Citation Nr: 21063186 Decision Date: 10/13/21 Archive Date: 10/13/21 DOCKET NO. 20-02 914 DATE: October 13, 2021 ORDER Entitlement to service connection for tinnitus is granted. Entitlement to service connection for a low back disability is denied. Entitlement to service connection for a left foot disability, to include callouses and to include as due to a service connected disability is denied. Entitlement to service connection for a right foot disability, to included callouses and to include as due to a service connected disability is denied. Entitlement to service connection for a left foot disability to include bunions and to include as due to a service connected disability is denied. Entitlement to service connection for a right foot disability, to include bunions and to include as due to a service connected disability is denied. Entitlement to service connection for a right hip disability is denied. Entitlement to service connection for a left knee disability is denied. FINDINGS OF FACT 1. Resolving reasonable doubt in the Veteran's favor, there is a relative equal balance of evidence for and against whether his tinnitus is caused by active service and his service connected bilateral hearing loss. 2. The weight of the competent and credible evidence is against finding that the Veteran's low back arthritis manifested in service or within one year of service; and is not etiologically caused by an in-service injury, event or illness. 3. The weight of the competent and credible evidence is against finding that the Veteran's left foot disability including callouses manifested in service, is not etiologically caused by an in-service injury, event or illness; and is not otherwise etiologically secondary (caused or aggravated) to a service connected disability. 4. The weight of the competent and credible evidence is against finding that the Veteran's right foot disability including callouses manifested in service, is not etiologically caused by an in-service injury, event or illness; and is not otherwise etiologically secondary (caused or aggravated) to a service connected disability. 5. The weight of the competent and credible evidence is against finding that the Veteran's left foot arthritis and bunions manifested in service, or within one year of service, and is not etiologically caused by an in-service injury, event or illness; and is not otherwise etiologically secondary (caused or aggravated) to a service connected disability. 6. The weight of the competent and credible evidence is against finding that the Veteran's right foot arthritis and bunions manifested in service, or within one year of service, and is not etiologically caused by an in-service injury, event or illness; and is not otherwise etiologically secondary (caused or aggravated) to a service connected disability. 7. The weight of the competent and credible evidence is against finding that the Veteran's right hip disability manifested in service and is not etiologically caused by an in-service injury, event or illness. 8. The weight of the competent and credible evidence is against finding that the Veteran's left knee arthritis manifested in service or within one year of service; and is not etiologically caused by an in-service injury, event or illness. CONCLUSIONS OF LAW 1. The criteria for service connection for tinnitus have been met. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.309, 3.310 (2020). 2. The criteria for service connection for a low back disability have not been met. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.309 (2020). 3. The criteria for service connection for left foot disability including callouses have not been met. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.309, 3.310 (2020). 4. The criteria for service connection for right foot disability including callouses have not been met. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.309, 3.310 (2020). 5. The criteria for service connection for left foot disability including bunions have not been met. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.309, 3.310 (2020). 6. The criteria for service connection for right foot disability including bunions have not been met. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.309, 3.310 (2020). 7. The criteria for service connection for a right hip disability have not been met. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.309 (2020). 8. The criteria for service connection for a left knee disability have not been met. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.309 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the U.S. Army from April 1962 to April 1965 as an infantryman and paratrooper. These matters come before the Board of Veterans' Appeals (Board) from a July 2018 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans' Law Judge at a Board virtual hearing in November 2020. A transcript of the hearing has been associated with the claims file. Previously, the Veteran's claims were before the Board in February 2021 and were remanded for additional development. The prior remand directives have been completed and as such, the Board finds there has been substantial compliance with the prior remand directives, and the claims are again before the Board. See Stegall v. West, 11 Vet. App. 268, 271 (1998). During the course of the appeal service connection for a bilateral hearing loss disability was granted in an April 2021 rating decision effective January 22, 2018. As such represents a full grant of benefits sought on appeal this claim is no longer before the Board. SERVICE CONNECTION A veteran is entitled to VA disability compensation if there is a disability resulting from personal injury suffered or disease contracted in line of duty in active service, or for aggravation of a preexisting injury suffered or disease contracted in line of duty in active service. 38 U.S.C. §§ 1110, 1131. To establish a right to compensation for a present disability, a Veteran must show: "(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service" - the so-called "nexus" requirement. Shedden v. Principi, 381 F.3d 1163, 1167 Fed. Cir. (2004). For the showing of chronic disease in service there is required 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 or a diagnosis including the word "Chronic." When the disease identity is established (leprosy, tuberculosis, multiple sclerosis, etc.), there is no requirement of evidentiary showing of continuity. Continuity of symptomatology is required only where the condition noted during service (or in the presumptive period) is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. 38 C.F.R. § 3.303(b). Service connection for a recognized chronic disease 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. A disability which is proximately due to or the result of a service connected disease or injury shall be service connected. 38 C.F.R. § 3.310 (a). Any increase in severity of a non-service connected disease or injury that is proximately due to or the result of a service connected disease or injury, and not due to the natural progress of the nonservice connected disease or injury will be service connected. 38 C.F.R. § 3.310 (b). 1. Entitlement to service connection for tinnitus The Veteran contends that service connection is warranted for his current tinnitus. The Veteran contends that his tinnitus is related to service and his in-service noise exposure and hearing loss. The Veteran testified in November 2020 to significant noise exposure in-service. The Veteran testified to current buzzing and ringing regularly occurring several times a month in his ears. The Veteran reported experiencing ringing and buzzing in his ears for a long time and more than 20 years. The Veteran contends that his tinnitus is related to his in-service duties as an infantryman and noise exposure to helicopters and the regular use of weapons. The Veteran and the associated lay statements are competent to describe his current symptoms, in-service events, and the occurrence of ongoing symptoms, and to this extent, these statements are credible. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). In February 2015, the United States Court of Appeals for Veterans Claims (Court) held that tinnitus was a disease, rather than merely a symptom and that 38 C.F.R. § § 3.309(a) "includes tinnitus, at a minimum where there is evidence of acoustic trauma, as an organic disease of the nervous system." See Fountain v. McDonald, 27 Vet. App. 258 (2015). As the Court held tinnitus to be a chronic disease subject to applicable presumptions, the disease now falls within the parameters of 38 C.F.R. § § 3.303(b), as to claims of chronicity. Tinnitus is a condition that may be diagnosed by its unique and readily identifiable features, and the presence of the disorder is not a determination that is medical in nature and is capable of lay observation. See Charles v. Principi, 16 Vet. App. 370, 374 (2002) (noting that "ringing in the ears is capable of lay observation"). The question for the Board is whether the Veteran has a current tinnitus disability that began during service, during the applicable presumptive period or is at least as likely as not caused by an in-service, injury or disease; or caused or aggravated by a service connected disability. There is some dispute as to whether the Veteran has a current diagnosis of tinnitus, however resolving reasonable doubt in the Veteran's favor, the Board finds that the Veteran has a current tinnitus. The Veteran has reported that he currently has tinnitus, which he is competent to report. Jandreau, 492 F.3d at 1377; Charles, 16 Vet. App. at 370. Lay statements and treatment records note the Veteran has a current tinnitus. The Veteran and the associated lay statements are competent to report his ongoing symptomology and reports of tinnitus with ongoing buzzing and ringing in his ears regularly occurring several times a month and lasting for at least an hour. Additionally, the Board finds these statements are credible. The Veteran contends that his tinnitus is related to service and his in-service noise exposure. The Veteran's service treatment records (STRs) and service personnel records have been associated with the claims file. The Veteran's DD 214 noted his military occupational specialty (MOS) was as a weapons infantryman. Further, the Veteran earned the parachutists badge and Ranger tab. At separation from service in March 1965 on the report of medical examination clinical evaluation was normal. At separation on the report of medical history in March 1965 the Veteran denied running ears and ear trouble. As such, the Board finds an in-service event and that exposure to hazardous noise is conceded. During the course of the appeal service connection for a bilateral hearing loss disability was granted. The question before the Board is whether the Veteran's tinnitus began during service, is caused by an in-service injury or disease or is caused or aggravated by his service connected bilateral hearing loss. The Veteran was afforded a VA hearing loss and tinnitus examination in May 2018. The Veteran reported tinnitus that reoccurs as an intermittent buzz in his ears occurring once or twice a month for several minutes. The examiner noted that the Veteran's tinnitus is a symptom associated with his hearing loss, as tinnitus is known to be associated with hearing loss. The examiner noted that the Veteran's description of his ear noise and does not meet the criteria for disabling tinnitus from noise exposure and would be better categorized as transient ear noise. The examiner noted that typically when a person experiences bothersome constant and disabling tinnitus it is persistent starting from the time the time of the acoustic trauma. Disabling tinnitus is defined as constant or frequent ear noise that is bothersome during tasks of daily living. Noise induced tinnitus starts directly after a noise exposure episode and persists from that time forward. The examiner noted that the Veteran's tinnitus does not impact his ordinary conditions of daily life. Then, the Veteran was afforded a VA supplemental hearing loss and tinnitus opinion in March 2021. The VA examiner noted that the Veteran's tinnitus is less likely than not caused by or a result of his military noise exposure. The examiner noted that the Veteran reports his tinnitus to be infrequent and intermittent occurrence that started approximately 20 years ago, which would mean onset in 2000. This is decades post-military separation and several decades post-military noise exposure. The examiner noted that the Veteran's symptoms are best categorized as transient ear noise and not disabling tinnitus from noise exposure. The examiner noted that tinnitus that is bothersome, constant, disabling and peristent from the time of acoustic trauma. Noise-induced tinnitus starts directly after noise exposure and persistent from that time forward. Transient, intermittent ear noise, or tinnitus occurring many decades after separation from service is not tinnitus attributed to military noise exposure. The examiner noted a review of the Veteran's claims file and STRs, the Veteran's and his wife's reports of hearing loss present in the 1960 but makes no mention of reports of tinnitus. As such the examiner noted that the Veteran's separation physical showed normal health and hearing. The examiner found there is no medically sound basis for attributing his current tinnitus to a service injury. Further, while the examiner noted the Veteran's conceded exposure to noise in-service, the Veteran's tinnitus is not a delayed onset condition from his in-service noise exposure. Tinnitus that is onset many years post military separation is not likely a symptom of military noise-induced impairment. Then the Veteran was afforded a VA hearing loss and tinnitus examination in June 2021. The examiner noted bilateral sensorineural hearing loss and recurrent tinnitus. The Veteran reported a lower pitched hum, air hose leak noise as well as a ringing in his ears. The Veteran reports his tinnitus is intermittent and has been present for a very long time but does not remember when the symptoms began. He reports these symptoms occur several times a month lasting up to an hour and impact both ears. The examiner noted that the Veteran has a diagnosis of clinical hearing loss and his tinnitus is at least as likely as not a symptom associated with his hearing loss, as tinnitus is known to be a symptom associated with hearing loss. The Board notes that there is both favorable and unfavorable evidence relating to the Veteran's claim. However, resolving reasonable doubt in the Veteran's favor the Board finds that service connection for tinnitus is warranted. During the course of the appeal service connection for hearing loss was granted and the Veteran's tinnitus has been consistently shown to at least as likely as not a symptom associated with his hearing loss. The VA examiner in May 2018 noted that the Veteran's tinnitus is a symptom associated with his hearing loss, as tinnitus is known to be associated with hearing loss. Additionally, the VA examiner in June 2021, noted that the Veteran's tinnitus was indicative of intermittent ringing in his ears occurring several times a month lasting for an hour and that Veteran's tinnitus is at least as likely as not a symptom associated with his hearing loss. The Board finds these opinions are entitled to probative weight. As such the Board finds that the Veteran's tinnitus is related to his service connected hearing loss and service connection is warranted. Herein, the Board grants entitlement to service connection for tinnitus. 2. Entitlement to service connection for a low back disability The Veteran contends that service connection is warranted for a low back disability. The Veteran and associated lay statements report that his current low back disability is related to service. The Veteran testified in November 2020 to participating in many parachute jumps in-service and experiencing pain after several hard parachute jumps. The Veteran's wife reported the Veteran has experienced ongoing low back pain during their marriage. The Veteran testified to on and off low back pain since service at different times with feelings of an achy back and needing to rest at times. The Veteran testified that he believes his current low back disability is due to wear and tear on his body from service. The Veteran testified to ongoing low back symptomology that has continued since service. The Veteran contends that his low back disability is related to his service and his parachute jumps. The Veteran reported completing 24 parachute jumps in-service and completing rigorous Ranger TAB training and Recondo school training. The Veteran and associated lay statements report ongoing low back pain and symptomology that has worsened in recent years. The question for the Board is whether the Veteran has a current low back disability that began during service, manifested during the applicable presumptive period, or is at least as likely as not caused by an in-service injury or disease. The Veteran has a diagnosis of low back arthritis. The Veteran's STRs and personnel records have been associated with the claims file. The Veteran's MOS was a weapons infantryman. Personnel records note the Veteran completed Ranger course training in May 1964. Personnel records note the Veteran completed 27 parachute jumps. At separation on the report of medical examination in March 1965 clinical evaluation of the spine and musculoskeletal system was normal. On a report of medical history at separation in March 1965 the Veteran denied arthritis, a bone, joint or other deformity. Based on the Veteran's statements and treatment records the Board finds an in-service event, in that he completed 27 parachute jumps in-service and was involved in rigorous Ranger and Recondo training, but without a clear clinical confirmation of symptoms, injury, or a diagnosis of a low back disability. In an October 1986 private physical examination, the Veteran denied any back pain. In July 2001, the Veteran sought treatment for a 3-4 week history of back pain caused by doing physical labor at home. He also referred to an injury when he jumped off a tractor eight years earlier and "cracked a bone in his back" that healed. Private records in 2011, 2012, and 2014 show that the Veteran denied any lower back pain. In December 2015, a private physician noted that the Veteran sought treatment for back pain that started two weeks earlier while hunting. The Veteran was afforded a VA examination in May 2018. The Veteran reported right tailbone pain for the last 5 to 10 years. X-ray imaging noted degenerative changes. The examiner noted degenerative arthritis of the spine. The Veteran reports that he has sharp low back pain on his right side. The Veteran reported flare ups of back pain with random pains. No functional loss or functional impairment was noted. Range of motion testing was normal; pain was noted but did not result in or cause functional loss. There was no evidence of pain on weight bearing and with passive range of motion. Repetitive use testing did not result in any additional loss of range of motion. Muscle strength testing was normal with no muscle atrophy. A reflex exam and sensory exam were normal. No ankylosis or signs of radiculopathy was noted. The examiner noted that the Veteran's back condition does not impact his ability to work. The examiner found that the Veteran's current low back disability was less likely than not incurred in or caused by the claimed in-service injury, event or illness. The examiner noted a thorough review of the claims file and no evidence of treatment or an injury in-service. The examiner attributed that the Veteran's current low back arthritis is most likely due to aging, noting onset of symptoms began significantly approximately 10 years earlier. July 2018, May 2019 and February 2020 private treatment records noted no current back pain, but in July 2020, the Veteran reported intermittent back pain. Then, a supplemental opinion in March 2021 and April 2021 which have been associated with the claims file. The examiner noted a review of the newly associated treatment records. The examiner noted that it was less likely than not that the Veteran's current low back arthritis was caused by an in-service injury, event or disease including parachute jumps and Ranger training. The examiner noted additional review of medical and lay evidence and the reports of a fracture in his low back in 2001 occurring 8 years earlier from jumping off a tractor in 1992. The examiner found that the Veteran's 1992 tractor injury is most likely the cause of his current low back arthritis. As to presumptive service connection, the examiner noted that it is less likely than not that the Veteran's low back arthritis began during active service, manifested within the applicable presumptive period after discharge from service, or was noted during service with continuity of the same symptomology since service. The examiner noted that the Veteran's current low back arthritis is attributed to an injury in 1992 falling off a tractor which is the current cause of his arthritis. The examiner noted that the Veteran's STRs note no low back arthritis or symptomology diagnosed, evaluated or treated in service. In addition, a supplemental opinion from May 2021 has been associated with the claims file. The examiner noted a review of the medical literature regarding osteoarthritis, which is a common wear and tear disease, and that the underlying cause of this condition is typically chronic repetitive motion that results in inflammation and structural joint damage. The examiner noted based on a review of the medical literature, evidence and lay statements of record that it is less likely than not that the Veteran's current low back arthritis was caused by an in-service injury, event or illness including performing over 20 parachute jumps and Ranger training. The examiner noted that it is more likely that the Veteran's reported fracture in his low back in 1992 where he jumped off a tractor and sustained a fracture is the cause of his current injury. The examiner noted that the Veteran's arthritis was diagnosed and evaluated more than 40 years after discharge from service and the evidence of record consistently suggests that there were interceding events after service and the applicable presumptive period that are more likely the cause of his current low back condition. The examiner found it is less likely than not that the Veteran's current low back arthritis manifested during service or within the applicable presumptive period or was noted during service with the continuity of the same symptomology since service. VA and private treatment records have been associated with the claims file and note reports of low back pain in July 2001 and X-ray imaging noted degenerative changes. The Veteran reported an injury where he jumped off a tractor and cracked a bone in his back about 8 years before, this injury healed, and he has not had any problems with his back since. July 2001 treatment records note the Veteran reported low back pain after completing physical labor and tasks at home. These treatment records do not contradict the VA examinations and are absent indications between the Veteran's current low back disability and an in-service disease or injury. The Veteran's representative in August 2021 correspondence generally contends that service connection is warranted, and that the VA examiner failed to fully consider the Veteran's lay statements. The Board notes that the representative is not a competent authority to determine what information may be found probative to a competent examiner. The Board has considered the Veteran's and his representative's contentions however, VA benefits may not be granted based on speculative opinions. Rather, opinions must be made by competent professionals and be based on a rationale that is clear to the Board. The Veteran's representative is not competent to provide a medical opinion. Furthermore, even if the representative was found to be a competent source of opinion, evidence favorable to a veteran's claim that does little more than suggest a possibility that his illnesses might have been caused by service or a service connected disability is insufficient to establish service connection. See Stegman v. Derwinski, 3 Vet. App. 228, 230 (1992). Lastly, the benefit of the doubt rule is for application when the evidence is in equipoise, which occurs only when there is an approximate balance between the positive and negative evidence. 38 C.F.R. § 3.102. That evidence must be both competent and credible. Here, there is no such balance. After consideration of all the evidence of record the Board finds that the weight of the evidence is against finding that service connection for a low back disability is warranted. The Board concludes that service connection for a low back disability is not warranted as the Veteran's current low back disability is not caused by service. The Veteran's and the associated lay statements and testimony regarding his current symptoms are competent. However, the reports of continued pain and symptomology since service warrants less probative weight as he denied any low back pain or arthritis at discharge from service in March 1965 when this was an opportunity to identify a chronic disability. He and his spouse reported that he endured pain since service, but that is inconsistent with the private records showing no pain for many years when specifically asked in a clinical setting. While the Veteran and associated lay statements report that his current low back disability is related to his service and his ongoing symptomology is related to service, the record does not reflect that they have the requisite training or expertise to offer a medical opinion linking a current disability to service and as such the Veteran and the associated lay statements are not competent to provide a nexus opinion in this case. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). The Board finds that the medical evidence is more probative and credible than the lay opinions of record. The competent medical evidence specifically the March 2021, April 2021 and May 2021 supplemental opinions taken in consideration together are entitled to significant probative weight. The VA examiner noted that it was less likely than not that the Veteran's current low back arthritis was caused by an in-service injury, event or disease including parachute jumps and Ranger training. The examiner noted additional review of medical and lay evidence and the reports a fracture in his low back in 2001 occurring 8 years earlier from a 1992 tractor accident. The examiner also noted a review of the medical literature regarding osteoarthritis, which is a common wear and tear disease, and that the underlying cause of this condition is typically chronic repetitive motion that results in inflammation and structural joint damage. The examiner noted based on a review of the medical literature, evidence and lay statements of record that it is less likely than not that the Veteran's current low back arthritis was caused by an in-service injury, event or illness including performing over 20 parachute jumps and Ranger training. The examiner noted that it is more likely that the Veteran's current low back injury is attributed to a 1992 injury where he jumped off a tractor and sustained a fracture. The examiner noted that the Veteran's arthritis was diagnosed and evaluated more than 40 years after discharge from service and the evidence of record consistently suggests that there were interceding events after service and the applicable presumptive period that are more likely the cause of his current low back condition. As to presumptive service connection the examiner noted that it is less likely than not that the Veteran's low back arthritis began during active service, manifested within the applicable presumptive period after discharge from service, or was noted during service with continuity of the same symptomology since service. The Veteran's current low back arthritis is attributed to an injury in 1992 falling off a tractor. The Veteran's STRs note no low back arthritis or symptomology diagnosed, evaluated, or treated in service. The Board finds that direct service connection is not warranted as the Veteran's low back disability was not onset in or caused by service. The Board notes the STRs note at separation in March 1965 clinical evaluation of the spine and musculoskeletal system was normal and the Veteran on the report of medical history denied swollen or painful joints, use of a brace or back support or arthritis or a bone joint or other deformity. The Board has considered the Veteran's lay statements and associated lay statements and testimony; however, the Board gives more probative weight to the competent medical evidence especially the March 2021, April 2021 and May 2021 VA examinations. As such the Board finds the Veteran's current low back disability was less likely than not caused by active service. As to presumptive service connection the Veteran's low back arthritis did not manifest until many years post-service. The Board concludes that while the Veteran has arthritis, which falls within a chronic disease under 38 U.S.C. § 1101 (3)/38 C.F.R. § 3.309(a), however such was not chronic in service nor did such manifest to a compensable degree in service or within the presumptive period, and continuity of symptomatology is not established. The Veteran's arthritis was not noted during service or within one year of separation. See Walker, 708 F.3d 1331. At separation on the report of medical examination in March 1965 clinical evaluation was normal. Service records do not support an onset of the Veteran's low back arthritis in active service. Based on the probative evidence of record the Board finds that the Veteran's arthritis did not manifest within the one-year period after service and service connection is not warranted on a presumptive basis. Private treatment records note low back arthritis was diagnosed in 2001 which is more than 35 years after separation. In addition, in weighing the evidence of record the Board finds the competent and credible evidence of record is against finding continuity of symptomatology. As a result, service connection based on continuity of symptomology is not warranted. In conclusion, the Board finds that the preponderance of the evidence is against the Veteran's claim for service connection for a low back disability. Since the preponderance of the evidence is against the claim, the benefit of the doubt rule is not applicable. See 38 U.S.C. § 5107 (b); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 5557 (1990); 38 C.F.R. § 3.102. For these reasons, the claim is denied. 3. Entitlement to service connection for a left foot disability, to include callouses and to include as due to a service connected disability 4. Entitlement to service connection for a right foot disability, to include callouses and to include as due to a service connected disability 5. Entitlement to service connection for a left foot disability, to include bunions and to include as due to a service connected disability 6. Entitlement to service connection for a right foot disability, to include bunions and to include as due to a service connected disability The Veteran contends that service connection is warranted for a left foot disability to include callouses and to include as due to a service connected disability. In addition, the Veteran contends that service connection is warranted for a right foot disability to include callouses and to include as due to a service connected disability. Further, the Veteran contends that service connection is warranted for a left foot disability to include bunions and to include as due to a service connected disability. The Veteran also contends that service connection is warranted for a right foot disability to include bunions and to include as due to a service connection disability. The Veteran testified in November 2020 that his current right and left foot bunions and callouses are related to service. The Veteran's wife testified that the Veteran has had difficulty finding shoes since she has known him for the past 55 years. The Veteran testified to ongoing pain in his feet which he believes may be related to running long distances in-service in combat boots. Further, the Veteran testified that the rigors of Ranger school and his duties teaching infantryman were especially rigorous. The Veteran reported completing 27 parachute jumps in service and completing rigorous Ranger training and Recondo school training. The Veteran testified to ongoing foot issues since service that have worsened over time. The Veteran contends that his bilateral foot condition is a result of his knee, back and hip disabilities which have altered his gait and caused bunions and callouses on his feet. The Veteran and associated lay statements report ongoing symptomology associated with his right and left feet which has worsened in recent years. The Board notes that herein for the sake of brevity the Board will refer to the Veteran's right and left foot disabilities to include callouses and bunions and to include the entirety of his right and left foot symptomology. Herein, a discussion of the Veteran's right and left foot disabilities includes the entirety of his associated symptomology including callouses and bunions. For the sake of brevity, the Board will discuss these service connection claims together. The question for the Board is whether the Veteran has a current left foot disability to include callouses and bunions that began during service, manifested during the applicable presumptive period, or is at least as likely as not caused by an in-service injury or disease; or caused or aggravated by a service connected disability. Further, the next question for the Board is whether the Veteran has a current right foot disability to include callouses and bunions that began during service, manifested during the applicable presumptive period, or is at least as likely as not caused by an in-service injury or disease; or caused or aggravated by a service connected disability. The Veteran has a diagnosis of left foot hallux valgus, calluses and degenerative changes and right foot hallux valgus, degenerative changes and calluses. The Veteran's STRs and service personnel records have been associated with the claims file. Personnel records note the Veteran served as a weapons infantryman and earned the parachutists badge and Ranger tab. Personnel records note the Veteran completed 27 parachute jumps. On the report of medical examination at separation in a March 1965 clinical evaluation of the feet and lower extremities was normal. In March 1965 on the report of medical history in preparation for separation the Veteran denied swollen or painful joints, arthritis, bone, joint or other deformity and foot trouble. Based on the Veteran's statements and testimony the Board finds an in-service event in that he completed 27 parachute jumps in-service and was involved in rigorous Ranger and Recondo training, but without a clear clinical confirmation of symptoms or a diagnosis of a left and right foot disability. Private records starting in 1986 are silent for chronic foot pain. In April 2014, private records show that the Veteran sought treatment for left foot pain that he had experienced for several months but only in bare feet or slippers. When wearing shoes as a courier, he did not have pain. The Veteran was afforded a VA foot examination in May 2018. The examiner noted bilateral pes planus, bilateral hallux valgus and bilateral calluses. The Veteran reported callouses on the ball of both feet and they cause pain when walking on hard surfaces. The Veteran reports he has been prescribed inserts for his shoes which helps some with pain. The Veteran reports flare ups impacting the function of his foot with walking on hard surfaces which increases pain. No functional loss or functional impairment was noted. The Veteran reports regular use of arch supports but ongoing pain and tenderness of his feet. A bilateral lower extremity deformity causing alteration of the weight bearing line was noted with hallux valgus. Mild to moderate symptoms relating to hallux valgus condition were noted. Foot pain was noted on examination which contributes to functional loss with pain on weight bearing and interference with standing. The examiner noted the Veteran's foot conditions impact his ability to perform occupational tasks in that he has difficulty walking or standing on hard surfaces. The examiner noted that it is less likely than not that the Veteran's bilateral foot conditions are proximately due to or the result of his claimed back, left knee and right hip disabilities. The examiner found that based on a review of the evidence of record the Veteran's bilateral foot conditions are not secondary to his claimed back, left knee or right hip conditions. Then, the Veteran was afforded a VA foot supplemental opinion in March 2021 and April 2021. The examiner noted that it is less likely than not that the Veteran's current right and left foot disabilities including bunions and callouses, and degenerative changes are caused by an in-service injury, event or disease including parachute jumps and Ranger training in-service. The examiner noted a thorough review of the Veteran's claims file and his STRs. The examiner noted that hallux valgus is a deformity caused over a long period of time and the first evidence of diagnosed foot conditions was in 2014. As to presumptive service connection the VA examiner noted that it is less likely than not that the Veteran's right and left foot arthritis began during active service, manifested within the applicable presumptive period after discharge form service or was noted during service with continuity of the same symptomology since service. The examiner noted that based on a review of the medical evidence the onset of the Veteran's bilateral foot arthritis was more than 40 years after discharge from service, with no evidence in the STRs of symptomology of the feet. As to secondary service connection, the examiner noted that the Veteran's low back, right hip and left knee disabilities are not likely related to military service and thus consideration of secondary service connection is not warranted. In addition, the Veteran was afforded a VA supplemental opinion in May 2021. The examiner noted degenerative changes and bilateral foot pain, rupture of discoid mucus cyst, and hallux valgus with a bunion deformity. The examiner noted an extensive review of the medical literature. The examiner noted that bunions are a deformity that occurs from pressure on the big toe joint resulting in misalignment and the formation of a bony bump. Bunions can be caused from foot mechanics, foot structure and usually happen gradually over time. Further, while standing for long periods of time and wearing ill-fitting narrow shoes can make bunion pain worse, however such does not cause the problem. The examiner noted that it is less likely than not that the Veteran's current right and left foot disabilities including bunions and callouses are caused by an in-service injury, event or illness including performing over 20 parachute jumps and Ranger training. The examiner noted that hallus valgus is the most common deformity of the forefoot and toes and over 35 percent of individuals over 65 years old have hallux valgus. This foot condition occurs from years of pressure of the big toe joint and is more common in older adults. Calluses and corns are thick hardened layers of skin that develop when your skin tries to protect itself against friction and pressure. As to right and left foot arthritis the examiner found that it is less likely than not that the Veteran's arthritis began during active service, manifested within the applicable presumptive period after discharge from service, or was noted during service with continuity of the same symptomology since service. The examiner noted that the medical evidence indicates onset of arthritis more than 40 years after separation from service and no evidence in the STRs of symptomology of right and left foot arthritis or associated symptomology evaluated, identified or treated during active service or manifested within the applicable presumptive period after discharge from service, or was such noted during service with the continuity of the same symptomology since service. VA and private treatment records have been associated with the claims file and note reports of foot pain and difficulty in 2014. April 2014 X-ray imaging noted left foot degenerative changes with hallux valgus and bunion deformity. Private treatment records note in May 2017 a significant hallux valgus deformity. The Veteran reported difficulty with his toes and pain on the bottom and ball of his foot. These treatment records do not contradict the VA examinations and are absent indications between the Veteran's current left and right foot disabilities and an in-service disease or injury. The Veteran's representative in August 2021 correspondence generally contends that service connection is warranted, and that the VA examiner failed to fully consider the Veteran's lay statements. The Board notes that the representative is not a competent authority to determine what information may be found probative to a competent examiner. The Board has considered the Veteran's and his representative contentions however, VA benefits may not be granted based on speculative opinions. Rather, opinions must be made by competent professionals and be based on a rationale that is clear to the Board. The Veteran's representative is not competent to provide a medical opinion. Furthermore, even if the representative was found to be a competent source of opinion, evidence favorable to a veteran's claim that does little more than suggest a possibility that his illnesses might have been caused by service or a service connected disability is insufficient to establish service connection. See Stegman v. Derwinski, 3 Vet. App. 228, 230 (1992). Lastly, the benefit of the doubt rule is for application when the evidence is in equipoise, which occurs only when there is an approximate balance between the positive and negative evidence. 38 C.F.R. § 3.102. That evidence must be both competent and credible. Here, there is no such balance. After consideration of all the evidence of record the Board finds that the weight of the evidence is against finding that service connection for a left foot disability, to include callouses and bunions and service connection for a right foot disability to include callouses and bunions is warranted. The Board concludes that service connection for a left and right foot disability is not warranted as the Veteran's current left and right foot disabilities were not caused by service. The Veteran's and the associated lay statements and testimony regarding his current symptoms are competent. However, his reports of continued pain and symptomology since service warrants less probative weight as he denied left and right foot abnormalities at separation in March 1965 in the discharge exam when this was an opportunity to identify a chronic disability. Although the Veteran and his spouse reported that he endured pain and used orthotics, that is not consistent with a long period of private care that noted no foot abnormalities for many years despite work as a courier that required extended walking. While the Veteran and associated lay statements report that his current left and right foot disabilities are related to his service and his ongoing symptomology is related to his current left and right foot disabilities and service the record does not reflect that they have the requisite training or expertise to offer a medical opinion linking a current disability to service and as such the Veteran and the associated lay statements are not competent to provide a nexus opinion in this case. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). The Board finds that the medical evidence is more probative and credible than the lay opinions of record. The competent medical evidence specifically the March 2021, April 2021 and May 2021 VA opinions taken in consideration together are entitled to significant probative weight. The examiner noted an extensive review of the medical literature, treatment records and claims file. The examiner noted that bunions are a deformity that occurs from pressure on the big toe joint resulting in misalignment and the formation of a bony bump. Bunions can be caused from foot mechanics, foot structure and usually happen gradually over time. Further, while standing for long periods of time and wearing ill-fitting narrow shoes can make bunion pain worse such does not cause the problem. The examiner noted that it is less likely than not that the Veteran's current right and left foot disabilities including bunions and callouses are caused by an in-service injury, event or illness including performing over 20 parachute jumps and Ranger training. The examiner noted that hallus valgus is the most common deformity of the forefoot and toes and over 35 percent of individuals over 65 years old have hallux valgus. This foot condition occurs from years of pressure of the big toe joint and is more common in older adults. Calluses and corns are thick hardened layers of skin that develop when your skin tries to protect itself against friction and pressure. As to presumptive service connection the examiner noted that it is less likely than not that the Veteran's right and left foot arthritis began during active service, manifested within the applicable presumptive period after discharge form service or was noted during service with continuity of the same symptomology since service. The examiner noted that based on a review of the medical evidence the onset of the Veteran's bilateral foot arthritis was more than 40 years after discharge from service, with no evidence in the STRs of symptomology of the feet. The Board finds that direct service connection is not warranted as the Veteran's left and right foot disabilities was not onset in or caused by service. The Board notes that the STRs note in March 1965 on the report of medical history the Veteran denied swollen or painful joints, arthritis, bone, joint or other deformity and foot trouble. The Board has considered the Veteran's lay statements and testimony however, the Board gives more probative weight to the competent medical evidence especially the March 2021, April 2021 and May 2021 VA opinions. As such the Board finds the Veteran's left and right foot disability is less likely than not caused by active service. As to secondary service connection, the Veteran contends that his current right and left foot disabilities are caused by his low back, right hip and left knee disabilities due to his altered gait. However, as discussed within this decision service connection for low back, right hip and left knee disabilities is denied. As these are not service connected conditions the Board finds that consideration for secondary service connection is not warranted and must be denied. As to presumptive service connection the Veteran's left and right foot arthritis did not manifest until many years post-service. The Board concludes that while the Veteran has arthritis, which falls within a chronic disease under 38 U.S.C. § 1101 (3)/38 C.F.R. § 3.309(a), however such was not chronic in service nor did this manifest to a compensable degree in service or within the presumptive period, and continuity of symptomatology is not established. The Veteran's arthritis was not noted during service or within one year of separation. See Walker, 708 F.3d 1331. At separation on the report of medical examination in March 1965 clinical evaluation of the lower extremities, feet and musculoskeletal system was normal. Service records do not support an onset of the Veteran's arthritis in active service. Based on the probative evidence of record the Board finds that the Veteran's arthritis did not manifest within the one-year period after service and service connection is not warranted on a presumptive basis. VA treatment records note arthritis in 2014 which is almost 45 years after separation from service in 1965. In addition, in weighing the evidence of record the Board finds the competent and credible evidence of record is against finding continuity of symptomatology. As a result, service connection based on continuity of symptomology is not warranted. In conclusion, the Board finds that the weight of competent and credible evidence is against the Veteran's claims for service connection for a left foot disability to include callouses and to include as due to a service connected disability as well as the claim for service connection for a right foot disability to include callouses and to include as due to a service connected disability and service connection for a left foot disability to include bunions and to include as due to a service connected disability and service connection for a right foot disability to include bunions and to include as due to a service connected disability. The benefit of the doubt rule is not applicable. See 38 U.S.C. § 5107 (b); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 5557 (1990); 38 C.F.R. § 3.102. For these reasons, the claims are denied. 7. Entitlement to service connection for right hip disability The Veteran contends that service connection is warranted for a current right hip disability. The Veteran reports that his right hip disability is related to service and his in-service training which involved multiple parachute jumps and Ranger training. The Veteran testified in November 2020 to ongoing right hip symptomology since service. The Veteran contends he has experienced on and off ongoing right hip pain since service. The Veteran testified that at times he experiences right hip pain related to increased activity. The question for the Board is whether the Veteran has a right hip disability that began during service or is at least as likely as not caused by an in service injury or disease. The Veteran has right hip pain and symptomology, under 38 U.S.C. § 1110, there must be a disability due to an identified personal injury suffered or disease or injury, contracted in-service. Where pain alone results in functional impairment, even if there is no identified underlying diagnosis, it can constitute a disability. However, subjective pain in and of itself will not establish a current disability. Consideration should be given to the impact, or lack thereof, from pain, focusing on evidence of functional limitation caused by pain. Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir., 2018). Herein, the Board considered the Veteran's reports of pain and symptomology in his right hip which impacts walking, bending and completing activities of daily living at times and results in functional limitation resulting in working impairment and thus constituting a disability. The Veteran's STRs and service personnel records have been associated with the claims file. Personnel records note the Veteran served as a weapons infantryman and was awarded the parachutist badge and Ranger tab. The Veteran completed rigorous Ranger training and Recondo school training. Personnel records note the Veteran completed 27 parachute jumps. At separation in March 1965 on the report of medical examination clinical evaluation of the lower extremities and musculoskeletal system was normal. Based on the Veteran's statements and treatment records the Board finds an in-service event, in that the Veteran completed 27 parachute jumps in-service and was involved in rigorous Ranger and Recondo training, but without a clear clinical confirmation of symptoms or a diagnosis of a right hip disability. The Veteran was afforded a VA examination in May 2018. The Veteran reported right hip pain on his side from his low back. The Veteran denied hip joint problems. The Veteran reported no history of hip joint pain, hip dislocation, locking up or giving out of his hip. The Veteran reports shooting pain that does not last long. The examiner noted that the Veteran does not have a current right hip diagnosis. The Veteran denied flare ups and no functional loss or functional impairment was noted. Range of motion testing was normal, with no pain. Muscle strength testing was normal at 5/5 with no muscle atrophy. The examiner noted that there is no functional impact. The examiner found that it was less likely than not that the Veteran's claimed right hip condition was incurred in or caused by the claimed in-service injury, event or illness. The examiner noted that based upon a review of the available information and examination there was no current right hip diagnosis. Then, the Veteran was afforded a VA supplemental opinion in March 2021 and in April 2021. The examiner noted that the Veteran's right hip disability was less likely than not incurred in or caused by the claimed in-service injury, event or illness including parachute jumps and Ranger training. The examiner noted the Veteran's STRs noted no right hip condition. Treatment records in 1996 note a right leg injury with reported surgery from a tipped tractor accident earlier that year. In addition, the Veteran was afforded a VA supplemental opinion in May 2021. The examiner noted consideration of the claims file, treatment records and associated lay statements. The examiner noted an injury in 1996, where the Veteran's right leg was in a cast after a tractor accident. The examiner noted that it is less likely than not that current right hip pain was incurred in or caused by the claimed in-service injury, event or disease including his in-service parachute jumps and Ranger training. The VA examiner noted in 1996 the Veteran was seen for a right leg injury from a tipped tractor injury that year. The examiner noted no evidence of right hip arthritis. VA and private treatment records have been associated with the claims file. A review of these records shows that the earliest self-report of right hip symptomology and leg pain in 1996, after a tractor accident. Private treatment records noted right hip and leg pain in September 2014 after bear hunting and sitting in a tree stand for a long time in an awkward position. Private treatment records noted right lower extremity discomfort and rest, ice and elevation were recommended. These treatment records do not contradict the VA examinations and are absent indications between the Veteran's current right hip disability and an in-service disease or injury. The Veteran's representative in August 2021 correspondence generally contends that service connection is warranted, and that the VA examiner failed to fully consider the Veteran's lay statements. The Board notes that the representative is not a competent authority to determine what information may be found probative to a competent examiner. The Board has considered the Veteran's and his representative's contentions however, VA benefits may not be granted based on speculative opinions. Rather, opinions must be made by competent professionals and be based on a rationale that is clear to the Board. The Veteran's representative is not competent to provide a medical opinion. Furthermore, even if the representative was found to be a competent source of opinion, evidence favorable to a veteran's claim that does little more than suggest a possibility that his illnesses might have been caused by service or a service connected disability is insufficient to establish service connection. See Stegman v. Derwinski, 3 Vet. App. 228, 230 (1992). Lastly, the benefit of the doubt rule is for application when the evidence is in equipoise, which occurs only when there is an approximate balance between the positive and negative evidence. 38 C.F.R. § 3.102. That evidence must be both competent and credible. Here, there is no such balance. After consideration of all the evidence of record the Board finds that the weight of the evidence is against finding that service connection for a right hip disability is warranted. The Board concludes that service connection for a right hip disability is not warranted on a direct basis as the Veteran's current right hip symptomology was not caused by service. The Veteran's testimony and statements and associated lay statements regarding his current symptoms, in-service events and ongoing symptomology are credible. While the Veteran and the associated lay statements report that his current right hip disability is generally related to service the record does not reflect that he or the associated lay statements have the requisite training or expertise to offer a medical opinion linking a current disability to service and as such the Veteran and the associated lay statements are not competent to provide a nexus opinion in this case. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). The Board finds that the medical evidence is more probative and credible than the lay opinions of record. The competent medical evidence of record including the VA examinations and supplemental opinions in March 2021, April 2021 and May 2021 taken in consideration together are entitled to significant probative weight. The examiner noted consideration of the claims file, treatment records and associated lay statements. The examiner noted that the Veteran's right hip disability was less likely than not incurred in or caused by the claimed in-service injury, event or illness including parachute jumps and Ranger training. The examiner noted the Veteran's STR noted no right hip condition. Treatment records in 1996 note a right leg injury with reported surgery from a tipped tractor earlier that year. The VA examiner noted in 1996 the Veteran was seen for a right leg injury from a tipped tractor injury that year. The examiner noted no evidence of right hip arthritis. Further, at separation in March 1965 clinical evaluation of the lower extremities and musculoskeletal system was normal. As such the Board finds that the Veteran's current right hip disability is less likely than not related to active service. In conclusion, the Board finds that the preponderance of the evidence is against the Veteran's claim for service connection for a right hip disability. Since the preponderance of the evidence is against the claim, the benefit of the doubt rule is not applicable. See 38 U.S.C. § 5107 (b); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 5557 (1990); 38 C.F.R. § 3.102. For these reasons, the claim is denied. 8. Entitlement to service connection for a left knee disability The Veteran contends that service connection is warranted for a left knee disability. The Veteran reports that his current left knee disability is related to service. The Veteran testified in November 2020 that his left knee pain and symptomology has been ongoing for a long time and has worsened in recent years. The Veteran testified to in-service undergoing many parachute jumps and the rigors of Ranger training. The Veteran's wife also testified that he has experienced knee pain at different times, during the past 55 years of marriage, but his pain worsened recently, and he now needs a total left knee replacement. The Veteran's wife reports ongoing left knee complaints during the parties 55 year marriage. The Veteran generally has reported ongoing symptoms of left knee discomfort since service at different times. The Veteran's wife testified that he has difficulty bending, picking items up and completing activities of daily living in part due to his left knee pain. The question for the Board is whether the Veteran has a left knee disability that began during service, manifested during the applicable presumptive period, or is at least as likely as not caused by an in-service, injury or disease. The Veteran has a diagnosis of left knee degenerative arthritis. The Veteran's STRs and service personnel records have been associated with the claims file. Personnel records note the Veteran served as a weapons infantryman and was awarded the parachutists badge and Ranger tab. Personnel records note the Veteran completed rigorous Ranger training and Recondo school training. Personnel records note the Veteran completed 27 parachute jumps. At separation in March 1965 on the report of medical examination clinical evaluation of the lower extremities and musculoskeletal system was normal. Further, at separation in March 1965 on the report of medical history the Veteran denied arthritis, bone, joint or other deformity and a "trick" or locked knee. Based on the Veteran's statements and testimony the Board finds an in-service event in that he completed 27 parachute jumps in-service and was involved in rigorous Ranger and Recondo training, but without a clear clinical confirmation of symptoms or a diagnosis of a left knee disability. In private outpatient records in June 2014, the Veteran reported twisting his left knee while carrying a ladder on a slanted hillside and experiencing an abrupt onset of knee pain. The attending physician diagnosed a meniscus tear and an anterior cruciate ligament tear of unknown age. The Veteran underwent arthroscopic surgery. The Veteran was afforded VA examination in May 2018. The Veteran reported left knee pain with weight bearing and increased activity. The Veteran reports some swelling at times. The examiner noted left knee degenerative arthritis. The examiner noted the Veteran underwent arthroscopic surgery about 5 years ago. The Veteran reports ongoing use of over the counter pain medication and a knee brace as needed. Flare ups of the left knee were noted with increased pain with increased activity. Functional impairment was noted with difficulty bending and kneeling. Range of motion testing noted flexion from 0 to 120 degrees and extension from 120 to 0 degrees with pain and tenderness. There was no evidence of pain on weight bearing. Repetitive use testing did not result in any additional loss of range of motion. Physical examination of the knee noted no lower edema, some discomfort when stressing the medial meniscus and grinding with passive motion. X-ray imaging noted degenerative changes. There was no evidence or history of recurrent subluxation or lateral instability. Recurrent effusion was noted with intermittent swelling. The examiner noted that the Veteran's left knee condition impacts his ability to perform occupational tasks in that he has difficulty bending, kneeling and going up and down steps. The examiner noted that it was less likely than not that the Veteran's left knee disability was incurred in or caused by the claimed in-service injury, event or illness. The examiner noted onset of a left knee injury approximately 6 years ago with chronic symptoms since, and no evidence of treatment or an injury in-service. The VA examiner attributed the Veteran's current left knee disability to aging and his prior left knee surgery. The Veteran was afforded a supplemental VA opinion in March 2021 and in April 2021. The examiner noted an extensive review of the claims file and treatment records and associated lay statements. The examiner found that it is less likely than not that the Veteran's current left knee disability is caused by an in-service injury, event or disease including parachute jumps and Ranger training. The examiner noted consideration of the veteran performing over 20 parachute jumps in-service and completing rigorous training. The examiner noted that the Veteran was not evaluated for or treated in-service for a left knee disability. The examiner noted that at separation from service the Veteran's knees were normal on examination. The examiner noted a well-documented left knee injury in 2014 which required surgical intervention and ongoing complaints, and that the Veteran's current left knee disability did not begin in service. As to presumptive service connection the VA examiner found that it is less likely than not that the Veteran's left knee arthritis began during active service, manifested within the applicable presumptive period after discharge from service or was noted during service with continuity of the same symptomology since service. The Veteran's left knee arthritis was diagnosed many years after discharge from service and is more likely attributed to his activities working as a line man post-service climbing poles, and as a courier in a medical facility, and years of bear and elk hunting and his well-documented knee injury in 2014 with surgery. In addition, the Veteran was afforded a VA supplemental opinion in May 2021. The examiner noted that it is less likely than not that the Veteran's left knee arthritis was incurred in or caused by the claimed in-service injury, event or illness including performing over 20 parachute jumps and Ranger training. The examiner noted based on a review of the medical evidence and lay statements of record that based on the evidence of record and in consideration of the lay statements the Veteran suffered a medial tear in May 2014 and there is no evidence of injuries during service or within the presumptive period after discharge or a continuity of the same symptomology since service. At separation clinical evaluation noted normal knees. The Veteran's current left knee disability was onset after military discharge with well documented reports of an injury in 2014 that required surgical intervention and a subsequent left total knee replacement. The examiner noted that degenerative changes in the knee from wear in tear occurs most often in people older than 50 as the cartilage of the knee wear away and can worsen with a tear of the meniscus in a twisting injury which the Veteran had post-service. VA and private treatment records have been associated with the claims file. May 2014 private treatment records note an injury carrying a ladder down a slopped hill and current left knee pain and swelling X-ray imaging noted mild degenerative changes and bony abnormality. An MRI noted a symptomatic medial meniscus tear of the left knee. The Veteran underwent a medial meniscus repair in June 2014. Treatment records note ongoing reports of left knee pain for 4 years in July 2020 with degenerative changes based on X-ray imaging. Treatment records note use of corticosteroid injections and a left knee brace. Treatment records note the Veteran underwent a total left knee arthroplasty in August 2020. Treatment records note the Veteran is status post total left knee arthroplasty. These treatment records do not contradict the VA examinations and are absent indications between the Veteran's current left knee disability and an in-service disease or injury. The Veteran's representative in August 2021 correspondence generally contends that service connection is warranted, and that the VA examiner failed to fully consider the Veteran's lay statements. The Board notes that the representative is not a competent authority to determine what information may be found probative to a competent examiner. The Board has considered the Veteran's and his representative contentions however, VA benefits may not be granted based on speculative opinions. Rather, opinions must be made by competent professionals and be based on a rationale that is clear to the Board. The Veteran's representative is not competent to provide a medical opinion. Furthermore, even if the representative was found to be a competent source of opinion, evidence favorable to a veteran's claim that does little more than suggest a possibility that his illnesses might have been caused by service or a service connected disability is insufficient to establish service connection. See Stegman v. Derwinski, 3 Vet. App. 228, 230 (1992). Lastly, the benefit of the doubt rule is for application when the evidence is in equipoise, which occurs only when there is an approximate balance between the positive and negative evidence. 38 C.F.R. § 3.102. That evidence must be both competent and credible. Here, there is no such balance. After consideration of all the evidence of record the Board finds that the weight of the evidence is against finding that service connection for a left knee disability is warranted. The Board concludes that service connection for a left knee disability is not warranted on a direct basis as the Veteran's current left knee disability was not caused by service. The Veteran's testimony and statements and associated lay statements regarding his current symptoms, in-service events and ongoing symptomology are competent. Although the Veteran and his spouse called attention to the rigorous Army training and the Veteran's ability to endure discomfort since then, it is not consistent with the long period of private comprehensive treatment that did not show knee abnormalities for many years after service when there were opportunities to report knee problems. While the Veteran and the associated lay statements report that his current left knee disability is generally related to service, the record does not reflect that he or the associated lay statements have the requisite training or expertise to offer a medical opinion linking a current disability to service and as such the Veteran and the associated lay statements are not competent to provide a nexus opinion in this case. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). The Board finds the medical evidence is more probative and credible than the lay opinions of record. The competent medical evidence of record including the VA examinations taken in consideration together in March 2021, April 2021 and May 2021 are entitled to significant probative weight. The examiner noted an extensive review of the claims file and treatment records and associated lay statements. The examiner found that it is less likely than not that the Veteran's current left knee disability is caused by an in-service injury, event or disease including parachute jumps and Ranger training. The examiner noted consideration of the veteran performing over 20 parachute jumps in-service and completing rigorous training. The examiner noted that the Veteran was not evaluated for or treated in-service for a left knee disability. The examiner noted that at separation from service the Veteran's knees were normal on examination. The examiner noted a well-documented left knee injury in 2014 which required surgical intervention and ongoing complaints, and that the Veteran's current left knee disability did not begin in service. As to presumptive service connection the VA examiner found that it is less likely than not that the Veteran's left knee arthritis began during active service, manifested within the applicable presumptive period after discharge from service or was noted during service with continuity of the same symptomology since service. The Veteran's left knee arthritis was diagnosed many years after discharge from service and is more likely attributed to his activities working as a line man post-service climbing poles, and as a courier in a medical facility, and years of bear and elk hunting and his well-documented knee injury in 2014 with surgery. In addition, the Veteran was afforded a VA supplemental opinion in May 2021. The examiner noted that it is less likely than not that the Veteran's left knee arthritis was incurred in or caused by the claimed in-service injury, event or illness including performing over 20 parachute jumps and Ranger training. The examiner noted based on a review of the medical evidence and lay statements of record that based on the evidence of record and in consideration of the lay statements the Veteran suffered a medical tear in May 2014 and there is no evidence of injuries during service or within the presumptive period after discharge or a continuity of the same symptomology since service. Veteran's current left knee disability was onset after military discharge with well documented reports of an injury in 2014 that required surgical intervention and a subsequent left total knee replacement. Degenerative changes in the knee from wear in tear occurs most often in people older than 50 as the cartilage of the knee wear away and can worsen with a tear of the meniscus in a twisting injury which the Veteran had post-service. The Board has considered the Veteran's reports of continued pain and symptomology since service but finds such warrants less probative weight, as he denied knee and lower extremity pain at discharge from service in March 1965, and such is counter to the medical opinions of record. As such the Board found that the Veteran's current left knee disability is less likely than not related to active service. As to presumptive service connection the Veteran's degenerative arthritis of the left knee did not manifest until many years post-service. The Board concludes that while the Veteran has arthritis, which falls within a chronic disease under 38 U.S.C. § 1101 (3)/38 C.F.R. § 3.309(a), however such was not chronic in service nor did such manifest to a compensable degree in service or within the presumptive period, and continuity of symptomatology is not established. The Veteran's arthritis was not noted during service or within one year of separation. See Walker, 708 F.3d 1331. At separation on the report of medical examination in March 1965 clinical evaluation of the lower extremities and musculoskeletal system was normal. Service records do not support an onset of the Veteran's left knee arthritis in active service. Based on the probative evidence of record the Board finds that the Veteran's arthritis did not manifest within the one-year period after service and service connection is not warranted on a presumptive basis. Private treatment records note degenerative changes of the left knee in 2014 which is more than 45 years after his separation from service in 1965. In addition, in weighing the evidence of record the Board finds the competent and credible evidence of record is against finding continuity of symptomatology. As a result, service connection based on continuity of symptomology is not warranted. In conclusion, the Board finds that the preponderance of the evidence is against the Veteran's claim for service connection a left knee disability. Since the preponderance of the evidence is against the claim, the benefit of the doubt rule is not applicable. See 38 U.S.C. § 5107 (b); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 5557 (1990); 38 C.F.R. § 3.102. For these reasons, the claim is denied. J.W. FRANCIS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K.R. Kardian, 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.