Citation Nr: 21063759 Decision Date: 10/15/21 Archive Date: 10/15/21 DOCKET NO. 14-40 461 DATE: October 15, 2021 ORDER Service connection for a lumbar spine disability is denied. Service connection for a right knee disability is denied. FINDING OF FACT The weight of the evidence fails to show that it is at least as likely as not that the Veteran's current lumbar spine arthritis and right knee osteoarthritis had onset in service or within one year thereafter, manifested to a compensable degree within one year from the date of discharge, or otherwise were caused by service, to include as a result of reported mistreatment by drill instructors, and documented acute low back and right knee injuries during service. CONCLUSIONS OF LAW 1. The criteria for service connection for a spine disability have not been met. 38 U.S.C. § 1110; 38 C.F.R. § 3.303, 3.307, 3.309. 2. The criteria for service connection for a right knee disability have not been met. 38 U.S.C. § 1110; 38 C.F.R. § 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSIONS The Veteran served on active duty from June 1968 to October 1971. In a May 2014 rating decision, the Regional Office (RO) denied his claim for service connection for his current lumbar spine and right knee disabilities, largely based on a negative etiological opinion. The Veteran appealed. In November 2018, the Board remanded the claim for an addendum etiological opinion that considered the Veteran's and his sister's newly submitted lay statements. Upon obtaining the requested opinion in August 2019, the Board denied the claim in its June 2020 decision which the Veteran appealed to the United States Court of Appeals for Veterans' Claims (Court). In May 2021, the Court granted a Joint Motion for Remand (JMR), vacating and remanding the June 2020 Board's decision for readjudication that provided an adequate statement of reasons and bases addressing the lay statements as to the continuity of the Veteran's symptomatology since service. In accordance with the Court's remand order, the Board issued a Notice, dated May 20, 2021, advising the Veteran that, if desired, he may submit additional argument and/or supporting evidence before the Board proceeds with readjudication of his appeal, which must be submitted within 90 days of the Notice. This period has elapsed. Upon considering the newly advanced arguments and reexamining all evidence of record afresh, viewed as a whole and in light of all pertinent laws, the Board has found that no further development is necessary and the appeal must be denied. As reflected in an August 2021 Appellate Brief, the representative argued the Board failed to provide an adequate statement of reasons or bases for its dismissal of the lay statements from the Veteran and his sister regarding the continuity of Veteran's symptomatology since service. At the outset, the Board notes that the gravamen of this appeal at this stage is a mere conjecture agreed upon by the parties. Of particular note, the Board stated its finding that "the Veteran has submitted no objective medical evidence or other competent evidence in support of his contention[s]" that his current multilevel lumbar spine arthritis and right knee osteoarthritis had onset in service or were caused by his reported mistreatment by drill instructors and his documented acute injuries to his back and right knee sustained during service many years ago. The medical evidence of record affirmatively showed that the Veteran's injuries sustained in service were likely acute, without any residuals upon separation from service, and otherwise not severe enough to cause the residuals resulting in his disabilities diagnosed more than forty years later. In the intervening years, the examiner noted that the Veteran was a career truck driver and then persuasively explained that the Veteran's current disabilities are very common in his profession and thus most likely due to his civilian occupation and his advanced age [which is a well-known high-risk zone for most people to develop some form of arthritis]. Of note here is the scope of the Veteran's and his sister's very generalized reports of "chronic pain," "great problems," "extreme pain," and "getting injections" in the back and knees for many years after service. Considering these lay reports devoid of any further specific details in light of the regulatory provisions unequivocally stating that a manifestation of joint pain in service does not mean that service connection will be granted for arthritis in the same general anatomical localization diagnosed as a clear-cut clinical entity at some later date, the lay statements offered no clinically significant symptomatology beyond generalized reports of pain and injections for the examiner to consider. The Board requested the RO to assist the Veteran in obtaining his private treatment records in an effort to discover potentially relevant clinical data, to include specific symptoms beyond generalized assertions of pain, any specific treatments beyond generalized assertion of getting injections, actual clinical evaluations, and/or clinical diagnoses as may have had been rendered by medical professionals. Regrettably, limited treatment records were obtainable at this juncture, despite VA's best efforts to procure them. As such, the Veteran's and his sister's reports of ongoing pain and treatments after service for many years remained unsupported by any clinical data of record prior to August 2013. As such, the Board found that the Veteran submitted no objective medical evidence to support his contentions or otherwise outweigh or place into doubt the examiner's negative etiological opinions supported by thorough and sound rationale consistent with the medical evidence of record viewed as a whole. Service connection generally may be granted for a disability incurred in or due to service. See 38 C.F.R. § 3.303(a). "Service connection" is a complex legal concept connoting many factors, but essentially means that a particular disease or injury, shown to had been incurred in or coincident to service, has caused a post-service disability. Id. This does not mean that service connection is automatically granted for every sign, symptoms, complaint, treatment, diagnosis, disease, injury, or other trauma in service. Likewise, service connection may not be automatically granted for any post-service disability conceivably related to service. Rather, establishing an entitlement to service connection, among the fundamental legal criteria, generally requires the evidence of record to show: (1) the existence of the claimed disability; (2) a relevant traumatic event in service, and (3) a causal link between the two. See Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Such a causal link generally must be established by medical evidence and must be shown with the probability of 50 percent or greater. In this case, upon entering the VA healthcare system in August 2013, the Veteran reported to his primary care provider that he had experienced chronic back pain since basic training more than 45 years earlier and had been getting injections since 1972. He further reported to the orthopedic clinic that he fell on deck aboard his ship and injured both of his knees in 1969. The Veteran reported in his December 2014 statement that he had been kicked in his back by drill instructors in approximately August 1968 and then was treated at an emergency room multiple times in October 1968, when he was home on leave. In an October 2014 correspondence, the Veteran's sister stated that she had been told by the Veteran of the ill treatment he had received from his drill instructors, had seen him in extreme pain many times, and had been transporting him to the doctors to get injections in his back and knees for nearly 25-30 years. She recalled one time, best to her recollection in October or November 1968, when the Veteran was on leave and had to be transported on a stretcher for hospital treatment. She further indicated that the Veteran had entered the Marine Corps in good health and then developed great problems with his back and knees. This evidence adequately identifies the potentially relevant traumatic events in service. The Veteran's service treatment records (STRs) reflect that he had complained of pain in the middle back due to lifting in April 1970 and pain in the lower right flank when he was lifting heavy objects in February 1971, which were diagnosed as muscle strains. His STRs further reflect an evaluation for right knee swelling and ecchymosis (bruising) deemed a probable knee contusion in January 1969 and a small right knee abrasion treated in November 1970. A May 2014 examination report reflects that the Veteran had been diagnosed with lumbar spine arthritis and right knee osteoarthritis in 2013, when he entered the VA healthcare system. As such, neither the existence of the claimed disabilities nor the apparently relevant in-service injuries to the same general anatomical localization are in dispute in this appeal. The Veteran's STRs, however, are devoid of any diagnoses of lumbar spine arthritis or right knee osteoarthritis during service. Physical examination reports upon his reenlistment in July 1969 and at his discharge from service in October 1971 reflect the medical evaluations of the Veteran's back and lower extremities as normal and without any noted limitations or residuals of past injuries. In cases, unlike here, where the evidence of record shows the conclusive clinical diagnoses of the claimed current disabilities during service, any further inquiry generally is not necessary. Otherwise, the requisite causal link between the current disabilities and in-service trauma must be established either on a fact-finding basis or may be presumed by operation of law in the specific circumstances of each case. As such, the central issue in this appeal is whether, be it actually or presumptively, the Veteran's current disabilities are etiologically related to his injuries sustained in service. Establishing the requisite causal link on a factual basis generally requires medical evidence. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). This is particularly true in this case presenting the Board with the medically complex musculoskeletal disabilities first diagnosed many years after service. Id. Absent specialized knowledge, training, or experience in such fields as medicine, pathophysiology, or epidemiology, a person is said to lack the requisite expertise to establish the medical basis for service connection. Id. As such, absent a suggestion that the Veteran or his sister possess the requisite expertise, they are not competent to establish the etiology of a diagnosed medical condition based on evaluation of medical imaging. This is why the Board must rely on the medical examiner's expertise. A May 2014 VA examination report provides an unequivocal medical opinion that it is less likely than not (meaning probability of less than 50 percent) that the Veteran's current lumbar spine arthritis and right knee osteoarthritis are etiologically related to service, to include as a result of his acute back and knee injuries without any residuals upon separation from service. To that end, the examiner considered the Veteran's statements made to the examiner, his primary care provider, and orthopedics clinic more than 40 years after his discharge. Upon further reviewing his STRs and post-service medical history, the examiner concluded that the evidence of record is ultimately devoid of any objective clinical data to show chronicity of the Veteran's current disabilities since service, a contention that is supported by his STRs affirmatively showing that his back and lower extremities were found to be normal and without any evidence of past injuries upon his discharge from service in October 1971. In the intervening years, the examiner noted that the Veteran has worked as a career truck driver for many years and by the time of the VA examination was sixty-two years old. The examiner cited to a recent comparison of truck drivers in the USA and in Sweden, which has found that in each country 50 percent of those questioned reported low back pain. Analysis of the possible reasons for this revealed that long-term vibration exposure from driving was among the highest risk factors for low back problems. Another recent Swedish study of over 1,000 salespeople found significantly increased risks of low back pain among those who drove long distances and spent a long time each day in their car. Driving a truck is equally physically demanding on the body. Prolonged sitting, long hours without proper sleep, and constant vibration can lead to spinal changes in the low back. Moreover, per Erik Gall, MD, a professor of clinical medicine in the rheumatology section and interim director of the Arizona Arthritis Center at the University of Arizona College of Medicine, "anything that puts unhealthy strains or stresses on the joints can cause arthritis," and any job that requires the same motions day after day, year after year, puts a person at increased risk for arthritis. This evidence combined with the Veteran's advanced age persuasively explains the most likely cause of his back problems. Otherwise, the examiner indicated that there is no evidence to support a finding that the acute injuries treated in the military over 40 years ago were the precursor to the Veteran's multilevel degenerative disease that is found in his lumbar spine at this time. In considering the Veteran's in-service back injuries, the examiner specifically noted that on both occasions in April 1970 and in February 1971, the Veteran was diagnosed with muscle strains due to lifting and had returned to duty without any documented or asserted limitations. The examiner further specifically noted no evidence of blunt trauma to the lower spine, which would have been consistent with kicks to the low back, while the STRs are devoid of any evidence showing or suggesting any chronic sequelae, particularly given the report of physical examination affirmatively showing no back abnormalities upon his separation from service in October 1971. Of further note here is the July 1969 medical report of physical examination for reenlistment reflecting that the Veteran's back and lower extremities were noted as normal and the Veteran was found to be fully qualified for military duties without any physical limitations. Ultimately, the examiner opined that the Veteran's in-service back injuries diagnosed as muscle strains with no residuals and no evidence of blunt trauma to the lower back were acute mild injuries and therefore his current lumbar spine arthritis first diagnosed over forty years later is less likely as not causally related to his service. In further considering the Veteran's right knee disability, the examiner offered substantially the same rationale; that is, absent any objective clinical evidence of chronic sequelae resulting from his right knee swelling and ecchymosis suspected as a probable contusion in January 1969 and a small right knee abrasion treated in November 1970, viewed in light of the October 1971 report affirmatively showing normal lower extremities, the Veteran's right knee osteoarthritis diagnosed over forty years later is less likely as not etiologically related to service. Here, the Board reiterates that both the July 1969 and October 1971 reports of examination reflect medical determinations that the Veteran's physical profile was excellent without any limitations and he was found to be physically "qualified for reenlistment and perform all duties of his rank." As such, upon considering the Veteran's subjective statements that were not merely unsupported by any objective clinical data to an extent necessary to form a medical opinion but also contrary to the objective medical evidence of record leading to the conclusions diametrically opposite to the Veteran's contentions, the examiner concluded that the Veteran's injuries sustained in service were acute and not severe enough to produce residual spine arthritis or right knee osteoarthritis diagnosed 40 years later, while his civil occupation and his advanced age are the significant intervening causes most likely underlying his current disabilities. In reviewing medical opinions, the Board considers such factors as the accuracy and completeness of the facts upon which an opinion is formed, any supporting scientific data and the general acceptance of the cited authorities, the depth and thoroughness of the analysis, the soundness of the rationale connecting data to the conclusions, as well as the veracity and scope of the ultimate conclusions. See, e.g., Hernandez-Toyens v. West, 11 Vet. App. 379 (1998); Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Nothing in the July 1969, October 1971, and May 2014 medical reports suggests any inadequacy in the information therein. Here, the Veteran also has not challenged the accuracy of the July 1969 and October 1971 reports of medical examination. Nor has he submitted any competent evidence that may place into doubt either the accuracy of facts relied upon by the examiner in May 2014 or persuasive soundness of the examiner's rationale offered in support of the rendered conclusions. In light of the Board's finding that the Veteran is not competent to render medical opinions, the Board finds that the July 1969 report of medical examination for reenlistment and the October 1971 report of medical examination upon separation are the only competent pieces of the evidence as to the Veteran's likely physical state in service, and the May 2014 VA examination report is the only competent evidence as to the nature and etiology of his current disabilities. Thus, the only competent evidence of record affirmatively showing that the Veteran's injuries sustained in service were acute and had resolved by the time of his discharge from serviceis uncontradicted. Following the May 2014 VA examination, the Veteran and his sister submitted lay statements. As was noted in the November 2018 Board remand, VA received a May 2014 statement in support of claim that the Veteran had thirteen years of therapy on his mid-back. However, upon a closer examination, this particular correspondence unequivocally reflects that it was intended to be filed on behalf of another veteran, given the mismatching name, service number, branch of service, file number, place of residence, and contested disabilities, apart from coincidently matching a back disability on review in this appeal. As such, this particular piece of the evidence has no probative value here. In her October 2014 correspondence, the Veteran's sister stated that she has been taking the Veteran to Dr. C.K. who gave injections in his knees and back for nearly 25-30 years. After Dr. C.K. died, she started transporting the Veteran to Dr. N.F. for treatment at Abie's Chiropractic Clinic. Further, she recalls one time approximately in October or November 1968, when the Veteran was home on leave and was transported on a stretcher to the hospital for treatment. She further recalls that her brother complained about the abuse of his drill instructor who had reportedly been kicking him in his back. She asserted that the Veteran was in great physical shape before he entered the Marine Corps, but had experienced great physical problems with his back and knees since service and she recalled having seen him many times in extreme pain due to ill treatment that he received. In his October 2014 substantive appeal (VA Form 9), the Veteran states: "I am telling the truth about what had happened to me in the service. I am asking VA to consider that my mistreatment by my drill instructors in the service caused my back problem and my knee problems." In December 2014, the Veteran submitted a statement in support of claim discussing at some length the circumstances of the alleged mistreatment by his drill instructors. The Veteran further indicated that the incident had occurred approximately in August 1968 and he was seen multiple times at an emergency room in October 1968 when he was home on leave. In a consideration of the Veteran's and his sister's statements concerning treatment, the Board remanded the claim, requesting the RO to assist the Veteran in obtaining his private medical treatment records. Specifically, the Veteran informed the RO that he was treated numerous times at Lee Memorial Hospital Emergency Room while on leave from service in October 1968. The obtained records reflect two emergency room visits in December 2014 and January 2015. The Veteran informed the RO that he was treated throughout the years at St. Joseph Lakeland Hospital Emergency Room. The obtained records reflect an emergency room visit in December 2014. The Veteran reported that he was treated by Dr. C.K. for his back and right knee from 1971 until the doctor's death and then by Dr. N.F. of Abie's Chiropractic Clinic for severe back problems from 1985 to 1987. The RO was notified that the requested records do not exist and, if had existed, would have been destroyed. The Veteran reported that he was treated by Dr. Z. (retired) from 1975 to 1987. The RO was unable to locate any contact for Dr. Z. or his office, while the phone number provided by the Veteran has been disconnected and the address provided by the Veteran is no longer associated with the doctor's office. The Veteran reported that he was treated for his back at Borgess Hospital in 1984-85. The reply reflects that the records for the requested period were destroyed and no further information is available. The RO informed the Veteran of its findings following at least two requests forwarded to each provider. Upon exhausting its reasonable efforts to obtain his private medical treatment records beyond those discussed above, the RO advised the Veteran that it is ultimately his responsibility to submit any medical records in a possession of non-Federal custodians, as well as notified him that, if he does not submit any additional records, the claim will be decided based on the evidence of record. To date, no additional private medical records have been received. The Board also requested the RO to obtain an addendum opinion considering the statements from the Veteran and his sister. At the outset of an August 2019 VA addendum report, the examiner indicated that all evidence from the Veteran's and now his sister's statements that he has had years of back problems is "anecdotal", which is accurate. With that, the examiner reiterated the opinion expressed in the May 2014 report that review of the available clinical information does not support a finding of any residuals of the low back and right knee injuries sustained during service. Upon considering that the Veteran has been diagnosed with multilevel lumbar spine arthritis more than forty years after sustaining acute back injuries, while working as a truck driver in the intervening years, the examiner again opined that the Veteran's current spine arthritis is most likely related to his occupation rather than the acute injuries in service. In addition to the rationale expressed in the May 2014 report, the examiner explained that back problems are prevalent among truck drivers who spent most of their time in a sitting position without moving and stretching. Doing this for 6-8 hours per day for years is likely to cause chronic back pain. In the examiner's opinion, this happens most commonly due to spinal compression and sciatica with nerve pinching (which is wholly consistent with the Veteran's current symptomatology) from constant sitting and bouncing on the buttocks, while noting that suspension systems were not as protective of the musculoskeletal system as they are now. The examiner further noted that truckers also are subject to various back injuries related to loading, unloading, and securing cargo. In further considering the Veteran's right knee disability, the examiner opined that following a career as trucker using his right leg to climb into the high cabin would place stress of the Veteran's body weight on his right knee and over many years is sufficient to cause knee osteoarthritis. As such, the examiner concluded that the Veteran's current disabilities are less likely as not related to his acute injuries in service and more likely than not are related to his post-service civilian occupation. In closing remarks, the examiner states: I have taken into consideration the anecdotal letter of support from the veteran's sister and the veteran's subjective report of injuries and problems post military. I cannot support these statements with clinical evidence provided. The Board acknowledges that the examiner did dub the Veteran's and his sister's statements as "anecdotal," which may imply incredible statements based on hearsay, such as reporting a story told by the Veteran rather than basing the report either on the first-hand knowledge or on an actual verifiable fact. The term "anecdotal" is also commonly used to refer to depicting small narrative incidents, which is equally plausible reading of the examiner's statement viewed in context of all evidence of record. Whatever the case might be, the examiner's characterization of the lay evidence as "anecdotal" played no part in the Board's own determination as to the competency, credibility, and probative weight of the lay statements. The Board, as a fact finder, does consider the competency and probative weight of each piece of the evidence of record. Miller v Wilkie, 32 Vet. App. 249, 257-262 (2020). Of note, however, whether or not the proffered testimony is credible has no bearing on the requirement that any witness first must be found competent to attest to the facts under consideration. Barr v. Nicholson, 21 Vet. App. 303, 309 (2007). As discussed, the Board has found that neither the Veteran nor his sister possess the expertise to render medical opinions. This is why, in the context of this decision, they are considered laypersons. Generally, lay testimonies are competent to an extent of describing the readily observable symptoms and manifestations of injury or illness. Barr v. Nicholson, 21 Vet. App. 303, 307-310 (2007). The caselaw in point further establishes that the laypersons are competent to attest to having a medical condition identifiable by a layperson, to report any diagnosis as has been rendered by medical professionals, and to describe specific symptoms supporting a later diagnosis by a medical professional. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). As such, the Board finds that the Veteran and his sister are competent to report the Veteran's observable symptomatology, any treatments received, and any clinical diagnoses as may have been rendered by medical professionals. Unless patently incredible, such reports are presumed credible at the submission stage. See Justus v. Principi, 3 Vet. App. 510, 513 (1992). The lay reports well may warrant a further development, to include assisting the Veteran in obtaining any private treatment records he reasonably identifies, providing another examination, or obtaining an addendum opinion based on new facts previously unavailable to the examiner, as has been done in this case. However, the initial presumption of credibility does not mean or imply that the facts purported in the lay reports must be found competent, credible, and be assigned a significant probative weight. The Veteran did report abuse by drill instructors in August 1968. The Veteran further reported that he was treated multiple times in October 1968. The Veteran's sister recalls the Veteran's telling her about abuse by a drill sergeant and then having to transport the Veteran on a stretcher for hospital treatment around the same timeframe. Unfortunately, these statements do not describe any specific symptoms, any specific treatment, or any diagnosis actually rendered by a medical professional at that time, and do not offer any details that may place any doubt on the conclusion that the Veteran had not been diagnosed with a chronic back or knee disability by July 1969. As such, the Board does not have to reach a question of whether or not the Veteran or his sister are actually telling the truth, which is not at issue here because a conceivably credible report of mistreatment is not a disability which VA may compensate. Rather, such a mistreatment must be shown to have caused the Veteran's current disabilities. To that end, this is less likely as not the case here because the evidence of record affirmatively shows no chronic sequalae of the alleged mistreatment during service and therefore any physical injuries that may have been sustained as a result of the reported mistreatment were acute. Of note, the Veteran's separation physical was normal with regard to the lower extremities and spine. This finding aligns with the evidence of record viewed as a whole. Of particular note, by the time of the Veteran's reenlistment in July 1969, he had been found in sound health and physically qualified for all duties of his rank. The Veteran in fact had carried out his physically arduous military duties in the Marine Corps for over three years after the reported incident without any subjective or objective residuals of the alleged mistreatment and separated from service in sound health, as noted upon his discharge in October 1971. The Board acknowledges the representative's contention, as advanced in the June 2015 brief, that the Veteran was not offered any examination of his back or his knees beyond the initial appointments that could have rendered an actual diagnosis, which the Board finds unpersuasive. In April 1970, the Veteran reported back pain in the middle of his back due to lifting, which was noted as slightly tender and diagnosed as muscle strain. The following day, the Veteran returned to sick call and reported worsening of pain. The following week, the Veteran went to sick call complaining of inguinal pain (due to adenopathy) without any reports of ongoing back pain. Further, the STRs reflect multiple complaints, to include headaches, cold symptoms, and throat pains. For example, within the period of four weeks in June-July 1970, the Veteran had reported to sick call three times complaining of throat pain. As such, there is no indicia that the Veteran had any reservations of going to sick call or would not be evaluated when needed. Likewise, there is no indicia that the Veteran was discouraged from going to sick call. As noted, the Veteran actually had been seen two days in a row for his back pain in April 1970. A week later, he again went to sick call but made no such complaints. Moreover, contrary to the representative's assertion, the STRs do reflect the actual diagnoses, namely, a back muscle strain, a probable right knee contusion, and a right knee abrasion. Further, for example, a November 1970 sick call note reflects that the Veteran was seen for his right knee pain and was specifically and unequivocally prompted to "return if needed." As such, the Board finds that the Veteran likely would have reported any ongoing low back and right knee pain if that were the case, as he actually did when he needed on dozens of occasions. Upon considering that the Veteran's statements may be reasonably construed as an implicit challenge to the accuracy of the October 1971 report, the Board expressly finds the Veteran's statements documented contemporaneously with his complaints for the purposes of medical treatment to be more probative than his and his sister's lay statements made over forty years later for the purpose of procuring VA benefits. Both the July 1969 and October 1971 examinations were conducted by medical professionals. As such, the Veteran's back and knees in fact had been evaluated at least once beyond the initial complaints, which effectively rebuts the representative's competing contention that the Veteran was never evaluated beyond his initial complaints. For the period after service, the Board reiterates that the Veteran did competently report the places and dates of treatment for his back and right knee after service, as well as ongoing back and knee pain and receiving injections. However, none of this reported information offers any specific clinical data for the examiner to consider or otherwise to place into doubt the examiner's opinion that the lay statements are unsupported by any clinical data and do not outweigh the more reliable medical evidence affirmatively showing that it is more likely than not that the Veteran's back and knee injuries in service were acute and not severe enough to cause residuals resulting in his current disabilities. In weighing the Veteran's belief that his current lumbar spine arthritis and right knee osteoarthritis were incurred in or due to service against the only competent medical opinion that it is less likely as not that the Veteran's current disabilities first documented in 2013 are etiologically related to his acute injuries sustained in service and more likely than not are due to his occupational career as a truck driver and his advanced age, the Board accords the medical opinion a greater probative weight. By implication, the weight of the evidence tips the scales against a factual finding that it is at least as likely as not that the Veteran's current back and right knee disabilities were either incurred in or caused by service. The JMR did stress that consideration should be given to whether service connection could be established based on continuity of symptomatology. Under this doctrine, certain chronic diseases listed in 38 C.F.R. § 3.307(a), to include arthritis, may be presumed to have had been incurred in service in cases where the claimed disease is first shown as such in service or within one year from the date of discharge and then further shows that the same disease manifested at a later date. 38 C.F.R. § 3.303(b). To this end, the evidence must show a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity at the time of service. See 38 C.F.R. §§ 3.303(b), 3.307(a). Only then, after identifying the nature of the disease within the presumptive period while its chronicity remains in dispute, continuity of symptomatology may be invoked as the basis for establishing the chronicity of the disease. Id. In the instant case, this rule means the current lumbar spine arthritis and/or right knee osteoarthritis must be shown to have had first manifested in service or within one year thereafter. Of particular note, the regulations are unequivocal in that this rule does not mean that any manifestation of joint pain in service permits a grant of service connection for arthritis first shown as a clear-cut clinical entity at any later date. Id. Particularly in light of these regulatory provisions, the Board notes that neither the Veteran nor his sister described any symptomatology beyond the generalized reports of pain and therefore finds that the record is devoid of the requisite evidence showing a combination of manifestations sufficient to identify the disease entity as lumbar spine arthritis and right knee osteoarthritis at the time of service or within the presumptive period of one year thereafter. To that end, the Board has revisited the examiner's opinion that the Veteran's injuries sustained in service were acute and had resolved by time of his discharge, as based on the October 1971 report reflecting normal findings upon separation, which the Board has found to be most probative for that period. The Board further acknowledges the June 2015 and May 2021 briefs, in which the representative asserts that the Veteran and his sister have provided credible and competent accounts of his symptoms since his departure from service. Clearly on the contrary, the Veteran's and his sister's generalized assertions of "chronic pain since basic training," "extreme pain due to ill treatment," and "great problems" with back and knees are ultimately devoid of any actual "account of his symptoms" as purported, or any other clinically significant symptomatology beyond pain which, as per discussed regulations, may not serve as the sole basis for service connection for arthritis diagnosed many years after service. This effectively renders the Veteran's and his sister's reports of ongoing pain to be insufficient to identify the onset of his current spine arthritis or right knee osteoarthritis in service or within a year thereafter. Further, the evidence of record fails to show that the Veteran's current disabilities had manifested to a compensable degree within one year from the date of discharge from service, which otherwise would permit a presumption of service connection. See 38 C.F.R. §§ 3.307(a), 3.309(a). A compensable degree of at least 10 percent for spine disability requires the evidence of documented arthritis shown by X-ray, or specific limitations in the back's ranges of motion, or incapacitating episodes requiring treatment and bed rest prescribed by a physician, neither of which is of record within one year after service. See 38 C.F.R. § 4.71a, DCs 5003, 5242, 5243. Neither the Veteran nor his sister have alleged otherwise. For example, in October 2014, the Veteran's sister attested to taking the Veteran to Dr. C.K. to get injections for "nearly 25-30 years," which places the beginning of the reported treatment approximately in 1974. This is beyond the one-year period from service. The Veteran reported to the RO that he has had been receiving treatment from Dr. C.K. beginning in 1971, while he reported to his primary care provider that he has been receiving injections since 1972. In either scenario, the Board concedes that memories do fade. This is why the Board remanded the claims. Upon exhaustion of reasonable efforts to corroborate those reports, the information therein remains uncorroborated and offers no evidence material to the Board's inquiry here. The "injections" are not among the rating criteria based on which the Board may find that the Veteran's disabilities had manifested to a compensable degree. Likewise, the Veteran's extreme pain and having great problems with his back, as competently reported by the Veteran's sister, also is not among the rating criteria unless pain is coupled with arthritis documented by x-ray. Neither the Veteran's nor his sister's reports describe any actual limitations in the Veteran's ranges of motion, any bed rest prescribed by a physician, or the diagnosis of arthritis of the spine as may have had been documented by X-ray at any time within one year of separation from service. Nor does the medical evidence of record suggests otherwise. Nor do the lay statements place the diagnosis and treatment of osteoarthritis of the right knee at any time within one year from the date of discharge. A compensable degree of at least 10 percent for a knee disability may be shown by the evidence of ankylosis, recurrent knee subluxation or instability, ligament tear, prescription of an assistive device (e.g., cane(s), crutch(es), walker) and bracing for ambulation, sprain causing persistent instability, patellar instability, cartilage, semilunar, dislocated, effusion into the joint, or motion limitations in the leg's extension and/or flexion, none of which is in evidence at any time prior to 2013. See 38 C.F.R. § 4.71, DCs 5256-61. The Veteran's sister did report that the Veteran had been transported on a stretcher for hospital treatment on one occasion. This report, however, fails to show the requisite prescription of an assistive device which must be coupled with the recurrent subluxation or instability of the knee(s). Id. Here, the JMR has directed the Board to consider whether continuity of symptomatology has been established by the lay statements. The Board finds that it has not. The Board notes that the Veteran was examined at separation and found to have a normal spine and normal lower extremities. As such, this document serves to sever any continuity of symptomatology from the Veteran's reported emergency room trip in 1968. The Board does not doubt that the Veteran has experienced back and knee pain over the years, but he was participating in a physically demanding occupation at that time, which has been linked by studies to orthopedic problems. Thus, while the Board does not dispute that the Veteran likely received back and knee treatment through the years as described by his sister, such treatment does not establish continuity of symptomatology. As such, the Board finds that service connection on a presumptive basis is not warranted in this case. The Board has considered any procedural deficiencies as well as any evidence that may warrant any further development. However, in light of the foregoing discussion, the evidentiary record before the Board does not raise a reasonable possibility that obtaining another medical opinion may substantiate the Veteran's claim or continuing the efforts to obtain his private treatment records would not be futile. See 38 U.S.C. § 5103A(c); 38 C.F.R. § 3.159(c)(1), (4). As such, any duty to assist the Veteran in developing his claim has been satisfied and no further duty to assist has arisen. Id. at § 3.159(d). No other material issues have expressly raised by the Veteran or reasonably raised by the evidence of record. The Board has been apprised of the debilitating impact of the Veteran's disabilities and is sympathetic to his circumstances, include his chronic pain necessitating frequent visits to emergency room. Unfortunately, the existing laws preclude the Board from granting any VA benefits out of its sympathies for a particular veteran. See Kelly v. Derwinski, 3 Vet. App. 171, 172 (1992). No matter how compelling, no circumstance can create a right to payment out of the United States Treasury, unless Congress has passed the law providing for such a payment. See Smith (Edward F.) v. Derwinski, 2 Vet. App. 429, 432-33 (1992). Further, the Board has no authority to grant benefits on an equitable basis and is ultimately bound by the existing law as passed by Congress, implemented by VA, and controlled by case law. See 38 U.S.C. §§ 503, 7104; Harvey v. Brown, 6 Vet. App. 416, 425 (1994). Under the current laws, the Board may not fill any gaps in any information on the Veteran's behalf beyond considering the claims sympathetically, interpreting the evidence liberally and in light most favorable to the Veteran, finding an inference of fact based on the evidentiary record, presuming a fact to the extent permissible by law, and ordering assistance within the boundaries of the VA's duty to assist veterans in developing their claims, and ensuring that all its decisions are equitable and just. Notwithstanding the Board's own authority and duty, it is ultimately the Veteran's responsibility to provide information necessary to substantiate his claim. See Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). The Veteran may at any time file a supplemental claim supported by new and relevant evidence. Such evidence may include etiological opinions from any medical providers of the Veteran's choice, lay statements attesting to specific symptoms, treatments, or hospitalizations, describing specific treatment received, and any other information such as medical bills, pharmacy receipts for over-the-counter or prescription medications, any statements from attending medical staff or lay statements from family members or colleagues having first-hand knowledge of and attesting to the Veteran's symptoms, manifestations, and/or any functional impairments observable by a layperson, generally accepted medical treatises, and any other evidence the Veteran may deem relevant to his claim. If such evidence is received within one year from the date of this decision, determined to be new and relevant, and eventually results in a grant of service connection, the effective date of such an award shall be preserved as of the date of original claim. To that end, the Veteran is encouraged to consult with his representative, to review the wealth of information readily available at the VA official website, to reach out to one of the VA representatives at his local VA regional office and VA medical centers, and to ask any specific questions he may have via a toll-free VA number. Meanwhile, absent any legal basis for a grant of the benefits sought here, the appeal is denied. MATTHEW W. BLACKWELDER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Alex Bardin, Associate 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.