unaccompanied by contemporaneous medical evidence. Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006). However, the lack of contemporaneous medical evidence can be considered and weighed against a Veteran's lay statements. Id. Further, a negative inference may be drawn from the absence of complaints or treatment for an extended period. Maxson v. West, 12 Vet. App. 453, 459 (1999), aff'd sub nom. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). Proof of a current disability is a threshold to establishing service-connection for any claimed disability. In the absence of proof of a present disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). To be a present as a current disability, there must be evidence of the condition at some time during the appeals period. Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998). After the evidence is assembled, it is the Board's responsibility to evaluate the entire record. See 38 U.S.C. § 7104(a) (2012). When there is an approximate balance of evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each issue shall be given to the claimant. See 38 U.S.C. § 5107 (2012); 38 C.F.R. §§ 3.102, 4.3. In Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990), the United States Court of Appeals for Veterans Claims (Court) stated that "a veteran need only demonstrate that there is an 'approximate balance of positive and negative evidence'' in order to prevail." To deny a claim on its merits, the preponderance of the evidence must be against the claim. See Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert, 1 Vet. App. at 54. Evidence and Analysis The Veteran was separated from active duty in April 2006 for a medical disability, that of a lower left extremity disability. The Veteran's record was evaluated by a service physical disability board of review, which found the Veteran's left ankle injury from March 2004 could not be sufficiently rehabilitated to meet service medical standards for retention on active duty, despite three surgeries on that left ankle. After leaving active duty, the Veteran filed a service connection claim for his left ankle, which was granted in June 2006 based on a diagnosis of a ruptured left posterior tibial tendon, status post repair and fusion. The Veteran's service treatment records for his entire period of active duty, from January 2002 to April 2006, are silent for any lumbar back, right hip, or right shoulder condition. The Veteran claims for both his lumbar back and right hip that his service-connected left ankle is the cause of those two disabilities., in that his left ankle disability causes him to walk with a gait that has created disability in each his lumbar back and his right hip. The Veteran testified before the undersigned Veterans Law Judge as to those claims with his theory of secondary service connection in a January 2020 Board hearing. The Veteran had foot surgery performed at a private treatment provider in December 2015, and follow up notes indicating improved lower back and right side hip pain after the foot surgery recovery. Right Hip The Veteran is seeking service connection for his right hip, to include as secondary to his service-connected left ankle injury. He testified in his January 2020 Board hearing before the undersigned Veterans Law Judge that his left ankle condition created an awkward gait that led to his right hip condition. The Veteran received a VA examination in July 2017 for his right hip. The left hip was also examined here but was normal in all measurements and assessments. The examiner diagnosed a right hip strain, and abnormal ranges of motion were noted. Pain on external rotation for the right hip was noted, but there was no pain on weight bearing. Muscle strength was five on a scale of five and occasional use of a brace and/or a cane to assist in ambulation was noted. X-rays were taken as part of this examination, but no arthritis of any kind was noted. No acute fracture, or lytic or blastic lesion was noted. This July 2017 examiner issued an opinion for secondary service connection for the right hip, saying it was less likely than not, less than 50 percent probability, that the Veteran's claimed right hip disability was the proximately due to the Veteran's service-connected left ankle disability, or was aggravated beyond its natural progression by the left ankle disability. The examiner's rationale was that the medical literature fails to support the Veteran's contention that his left ankle disability could lead to a hip disability of the degree the examination indicated. The VA examiner stated that if the Veteran's gait was substantially disrupted, for example in the case of a paralytic gait, then medical literature contains the possibility that such a severe disruption in gait could cause the pain in the back or pelvis, but this examiner stated the Veteran's gait is not near that level of disruption to his regular gait, even with his left ankle disability. This examiner did not provide an opinion for service connection for direct service connection for the right hip disability. The Veteran received another VA examination for his right hip in May 2021. This examiner diagnosed a right hip strain, based on reports of pain on the lateral side of the right hip, and that pain comes about with prolonged sitting or standing. The Veteran described his right hip pain as "deep and achy." The Veteran noted he sees a chiropractor on a regular basis for his right hip and his lumbar back. Right hip ranges of motion were abnormal in all axes, with pain in the right hip noted on flexion. Pain on motion was noted, but not pain on weight-bearing. The examiner considered the source of the pain as the lateral trochanter of the right thigh, with mild to moderate severity. The May 2021 VA examiner provided a negative opinion for both direct and secondary service connection. The direct opinion stated the Veteran's claimed right hip condition was less likely than not, less than 50 percent probability, incurred in or caused by the claimed inservice injury, event, or illness. The examiner's rationale was that the service treatment records do not note any right hip injury or condition during the Veteran's active service. The examiner noted a current disability in the right hip strain, but that there are no signs of chronicity for disability since active duty ended in April 2006. December 2015 and July 2017 are the earliest records that note complaints of and treatment for right hip pain. This examiner also provided a negative opinion for secondary service connection, saying the claimed right hip condition was less likely than not, less than 50 percent probability, proximately due to or the result of the Veteran's service-connected condition. The examiner's rationale noted there was no clear evidence from current medical literature that an injury to one joint would have any significant impact on another or opposite uninjured joint or limb, unless the injury resulted in a major muscle or nerve damage causing partial or complete paralysis, or shortening of the injured limb resulting in length discrepancy of more than 5 centimeters so that the individual's gait pattern has been altered to the extent that clinically there is an obvious Trendelenburg gait. The examiner pointed out that the level of severity is not supported based on record review, history, or examination. The examiner also pointed out that one's joint disease does not spread to another joint or cause damage to it, and therefore, the right hip disability is less likely than not related to the left ankle condition. 1. Entitlement to service connection for a right hip disability, to include as secondary to service-connected left ankle disability The Board finds the July 2017 and May 2021 VA examination reports and opinions to be of great probative value, along with both the VA treatment notes and private treatment regarding the Veteran's claimed right hip disability. Indeed, the VA examiners considered the Veteran's contention, the claims file, and clinical medical evidence before providing a negative opinion for direct service connection and secondary service connection. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (the probative value of a medical opinion is derived from a factually accurate, fully articulated, and soundly reasoned opinion). A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). The examiners' negative opinions were supported by a sufficiently clear and well-reasoned medical rationale and was consistent with the verifiable facts regarding the Veteran's contentions. See Bloom v. West, 12 Vet. App. 185, 187 (1999); Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998); see also Claiborne v. Nicholson, 19 Vet. App. 181, 186 (2005). The Board acknowledges that the Veteran is competent to testify as to his beliefs that his disabilities are related to service. Barr v. Nicholson, 21 Vet. App. 303, 307-08 (2007). In order for lay evidence to be competent, the individual must have personal knowledge, derived from his/her own senses, of what is being attested; "[c]ompetent testimony is thus limited to that which the witness has actually observed, and is within the realm of his personal knowledge." Layno v. Brown, 6 Vet. App. 465, 471 (1994). Here, the Veteran, via the supplied statements, is competent to testify about his symptoms relating to his claimed right hip symptoms. However, there is nothing in the record to suggest that the Veteran has the appropriate training, experience, or expertise to render a medical opinion regarding etiology of his right hip disability. See 38 C.F.R. § 3.159(a)(1) (setting forth that competent medical evidence means evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions). While the Veteran is competent to report what he has experienced, he is not competent to ascertain the etiology of any current condition, as the causative factors for such are not readily subject to lay observation. See Layno v. Brown, 6 Vet. App. 465 (1994); Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (concerning rheumatic fever); see also Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Accordingly, his assertions to that effect are of no probative value. The Board acknowledges the Veteran's statements that his right hip symptoms could be related to service. However, the Board notes that the Veteran's service treatment records, to include reports of medical history, are silent for any treatment or complaint of any right hip condition during active service ending in April 2006 or until July 2017, over 11 years after active service ended. The Board notes especially that even though the Veteran asserts a left ankle condition was the cause of his right hip condition, that the service treatment records were silent for any chronic effects of that left ankle condition, to include any right hip problems at the end of active service in April 2006 or afterwards until 2017. A negative inference may be drawn from the absence of complaints or treatment for an extended period. Maxson v. West, 12 Vet. App. 453, 459 (1999), aff'd sub nom. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). The Board also notes with emphasis that neither the January 2006 service medical board or the January 2014 appeal to the service board of corrections from the Veteran regarding his left ankle service injury mentioned any other impact of that injury, to include the right hip and/or the lumbar back claims by the Veteran. This fact is omitted from the Veteran's other lay statements. See Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991); Pond v. West, 12 Vet. App. 341 (1999) (although the Board must take into consideration the Veteran's statements, it may consider whether self-interest may be a factor in making such statements); Caluza v. Brown, 7 Vet. App. 498 (1995), aff'd, 78 F.3d 604 (Fed. Cir. 1996) (per curiam). The Board notes there are no other statements by any medical provider, VA or private, that are in favor of a possible nexus to service for the Veteran's claimed right hip disability. Upon review of the record, the Board concludes that entitlement to service connection for a right hip disability is not warranted. The Board notes a current diagnosis of a right hip disability in July 2017 and again in May 2021, and thus the requirement for a current disability is shown for the right hip claim. The Board acknowledges the Veteran's contentions, and the Veteran's post-service statements are noted. However, the Veteran's service medical records, to include all examinations, are silent for any existing right hip condition at the time of separation, and there is no competent evidence to tie the current assertion to any in-service disease or injury. Two VA examiners have discussed all of the Veteran's right hip disabilities and all possible risk factors raised by the record, and opined that the current right hip condition is not related back to active service by either direct or secondary service connection. The Board thus finds the Veteran fails the third prong of the test for entitlement to direct or secondary service connection. See Davidson v. Shinseki, 581 F.3d 1313, 1315-16 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); 38 C.F.R. §§ 3.303, 3.310. With regard to possible presumptive service connection for degenerative arthritis, the weight of evidence shows no formal diagnosis of any right hip arthritis on any examination, private or VA. As such, presumptive service connection is not warranted. 38 C.F.R. §§ 3.303, 3.309. Based on the above, the Board finds that the weight of the competent and credible evidence demonstrates that the Veteran's claimed right hip disability was not incurred in service. For these reasons, the Board finds that a preponderance of the evidence is against the claim of service connection for a right hip disability, and the claim must be denied. Because the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not for application. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Lumbar Back The Veteran is seeking service connection for his lumbar back, to include as secondary to his service-connected left ankle injury. He testified in his January 2020 Board hearing before the undersigned Veterans Law Judge that his left ankle condition created an awkward gait that led to his lumbar back condition. The Veteran submitted private medical records from April 2013 regarding his lumbar back, having complained of low back pain that radiated down his right leg. That private examiner noted back pain was most likely facet mediated on the right side and may be contributing to referral pain at the right hip. A subsequent treatment note from the same facility in December 2013 noted waxing and waning discomfort with the lumbar back, and that when the pain level is higher, the Veteran's gait shifts to favor his other side. This treatment also noted that the Veteran's lumbar syndrome included developing spondylosis. The Veteran had foot surgery performed at the same private treatment provider in December 2015, and follow up notes indicating improved lower back and right side hip pain after the foot surgery recovery. The Veteran received a VA examination in July 2017 for his lumbar back. The examiner diagnosed degenerative arthritis of the lumbar spine, and he noted the Veteran's complaints of chronic lumbar pain primarily on the right side, radiating into the right hip. The Veteran reported in the past he received cortisone injections for this back pain, but no pain medications. Abnormal ranges of motion were recorded, but no flareups were noted. Muscle strength was five on a scale of five, reflexes were normal, and sensory testing was normal, to include both lower extremities. Straight leg raise test was normal and no radiculopathy was noted. No ankylosis was noted. Occasional use of a brace and/or a cane to assist in ambulation was noted. X-rays were taken as part of this examination and degenerative changes were noted at L4-L5 and L5-S1. This July 2017 examiner issued an opinion for secondary service connection for the lumbar back, saying it was less likely than not, less than 50 percent probability, that the Veteran's claimed back disability was the proximately due to the Veteran's service-connected left ankle disability, or was aggravated beyond its natural progression by the left ankle disability. The examiner's rationale was that the medical literature fails to support the Veteran's contention that his left ankle disability could lead to a back or hip disability of the degree the examination indicated. The examiner that if the Veteran's gait was substantially disrupted, for example in the case of a paralytic gait, then medical literature contains the possibility that such a severe disruption in gait could cause the pain in the back or pelvis, but this VA examiner stated the Veteran's gait is not near that level of disruption to his regular gait, even with his left foot disability. This examiner did not provide an opinion for service connection for direct service connection for the back disability. VA provided another VA examination for the Veteran's lumbar back in May 2021. This examiner diagnosed degenerative arthritis of the lumbar spine and also right lower extremity radiculopathy. The examiner noted the Veteran's statements that his low back injury was sustained during active military service, and that his low back pain forces him to alter his walking gait because of his permanently injured ankle. The Veteran also noted that his low back injury radiates pain into the right thigh area. Range of motion measurements for the lower back were all in the abnormal range. Pain was evident on weight bearing and there was tenderness with palpation in the area of the lumbar spine segments. This examiner considered the Veteran's lumbar degenerative arthritis to be in the mild to moderate range, with radiation to the right buttock and hip. Mild radiculopathy of the right lower extremity with intermittent pain (usually dull) and numbness noted. No ankylosis was noted. An MRI was accomplished as part of this examination which indicated degenerative changes at L4-5 and L5-S1. The May 2021 VA examiner provided a negative opinion for both direct and secondary service connection. The direct opinion stated the Veteran's claimed lumbar back condition was less likely than not, less than 50 percent probability, incurred in or caused by the claimed inservice injury, event, or illness. The examiner's rationale was that the service treatment records do not note any lumbar injury or condition during the Veteran's active service. The examiner noted a current disability in the lumbar back degenerative arthritis, but that there are no signs of chronicity for the arthritis since active duty ended in April 2006. December 2007 and February 2008 are the earliest records that note complaints of and treatment for back pain. This examiner also provided a negative opinion for secondary service connection, saying the claimed back condition was less likely than not, less than 50 percent probability, proximately due to or the result of the Veteran's service-connected condition. The examiner's rationale noted there was no clear evidence from current medical literature that an injury to one joint would have any significant impact on another or opposite uninjured joint or limb, unless the injury resulted in a major muscle or nerve damage causing partial or complete paralysis, or shortening of the injured limb resulting in length discrepancy of more than 5 centimeters so that the individual's gait pattern has been altered to the extent that clinically there is an obvious Trendelenburg gait. The examiner pointed out that the level of severity is not supported based on record review, history, or examination. The examiner also pointed out that one's joint disease does not spread to another joint or cause damage to it, and therefore, the lumbar disability is less likely than not related to the left ankle condition. 2. Entitlement to service connection for a lumbar back disability, to include as secondary to service-connected left ankle disability The Board finds the July 2017 and May 2021 VA examination reports and opinions to be of great probative value, along with both the VA treatment notes and private treatment regarding the Veteran's claimed lumbar back disability. The Board also finds the April and December 2013 private medical records highly probative as to diagnosis of the lumbar back disability, though no opinion as to etiology was made. Indeed, the VA examiners considered the Veteran's contention, the claims file, and clinical medical evidence before providing a negative opinion for direct service connection and secondary service connection. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (the probative value of a medical opinion is derived from a factually accurate, fully articulated, and soundly reasoned opinion). A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). The examiners' negative opinions were supported by a sufficiently clear and well-reasoned medical rationale and was consistent with the verifiable facts regarding the Veteran's contentions. See Bloom v. West, 12 Vet. App. 185, 187 (1999); Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998); see also Claiborne v. Nicholson, 19 Vet. App. 181, 186 (2005). The Board acknowledges that the Veteran is competent to testify as to his beliefs that his disabilities are related to service. Barr v. Nicholson, 21 Vet. App. 303, 307-08 (2007). In order for lay evidence to be competent, the individual must have personal knowledge, derived from his/her own senses, of what is being attested; "[c]ompetent testimony is thus limited to that which the witness has actually observed, and is within the realm of his personal knowledge." Layno v. Brown, 6 Vet. App. 465, 471 (1994). Here, the Veteran, via the supplied statements, is competent to testify about his symptoms relating to his claimed lumbar back symptoms. However, there is nothing in the record to suggest that the Veteran has the appropriate training, experience, or expertise to render a medical opinion regarding etiology of his lumbar back disability. See 38 C.F.R. § 3.159(a)(1) (setting forth that competent medical evidence means evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions). While the Veteran is competent to report what he has experienced, he is not competent to ascertain the etiology of any current condition, as the causative factors for such are not readily subject to lay observation. See Layno v. Brown, 6 Vet. App. 465 (1994); Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (concerning rheumatic fever); see also Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Accordingly, his assertions to that effect are of no probative value. The Board acknowledges the Veteran's statements that his lumbar back symptoms could be related to service. However, the Board notes that the Veteran's service treatment records, to include reports of medical history, are silent for any treatment or complaint of any lumbar back condition during active service ending in April 2006 or until April 2013, 7 years after active service ended. The Board notes especially that even though the Veteran asserts a left ankle condition was the cause of his lumbar back condition, that the service treatment records were silent for any chronic effects of that left ankle condition, to include any lumbar back problems at the end of active service in April 2006 or afterwards until 2013. A negative inference may be drawn from the absence of complaints or treatment for an extended period. Maxson v. West, 12 Vet. App. 453, 459 (1999), aff'd sub nom. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). The Board also notes with emphasis that neither the January 2006 service medical board or the January 2014 appeal to the service board of corrections from the Veteran regarding his left ankle service injury mentioned any other impact of that injury, to include the right hip and/or the lumbar back claims by the Veteran. This fact is omitted from the Veteran's other lay statements. See Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991); Pond v. West, 12 Vet. App. 341 (1999) (although the Board must take into consideration the Veteran's statements, it may consider whether self-interest may be a factor in making such statements); Caluza v. Brown, 7 Vet. App. 498 (1995), aff'd, 78 F.3d 604 (Fed. Cir. 1996) (per curiam). The Board notes there are no other statements by any medical provider, VA or private, that are in favor of a possible nexus to service for the Veteran's claimed lumbar back disability. Upon review of the record, the Board concludes that entitlement to service connection for a lumbar back disability is not warranted. The Board notes a current VA diagnosis of a lumbar back disability in July 2017 and again in May 2021, and thus the requirement for a current disability is shown for the lumbar back claim. The Board acknowledges the Veteran's contentions, and the Veteran's post-service statements are noted. However, the Veteran's service medical records, to include all examinations, are silent for any existing lumbar back condition at the time of separation, and there is no competent evidence to tie the current assertion to any in-service disease or injury. Two VA examiners have discussed all of the Veteran's lumbar back disabilities and all possible risk factors raised by the record, and opined that the current lumbar back condition is not related back to active service by either direct or secondary service connection. The Board thus finds the Veteran fails the third prong of the test for entitlement to direct or secondary service connection. See Davidson v. Shinseki, 581 F.3d 1313, 1315-16 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); 38 C.F.R. §§ 3.303, 3.310. With regard to possible presumptive service connection for degenerative arthritis, the weight of evidence shows no formal diagnosis of any lumbar back arthritis on any examination, private or VA. As such, presumptive service connection is not warranted. 38 C.F.R. §§ 3.303, 3.309. Based on the above, the Board finds that the weight of the competent and credible evidence demonstrates that the Veteran's claimed lumbar back disability was not incurred in service. For these reasons, the Board finds that a preponderance of the evidence is against the claim of service connection for a lumbar back disability, and the claim must be denied. Because the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not for application. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Right Shoulder The Veteran is seeking service connection for his right shoulder, saying in lay statements and during testimony with the undersigned Veterans Law Judge in January 2020 that he injured his right shoulder playing sports during active service. Unlike the two previous service connection claims for the right hip and lumbar back, the Veteran has not alleged a theory of secondary service connection for this claim. The Veteran's service treatment records for his right shoulder are silent for any complaint, injury, or condition noted during active service ending in April 2006. The earliest complaint related to the right shoulder made to any treatment provider was in April 2013, where right shoulder osteoarthritis was noted. A 2 centimeter by 1 centimeter calcification along the anterior margin of the humeral metadiaphysis was noted, and was thought to possibly represent calcification associated with the biceps tendon. The Veteran received a VA examination for his right shoulder in May 2021. The examiner noted the Veteran's complaints of right shoulder pain, and made a diagnosis of right shoulder impingement syndrome. The Veteran stated his right shoulder pain is due to a sports injury incurred during active duty, and that the pain has worsened over time. The examiner noted pain in both shoulders that becomes worse with any overhead or movements to the side. The Veteran stated that his chiropractor regularly treats his shoulders. Difficulty in lifting the right arm and supporting weight during that raising motion was noted. Diminished ranges of motion in all axes were noted for the right shoulder. Pain on motion was noted along with pain on weight bearing. The examiner noted tenderness with palpation of the right shoulder with objective evidence of crepitus. No ankylosis was noted. The right shoulder was positive for Hawkins' impingement test, the liftoff subscapularis test, and the empty can test, suggesting a rotator cuff condition. The right shoulder was negative for any instability, though clicking and catching was noted. There were no signs of dislocation or any impairment of the clavicle, scapula, AC joint, or other impairment. There were no impairments of the humerus. The examiner noted the Veteran has worked as a truck driver for the last year and has lost zero to one week of time in that period. This May 2021 VA examiner provided a negative opinion for direct service connection. The opinion stated the Veteran's claimed right shoulder condition was less likely than not, less than 50 percent probability, incurred in or caused by the claimed inservice injury, event, or illness. The examiner's rationale was that the service treatment records do not note any right shoulder injury or condition during the Veteran's active service. The examiner noted a current disability in the right shoulder impingement syndrome, but that there are no signs of chronicity for disability since active duty ended in April 2006. December 2015 and July 2017 are the earliest records that note complaints of and treatment for right shoulder pain. 3. Entitlement to service connection for a right shoulder disability The Board finds the May 2021 VA examination report and opinion to be of great probative value, along with both the VA treatment notes and private treatment record from 2013 regarding the Veteran's claimed right shoulder disability. Indeed, the VA examiners considered the Veteran's contention, the claims file, and clinical medical evidence before providing a negative opinion for direct service connection. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (the probative value of a medical opinion is derived from a factually accurate, fully articulated, and soundly reasoned opinion). A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). The examiners' negative opinions were supported by a sufficiently clear and well-reasoned medical rationale and was consistent with the verifiable facts regarding the Veteran's contentions. See Bloom v. West, 12 Vet. App. 185, 187 (1999); Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998); see also Claiborne v. Nicholson, 19 Vet. App. 181, 186 (2005). The Board acknowledges that the Veteran is competent to testify as to his beliefs that his disabilities are related to service. Barr v. Nicholson, 21 Vet. App. 303, 307-08 (2007). In order for lay evidence to be competent, the individual must have personal knowledge, derived from his/her own senses, of what is being attested; "[c]ompetent testimony is thus limited to that which the witness has actually observed, and is within the realm of his personal knowledge." Layno v. Brown, 6 Vet. App. 465, 471 (1994). Here, the Veteran, via the supplied statements, is competent to testify about his symptoms relating to his claimed right shoulder symptoms. However, there is nothing in the record to suggest that the Veteran has the appropriate training, experience, or expertise to render a medical opinion regarding etiology of his right shoulder disability. See 38 C.F.R. § 3.159(a)(1) (setting forth that competent medical evidence means evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions). While the Veteran is competent to report what he has experienced, he is not competent to ascertain the etiology of any current condition, as the causative factors for such are not readily subject to lay observation. See Layno v. Brown, 6 Vet. App. 465 (1994); Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (concerning rheumatic fever); see also Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Accordingly, his assertions to that effect are of no probative value. The Board acknowledges the Veteran's statements that his right shoulder symptoms could be related to service. However, the Board notes that the Veteran's service treatment records, to include reports of medical history, are silent for any treatment or complaint of any right shoulder condition during active service ending in April 2006 or until April 2013, 7 years after active service ended. A negative inference may be drawn from the absence of complaints or treatment for an extended period. Maxson v. West, 12 Vet. App. 453, 459 (1999), aff'd sub nom. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). The Board also notes with emphasis that neither the January 2006 service medical board or the January 2014 appeal to the service board of corrections from the Veteran regarding his left ankle service injury mentioned any other impact of that injury, to include the right shoulder, right hip, and/or the lumbar back claims by the Veteran. This fact is omitted from the Veteran's other lay statements. See Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991); Pond v. West, 12 Vet. App. 341 (1999) (although the Board must take into consideration the Veteran's statements, it may consider whether self-interest may be a factor in making such statements); Caluza v. Brown, 7 Vet. App. 498 (1995), aff'd, 78 F.3d 604 (Fed. Cir. 1996) (per curiam). The Board notes there are no other statements by any medical provider, VA or private, that are in favor of a possible nexus to service for the Veteran's claimed right shoulder disability. Upon review of the record, the Board concludes that entitlement to service connection for a right shoulder disability is not warranted. The Board notes a VA current diagnosis of a right shoulder disability in July 2017 and again in May 2021, and thus the requirement for a current disability is shown for the right shoulder claim. The Board acknowledges the Veteran's contentions, and the Veteran's post-service statements are noted. However, the Veteran's service medical records, to include all examinations, are silent for any existing right shoulder condition at the time of separation, and there is no competent evidence to tie the current assertion to any in-service disease or injury. A qualified VA examiner has discussed all of the Veteran's right shoulder symptoms and all possible risk factors raised by the record, and opined that the current right shoulder condition is not related back to active service by direct service connection. The Board thus finds the Veteran fails the third prong of the test for entitlement to direct service connection. See Davidson v. Shinseki, 581 F.3d 1313, 1315-16 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); 38 C.F.R. § 3.303. With regard to possible presumptive service connection for degenerative arthritis, the weight of evidence shows no formal diagnosis of any right shoulder arthritis on any examination, private or VA. As such, presumptive service connection is not warranted. 38 C.F.R. §§ 3.303, 3.309. Based on the above, the Board finds that the weight of the competent and credible evidence demonstrates that the Veteran's claimed right shoulder disability was not incurred in service. For these reasons, the Board finds that a preponderance of the evidence is against the claim of service connection for a right shoulder disability, and the claim must be denied. Because the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not for application. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. MICHAEL A. PAPPAS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Setter, 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.