Citation Nr: 21066441 Decision Date: 11/01/21 Archive Date: 11/01/21 DOCKET NO. 10-36 036 DATE: November 1, 2021 ORDER Entitlement to service connection for chloracne, to include as due to herbicide exposure, is denied. Entitlement to service connection for xerosis (dry skin), to include as to due herbicide exposure, is denied. Entitlement to service connection for tinea unguium (onychomycosis), to include as due to herbicide exposure, is denied. Entitlement to service connection for a right hand disability, to include as due to herbicide exposure, is denied. Entitlement to service connection for a right leg disability, to include as due to herbicide exposure, is denied. Entitlement to service connection for a left foot disability, to include as due to herbicide exposure, is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against a finding that the Veteran had a diagnosis of chloracne at any time during the pendency of this appeal. 2. The Veteran has had other skin conditions variously diagnosed throughout the pendency of this appeal, to include his claimed xerosis and tinea unguium (onychomycosis), but these conditions were not incurred in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomology is not established; and the disability is not otherwise related to service, 3. The Veteran's right-hand disability was not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomology is not established; and the disability is not otherwise related to service. 4. The Veteran's right leg disability was not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomology is not established; and the disability is not otherwise related to service. 5. The Veteran's left foot disability was not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomology is not established; and the disability is not otherwise related to service. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for chloracne, to include as due to herbicide exposure, have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 2. The criteria for entitlement to service connection for xerosis (dry skin), to include as to due herbicide exposure, have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 3. The criteria for entitlement to service connection for tinea unguium (onychomycosis) to include as due to herbicide exposure have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 4. The criteria for entitlement to service connection for a right-hand disability, to include as due to herbicide exposure, have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 5. The criteria for entitlement to service connection for a right leg disability, to include as due to herbicide exposure have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 6. The criteria for entitlement to service connection for a left foot disability, to include as due to herbicide exposure, have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1958 to September 1962 and from March 1967 to May 1972. This matter is before the Board of Veterans' Appeals (Board) on appeal from a July 2009 Department of Veterans Affairs (VA) regional office (RO) rating decision. By way of background, the RO denied service connection for the disabilities on appeal in a July 2009 rating decision, and the Veteran perfected an appeal to the Board in July 2010. In July 2015 and November 2016, the Board remanded the issues on appeal for further development, specifically to obtain private and VA treatment records as well as medical examinations and opinions. In September 2017, the Board remanded the issues on appeal again, noting that the examinations obtained in accordance with the July 2015 and November 2016 remands were not adequate. Additional examinations were obtained, and the case was returned to the Board in October 2018. In November 2018, the Board again found that the examinations and opinions of record were inadequate and remanded the issues for new examinations and opinions. The requested opinions were obtained, and the appeal was once again recertified to the Board in May 2020. In July 2020, the Board again remanded the claims for further VA examination. Regarding the Veteran's claim for entitlement to service connection for a skin disability, the Board found that the October 2019 VA examination was inadequate as it failed to render an etiological opinion for all skin disabilities of record. As for the right hand, and bilateral foot disabilities, the Board found the October 2019 VA examination inadequate as it failed to opine whether the Veteran's herbicide exposure directly caused these disabilities. After addendum VA medical opinions were obtained, the Board once more remanded the Veteran's claims in February 2021 finding the August, September and October 2020 addendum opinions failed to provide etiological opinions for each individual skin, right hand, and bilateral foot disabilities. See Clemons v. Shinseki, 23 Vet. App. 1(2009). See also McLain v. Nicholson, 21 Vet. App. 319, 321 (2007) (holding that service connection may be granted for a disability that manifests at any point during the pendency of a claim, even if it subsequently resolves prior to resolution of the claim). Addendum VA medical opinions were obtained, and upon review of the claims file, substantial compliance with the Board's remand directives has been completed. See Stegall v. West, 11 Vet. App. 268 (1998). The Board notes, subsequent to the February 2021 remand, the RO granted service connection for various skin conditions in a June 2021 rating decision including, dermatis/poikiloderma, lentigines with no atypical features, seborrheic keratosis, actinic keratosis, basal cell carcinoma, and squamous cell carcinoma, at a 10 percent disability rating effective June 11, 2008. However, as these were not the only skin conditions noted by the Board in its prior remand and developed by the RO, the remaining identified skin conditions noted above are still before the Board for adjudication even though the benefit sought on appeal appears to have been fully granted. The Board has limited the discussion below to the relevant evidence required to support its finding of fact and conclusion of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008). Service Connection Generally, a veteran is entitled to service connection for a disability resulting from a disease or injury incurred or aggravated during active service. See 38 U.S.C. § 1110; 38 C.F.R. § 3.303 (a). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). To substantiate a claim of service connection, there must be evidence of (1) a current disability (for which service connection is sought); (2) incurrence or aggravation of a disease or injury in service; and (3) a causal connection between the disease or injury in service and the current disability. See Shedden v. Principi, 381 F.3d 1163(Fed. Cir. 2004). A disease diagnosed after discharge may still be service connected if all the evidence establishes that it was incurred in service. 38 C.F.R. § 3.303 (d); Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). Certain chronic diseases, including hypertension, may be presumed to have been incurred during service if they become disabling to a compensable degree within one year of separation from active duty. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. 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." Continuity of symptomatology after discharge is required where the condition noted during service is not, in fact, shown to be chronic, or where the diagnosis of chronicity may be legitimately questioned. 38 C.F.R. § 3.303 (b). The theory of continuity of symptomatology under 38 C.F.R. § 3.303 (b) does not apply to any condition that has not been recognized as chronic under 38 C.F.R. § 3.309 (a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). A veteran, who during active military, naval or air service, served in the Republic of Vietnam during the Vietnam Era shall be presumed to have been exposed during his or her service to an herbicide agent, to include Agent Orange, unless there is affirmative evidence to the contrary. 38 U.S.C. § 1116 (f); 38 C.F.R. § 3.307 (a)(6)(iii). The following diseases will be deemed service connected if the requirements of 38 C.F.R. § 3.307(a) are met, even if there is no record of such disease during service: AL amyloidosis, chloracne or other acneform disease consistent with chloracne; type 2 diabetes (also known as Type II diabetes mellitus); Hodgkin's disease; chronic lymphocytic leukemia (CLL); multiple myeloma; Non-Hodgkin's lymphoma; acute and subacute peripheral neuropathy; porphyria cutanea tarda; prostate cancer; respiratory cancers (cancer of the lung, bronchus, larynx or trachea); soft tissue sarcoma (other than osteosarcoma, chondrosarcoma, Kaposi's sarcoma, or mesothelioma), chronic B-cell leukemias, Parkinson's disease, and ischemic heart disease. 38 C.F.R. § 3.309(e). The absence of a specific disability on the list of enumerated diseases for which service connection due to in-service herbicide exposure is presumed, does not preclude the Appellant from establishing service connection based on a medical nexus between the disability and the Veteran's service (a direct basis). McLendon v. Nicholson, 20Vet. App.79 (2016); See Combee v. Brown, 34 F. 3d 1039, 1043-1044 (Fed. Cir. 1994). In other words, the mere absence of the disability on the presumptive list is not an adequate basis for denial of a service connection. 1. Entitlement to service connection for chloracne, to include as due to herbicide exposure, is denied. 2. Entitlement to service connection for xerosis (dry skin), to include as to due herbicide exposure, is denied. 3. Entitlement to service connection for tinea unguium (onychomycosis) to include as due to herbicide exposure, is denied. The Veteran generally contends that his skin disability, however diagnosed, is related to his service. Specifically, he asserts that his various skin disabilities are caused by exposure to herbicides while serving in Vietnam and that he has had symptoms since service. Again, the Veteran has already been service-connected for variously diagnosed skin conditions and, therefore, the Board's decision here is limited to chloracne, xerosis (dry skin), and tinea unguium (onychomycosis) specifically, which were not addressed in the prior grant. At the outset, the Board notes, that the Veteran's DD 214 verifies that he served in Vietnam from September 1971 until February 1972. Therefore, the presumption on herbicide exposure attaches. Chloracne or other acneform diseases consistent with chloracne is the only skin condition presumptively associated with Agent Orange exposure. See 38 C.F.R. § 3.309(e). Even so, a nexus can still be established on a direct basis for any disease not included on the list of presumptive diseases. See, e.g., Polovick v. Shinseki, 23 Vet. App. 48, 54 (2009). With regard to chloracne, the Veteran contends he had a chloracne breakout during service in 1974 over his face and neck that resolved without treatment in 7 days. He claims he had another breakout in 2009 and will occasionally have lesions on the back of his neck and hairline that go away without any treatment. Service treatment records (STRs) indicate that in March 1968 the Veteran was treated for boils and in November 1971 he was seen for a rash on his leg and groin, which was diagnosed as allergic dermatitis. There is no indication of any chloracne breakout (or any skin breakout) in 1974. Post service treatment records from August 2004 and September 2005 show that the Veteran did not have any skin issues upon physical examination. August 2008 treatment records noted that the Veteran had rashes on his face and hands. A July 2019 dermatology note diagnoses asymptomatic seborrheic keratosis, lentigines with no atypical features, actinic dermatitis, and xerosis. Despite the Veteran's contentions describing specifically chloracne breakouts and lesions, there is no documented chloracne breakout or lesions in the record. Over the course of the Veteran's lengthy appeal, he has been afforded VA medical opinions and examinations in July 2015, November 2016, October 2016, August 2020, September 2020, and October 2020. None of these examinations indicate the Veteran had a diagnosis of chloracne or other acneform disease consistent with chloracne. These examiners also all indicated negative nexus opinions with regard to his various skin conditions. Subsequent to the Board's February 2021 remand, new VA medical opinions were obtained in May 2021 for his claimed skin disabilities. With regard to chloracne, the May 2021 VA examiner described the Veteran's contended breakouts in service and post-service but found no evidence of a current breakout or documented evidence of past breakouts, no visible lesions, no documented history of a diagnosis of chloracne or symptoms of acneform lesions in any place in his records. The examiner noted there simply was no evidence the Veteran ever had or has chloracne. With regard to xerosis and tinea unguium, the May 2021 VA examiner opined that it was less likely that not that either of these conditions were incurred in or due to service. The entire claims file was reviewed, and the examiner noted the Veteran's contentions, reported medical and military history, to include using active medications for nail fungal infection since 2004, and dermatology notes for mild xerosis (dry skin) since July 2019. Given that the treatment and complaints were remote from service, the examiner found a nexus to service unlikely. In June 2021, an addendum VA medical opinion was provided concerning the Veteran's in-service treatment for boils and a rash on leg and groin. The examiner noted that the Veteran was treated for a boil in October 1958. This incident was referred to and explained as "an acute incidence...likely related to skin compromise during service and entry of bacteria leading to an acute bacterial infection". It was explained that "according to [the Veteran's] records, there are no subsequent incidences of boils for which he required treatment so it [is] not apparent that it caused any residuals/recurrences/chronic conditions after the initial incidence while on active duty." The June 2021 examiner also considered a November 1971 STR which noted treatment for a rash on the Veteran's leg and groin which was diagnosed as allergic dermatitis and treated with calamine lotion. The examiner noted that the Veteran's separation examination in April 1972 contained no reports of skin issues. Therefore, the examiner opined "that this was an acute rash that resolved with no residuals/recurrences". He further explained what allergic dermatitis is and that "Veteran likely had an environmental or contact exposure that caused the allergic dermatitis". It was further noted that it would not be possible to know a specific cause of "one-time acute incidence of allergic dermatitis without resorting to mere speculation and not knowing a timeline of exposures". The Board finds the May and June 2021 VA examiner's opinions to be persuasive. The examiner did not solely rely on the fact that xerosis and tinea unguium are not presumptive diseases, but rather considered other medical literature, the Veteran's specific military and medical history, as well the Veteran's lay statements in developing his medical opinion. Cf. Polovick v. Shinseki, 23 Vet.App. 48 (2009). The Board acknowledges the Veteran's belief that there is such a causal connection, but finds the Veteran lacks the competency to render such a medically complex opinion. See Layno v. Brown, 6 Vet. App. 465, 469(1994). It is well established that a layperson without medical training is not qualified to render a medical opinion regarding the diagnosis or etiology of certain disorders and disabilities. See 38 C.F.R. § 3.159 (a)(1). It is not shown that the Veteran is otherwise qualified through specialized education, training, or experience to offer a medical opinion as to the etiology of his skin conditions. Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). Thus, with respect to a nexus between the Veteran's current skin conditions and in-service occurrence, the Board assigns more probative weight to the May and June 2021 VA examiner's opinions which denied service connection after thorough review of the Veteran's file, medical history, and consideration of conceded herbicide exposure. Furthermore, these findings are consistent with prior VA medical opinions although supported by a more through rationale. As such, the Board finds no causal connection between the disease or injury in service and the current disabilities. See Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). The Board has also considered whether the Veteran is entitled to service connection for xerosis, chloracne, and tinea unguium as "chronic disease." See 38 C.F.R. § 3.303 (b). These skin conditions, however, are not included in the list of "chronic" diseases under 38 C.F.R. § 3.309(a). While chloracne is on the list of presumptive disease associated with Agent Orange exposure, as outlined above, the most probative medical evidence does not indicate the Veteran has chloracne. Rather, the Veteran described breakouts and lesions he believed were chloracne, but such a diagnosis has never been confirmed and, indeed, opined to be unlikely. While the Veteran is certainly competent to describe breakouts and lesions he experienced, a specific medical diagnosis such as chloracne requires medical knowledge and, therefore, the Board finds the medical opinions to be more competent and persuasive than the Veteran's own lay opinion. For these reasons, the Board finds service connection for these skin conditions is not warranted. In light of the above, the preponderance of the evidence is against the claim for xerosis, chloracne and tinea unguium and the benefit-of-the-doubt doctrine is not for application. The claim therefore must be denied. 38 U.S.C. § 5107 (b); see also Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). 4. Entitlement to service connection for a right hand disability, to include as due to herbicide exposure, is denied. 5. Entitlement to service connection for a right leg disability, to include as due to herbicide exposure, is denied. 6. Entitlement to service connection for a left foot disability, to include as due to herbicide exposure, is denied. The Veteran claims that his right hand and bilateral foot disabilities are related to service, to include his in-service exposure to herbicides while serving in Vietnam. The Board notes, as indicated above, that the Veteran's exposure to herbicides due to service in Vietnam has been conceded. His (STRs), however, contain no reports, symptoms, treatment, or diagnosis of any right hand or bilateral foot disabilities. Decades after service, the record shows the Veteran has been diagnosed with right thumb degenerative arthritis of the 1st MCP joint and with bilateral plantar fasciitis. See March VA treatment record and July 2015 VA examination. Diagnoses also include right upper extremity neuropathy, bilateral lower extremity neuropathy, and Raynaud's disease. See September 2020 VA examination. Lay reports by the Veteran in April and November 2020, indicate he contends he reported to an examiner during a flight medical examination in November 1969, that he felt tingling in his fingers and toes and the "odd sensations in the hands and feet I experienced visiting some Northern states while on leave when the nighttime temperatures fell below the warm level". Again, his STRs do not indicate any such complaints. Prior to the Board's most recent remand, the Veteran was afforded several VA examinations and medical opinions for his right hand and bilateral lower extremity conditions in July 2015, November 2016, October 2019, August 2020, and September 2020. The opinions of these various examiner's can best be summarized as negative in nature concluding with the September 2020 examiner's opinion that the Veteran's neuropathy and Raynaud's disease are less likely than not related to service as there was no evidence of these disabilities in service and because they developed more than 30 years after exposure to herbicides. The September examiner also explained that peripheral neuropathy has been associated with acute or subacute exposure to herbicides, "which is not the case here.". All prior examinations have been found to be inadequate for adjudication purposes over the course of the Veteran's appeal for various reasons. Most recently, in February 2021, the Board found that no VA examiner had rendered an etiological opinion regarding the diagnosed conditions of right thumb degenerative arthritis of the 1st MCP joint and bilateral plantar fasciitis therefore a remand was warranted. See McLain v. Nicholson, 21 Vet. App. 319, 321 (2007) (holding that service connection may be granted for a disability that manifests at any point during the pendency of a claim, even if it subsequently resolves prior to resolution of the claim). Subsequent to the Board's February 2021 remand, the Veteran was afforded several medical opinions for his various diagnosed conditions in April 2021. For the Veteran's diagnosis of bilateral lower extremity peripheral neuropathy, the examiner found the condition less likely than not related to his military service, to include exposure to herbicides. The examiner explained, a "review of the medical record and [STRs] shows no evidence of the diagnosis, treatment or symptoms suggestive of right and left lower extremity peripheral neuropathy while on active duty or within one year of separation". "Early onset peripheral neuropathy has been associated with herbicide exposure (within one year of exposure)", however "first mention of neuropathy was more than 28 years after separation". The examiner's offered opinion for the Veteran's right extremity peripheral neuropathy was identical. For the Veteran's right thumb degenerative arthritis of the 1st MCP joint, the examiner opined in the negative, indicating that medical records and STRs contained no evidence of the diagnosis or treatment for symptoms suggestive of right thumb arthritis while on active duty or within one year of separation. The examiner further explained that degenerative arthritis has not been associated with herbicide exposure. This opinion was again echoed for the Veteran's diagnosis of bilateral plantar fasciitis as well for other more general right foot, hand, and left foot disabilities. Lastly, the examiner provided a negative nexus opinion for the Veteran's Raynaud's disease. The examiner first explained that Raynaud's disease is a medical condition which "spasm of arteries causes episodes of reduced blood flow...typically, the fingers, and less commonly the toes, are involved". The examiner noted that this condition can be associated with "connective tissue disorders such as scleroderma or lupus, injuries to the hand, smoking, thyroid problems and medications such as birth control". It was further explained that "Raynaud's syndrome is diagnosed as idiopathy, that is, meaning that it is not associated with other diseases" and that it "is thought to be hereditary". Lastly, the examiner noted that a "search of current medical literature does not show an association between herbicide exposure and Raynaud's disease". In August 2021, the April 2021 examiner was asked to provide an addendum opinion concerning the Veteran's report of experiencing "odd sensations in the hands and feet" during a flight medical examination in November 1969. The examiner reported that the Veteran's medical records do not support chronicity or direct relation to military service or herbicide exposure for any of his conditions. It was explained that "the conditions were not treated until at least 30 years after service" and "while the Veteran's report of odd sensations in his hand and feet [was] reported in 1969, this does not conclude or support a diagnosis of Raynaud's disease" or neuropathy that occurred over 30 years later. The examiner further opined, the "medical records are not medically sound to support service connection for the conditions of right-hand disability, right thumb, right and left foot disabilities, right upper and lower extremity radiculopathy, and Raynaud's" therefore, "a nexus has not been established". The probative value of medical opinion evidence is based on the medical expert's personal examination of the patient, the physician's knowledge, and skill in analyzing the data, and the medical conclusion that the physician reaches. Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993). Whether a physician provides a basis for his or her medical opinion goes to the weight or credibility of the evidence in the adjudication of the merits. See Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998). Other factors for assessing the probative value of a medical opinion are the physician's access to the claims folder and the thoroughness and detail of the opinion. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000); Nieves-Rodriguez, 22 Vet. App. 295 (2008); Prejean v. West, 13 Vet. App. 444, 448-9 (2000). Here, the April 2021 opinion coupled with the August 2021 addendum was provided by a VA medical professional who possesses the necessary education, training, and expertise to provide the requested opinions. Additionally, the opinion is also shown to have been based on a review of the Veteran's record, to include consideration of all pertinent lay statements, and is accompanied by a sufficient explanation as to why the Veteran's various disabilities are not directly related to service, to include herbicide exposure. Furthermore, there is no competing medical opinion of record. The Board thus finds that the April and August 2021 opinion is dispositive of the issue at hand. In determining whether the record reflects that the Veteran's current bilateral lower extremity peripheral neuropathy, right upper extremity peripheral neuropathy, Raynaud's disease, right thumb degenerative arthritis of the 1st MCP joint, and bilateral plantar fasciitis are related to his service, the Board acknowledges the Veteran's belief that there is such a causal connection as well as his own description of in-service incurrence. The Board notes that the Veteran is competent to report the onset and continuity of symptoms such as pain. See Layno v. Brown, 6 Vet. App. 465, 469(1994). The Veteran is certainly competent to describe the circumstances of his military duties, the symptoms he felt during service, and the symptoms he felt since service. Competency and credibility, however, are two distinct inquiries. Whereas the former is a threshold legal concept that pertains to whether a particular piece of proffered evidence can even be considered by the factfinder, the latter pertains to the credibility and weight of such evidence as assigned by the trier of fact. See Rucker v. Brown, 10 Vet. App. 67, 74 (1997) (distinguishing between competence and weight and credibility and explaining that the "former is a legal concept determining whether testimony may be heard and considered by the trier of fact, while the latter is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted"). If evidence is not competent, it cannot be considered as evidence by the factfinder. Id. However, the mere fact that evidence is deemed competent does not mean that it must be found persuasive of a particular fact. See id. If evidence is found to be competent, it is for the Board to determine what, if any, probative value to assign to that evidence. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005) (it is the responsibility of the Board to assess the probative weight of the evidence). Here, although the Veteran is certainly competent to comment on the events in service, the Board finds the Veteran's contentions regarding in-service incurrence and continuity of symptoms since service not credible given the lack of continuity of complaints or medical treatment during service or for decades after service. Indeed, the Board observes the Veteran alleges he reported symptoms of "odd sensations in the hands and feet" after "visiting some Northern states while on leave when the nighttime temperatures fell below the warm level" during a flight medical examination in 1969. However, these assertions cannot be verified. In fact, the Veteran's November 1969 flight examination contains no reports of the presence or history of hand or foot issues. In addition, the Veteran's separation examinations also contained no complaints or indications of issues concerning the hands, feet, or lower extremities. The only documented report of symptoms occurs almost three decades after separation. In assessing the credibility of evidence, the Board may consider any number of factors, to include conflicting statements or evidence, and the potential bias of the declarant. See Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006); Pond v. West, 12 Vet. App. 341, 345 (1999). The lack of contemporaneous evidence is also relevant; however, it may not generally serve as the sole basis for discrediting lay statements or testimony. Buchanan, 451 F.3d at 1337. Here, the Board emphasizes the Veteran's credibility is not being discounted solely because of a lack of contemporaneous evidence. Rather, the Veteran himself admits he never sought continued treatment after separation from service even though he claims the symptoms were continuous. The idea that the Veteran would not complain of an acute or an ongoing issue for nearly three decades is incredible. The Veteran has not identified any instance of reporting his symptoms upon leaving military service until over 28 years after service. cf. Buczynski v. Shinseki, 24 Vet. App. 221, 224 (2011) (a lack of notation where such notation would normally be expected may be relied on as evidence against the existence of the fact or facts that ordinarily would have been noted). The Board again notes, the Veteran has reported experiencing "odd" sensations along with numbness and tingling in his hands and feet during service. See April and November 2020 Veteran Statements. However, the Veteran denied any hand, foot, or lower extremity issues during the November 1969 flight examination in direct contradiction of his lay statements. The Veteran again denied any hand, foot, or other lower extremity issues during his separation examinations. See July 1962 and July 1971 Separation Examinations. The Veteran once again denied any ongoing medical issues during subsequent flight examinations going so far as to report "I use no medications, and my health is excellent". See March 1973 and April 1974 Flight Examinations. Thus, the Board does not find the Veteran's statements of continuity of symptoms credible as they are in contradiction with other evidence of record. See Caluza v. Brown, 7 Vet. App. 478, 511 (1995), aff'd per curium,78 F.3d 604 (Fed. Cir. 1996) (when determining whether lay evidence is satisfactory, the Board may properly consider internal consistency, facial plausibility, consistency with other evidence submitted on behalf of the Veteran, and demeanor of witness (if hearing held)). Therefore, the Board finds the April and August 2021 addendum VA medical opinions to be significantly more credible and persuasive than statements made to VA for purposes of seeking compensation. Veteran's inconsistent and contradictory statements concerning his symptoms coupled with an almost three-decade gap between reports of symptoms lead the Board to conclude there is a preponderance of evidence against finding continuity of symptomology. See Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) (VA cannot ignore a veteran's testimony simply because the veteran is an interested party; personal interest may, however, affect the credibility of the evidence); see also Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006) (The Board can consider bias in lay evidence, the significant time delay between the affiants' observations and the date on which the statements were written, and conflicting statements of the veteran in weighting credibility). Further, the Veteran is not considered competent to medically attribute his current disabilities to a specific cause, as doing so requires medical knowledge and expertise that the Veteran has not been shown to possess. See Kahana v. Shinseki, 24 Vet. App. 428 (2011); Jandreau v. Nicholson, 492 F. 3d 1372, 1376-77 (Fed. Cir. 2007). Therefore, his statements do not constitute competent evidence that may be probative in showing an etiological relationship between the Veteran's in-service activities, including herbicide exposure, and the current right hand, right upper extremity, and bilateral lower extremity disabilities. To determine whether such a relationship exists, the Board turns to the competent medical evidence of record. The United States Court of Appeals for Veterans Claims has stated that the probative value of a medical opinion is based on the expert's personal examination of the patient, the physician's knowledge, and skill in analyzing the data, and the medical conclusion that the physician reaches. Further, the credibility and weight to be attached to these opinions are within the province of the adjudicator. See Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993). With respect to a nexus between the current right upper extremity peripheral neuropathy, bilateral lower extremity peripheral neuropathy, Raynaud's disease, right thumb degenerative arthritis of the 1st MCP joint, and bilateral plantar fasciitis and in-service occurrence, the Board assigns more probative weight to the April and August 2021 VA examiner's opinions which denied service connection after thorough review of the Veteran's medical history, STRs, personnel file, and consideration of all pertinent lay statements. As such, the Board finds no causal connection between the disease or injury in service and the current disabilities. See Shedden v. Principi, 381 F.3d 1163(Fed. Cir. 2004). The Board has also considered whether the Veteran is entitled to service connection for his current disabilities as "chronic" diseases and/or whether they are considered presumptive conditions due to herbicide exposure. See 38 C.F.R. § 3.303 (b) and 38 C.F.R. § 3.309 (e). The Veteran's peripheral neuropathy is listed as a presumptive disease under 38 C.F.R. § 3.309 (e) and Raynaud's diseases and arthritis are listed "chronic" disease under 38 C.F.R. § 3.303 (b). However, the Veteran's bilateral plantar fasciitis is not listed under either regulation. Again, the Board notes that the Veteran was diagnosed with the above disabilities at the earliest, almost three decades after his separation from active service. Thus, the record does not show that the Veteran's disability manifested to a compensable degree within one year of separation as required under 38 C.F.R. § 3.303 (b) and 38 C.F.R. § 3.309 (a) and (e) nor are the other conditions included in the list of presumptive or "chronic" diseases under those regulations. While the Veteran has reported onset of symptoms in and since service, the prolonged period from separation from service until, at the earliest 2000, without complaints and/or treatments for his alleged disabilities is evidence for consideration in determining continuity of symptomatology and weighs against a claim herein. See Mense v. Derwinski, 1 Vet. App. 354, 356 (1991). In the absence of credible evidence of right upper extremity peripheral neuropathy, bilateral lower extremity peripheral neuropathy, Raynaud's disease, right thumb degenerative arthritis of the 1st MCP joint, and bilateral plantar fasciitis within one year after separation or credible evidence of continuity of symptomatology, service connection is not warranted on a presumptive basis under the provisions of 38 C.F.R. §§ 3.303 (b), 3.307, and 3.309. (Continued on the next page) In light of the above, the preponderance of the evidence is against the claims and the benefit-of-the-doubt doctrine is not for application. The claims therefore must be denied. 38 U.S.C. § 5107 (b); see also Gilbert v. Derwinski, 1 Vet. App. 49, 57. SHEREEN M. MARCUS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. F. Minnitte, Attorney Advisor 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.