Citation Nr: 21068417 Decision Date: 11/10/21 Archive Date: 11/10/21 DOCKET NO. 16-26 678 DATE: November 10, 2021 ORDER Entitlement to service connection for residuals of a low back condition is denied. Entitlement to service connection for an acquired psychiatric disorder is denied. Entitlement to service connection for a right knee condition is denied. Entitlement to service connection for a left knee condition is denied. Entitlement to service connection for a right shoulder condition is denied. Entitlement to service connection for traumatic brain injury is denied. Entitlement to service connection for migraine headaches is denied. Entitlement to service connection for a right ankle condition is denied. Entitlement to service connection for a heart condition is denied. FINDINGS OF FACT 1. Arthritis of the lumbosacral spine was not manifested to a compensable degree within one year of separation from service; a chronic lower back disability was not manifested in service, and is not otherwise attributable to service. 2. Anxiety preexisted service and was not aggravated therein; a psychiatric disability other than anxiety disorder was not manifested in service, and is not otherwise attributable to service. 3. A right knee disability preexisted service and was not aggravated therein. 4. A left knee disability preexisted service and was not aggravated therein. 5. The preponderance of the evidence of record is against finding that the Veteran has had a right shoulder disability at any time during or approximate to the pendency of the claim. 6. The preponderance of the evidence of record is against finding that the Veteran has had residuals of a TBI at any time during or approximate to the pendency of the claim. 7. A migraine headache disability preexisted service and was not aggravated therein. 8. A right ankle disability preexisted service and was not aggravated therein. 9. A heart disability was not manifested in service and is not otherwise attributable to service; the Veteran's heart murmur is not productive of a disability for which service connection may be granted. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for residuals of a low back condition have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 5103; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 2. The criteria for entitlement to service connection for an acquired psychiatric disorder have not been met. 38 U.S.C. §§ 1101, 1110, 1153; 38 C.F.R. §§ 3.102, 3.303, 3.306. 3. The criteria for entitlement to service connection for a right knee condition have not been met. 38 U.S.C. §§ 1101, 1110, 1153; 38 C.F.R. §§ 3.102, 3.306. 4. The criteria for entitlement to service connection for a left knee condition have not been met. 38 U.S.C. §§ 1101, 1110, 1153; 38 C.F.R. §§ 3.102, 3.306. 5. The criteria for entitlement to service connection for a right shoulder condition have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 6. The criteria for entitlement to service connection for traumatic brain injury have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 7. The criteria for entitlement to service connection for migraine headaches have not been met. 38 U.S.C. §§ 1101, 1110, 1153; 38 C.F.R. §§ 3.102, 3.303, 3.306. 8. The criteria for entitlement to service connection for a right ankle condition have not been met. 38 U.S.C. §§ 1101, 1110, 1153; 38 C.F.R. §§ 3.102, 3.303, 3.306. 9. The criteria for entitlement to service connection for a heart condition have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from April 1969 to April 1971. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a July 2014 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge at a hearing in August 2019. A transcript is of record. The Board remanded the case in November 2019, October 2020, and again in April 2021 for further development, to include obtaining private medical records identified by the Veteran. Pursuant to the Board's April 2021 remand, the Veteran was asked in letters dated April 2021 and May 2021 to complete a new VA Form 21-4142 for medical providers including King of Hearts Clinic and Brick Hospital. In May 2021 and again in June 2021, the Veteran provided a Form 21-4142 that did not include either King of Hearts Clinic or Brick Hospital. Records have been obtained from the other identified providers. With respect to records from King of Hearts Clinic and Brick Hospital, the Board notes that the duty to assist is not a one-way street. See Wood v. Derwinski, 1 Vet. App. 190, 193 (1991) (noting that the duty to assist is not a one-way street). As the Veteran failed to provide these records or authorize VA to obtain them, VA's duty to assist him in development as to this matter is met. The Board finds that there was substantial compliance with its remand orders. See Dyment v. West, 13 Vet. App. 141, 146-47 (1999); Stegall v. West, 11 Vet. App. 268, 271 (1998). There has been substantial compliance with the remand directives. Thus, the Board will decide the appeal on the evidence of record. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303 (a). 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. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 38 F.3d 1163, 1167 (Fed. Cir. 2004)). That an injury or disease occurred in service is not enough; there must be chronic disability resulting from that injury or disease. If there is no showing of a resulting chronic condition during service, then a showing of continuity of symptomatology after service is required to support a finding of chronicity. 38 C.F.R. § 3.303 (b). Service connection may 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). Service connection may be established for a current disability on the basis of a presumption under the law that certain chronic diseases, to include arthritis, manifesting to a certain degree within a certain time after service must have had their onset in service. 38 U.S.C. §§ 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309(a). In the absence of proof of a present disability there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). A veteran will be considered to have been in sound condition when examined, accepted and enrolled for service, except as to defects, infirmities, or disorders noted at entrance into service, or where clear and unmistakable (obvious or manifest) evidence demonstrates that an injury or disease existed prior thereto and was not aggravated by such service. See 38 U.S.C. § 1132; 38 C.F.R. § 3.304 (b). Cases in which the condition is noted on entrance, are however, governed by the presumption of aggravation of a preexisting disability contained in 38 U.S.C. § 1153. This statute provides that a preexisting injury or disease will be considered to have been aggravated by active service where there is an increase in disability during such service, unless clear and unmistakable evidence shows that the increase in disability is due to the natural progress of the disease. 38 U.S.C. § 1153; 38 C.F.R. § 3.306. In such cases, the record must simply show by a preponderance of the evidence that there was an increase in disability during service to trigger the presumption of aggravation. See Wagner v. Principi, 370 F.3d 1089, 1096 (Fed. Cir. 2004). Aggravation may not be conceded where the disability underwent no increase in severity during service on the basis of all the evidence of record pertaining to the manifestations of the disability prior to, during, and subsequent to service. 38 U.S.C. § 1153; 38 C.F.R. §§ 3.304, 3.306(b). Temporary or intermittent flare-ups of a preexisting injury or disease are not sufficient to be considered "aggravation in service" unless the underlying condition itself, as contrasted with mere symptoms, has worsened. See Jensen v. Brown, 4 Vet. App. 304, 306 -07 (1993); Green v. Derwinski, 1 Vet. App. 320, 323 (1991); Hunt v. Derwinski, 1 Vet. App. 292, 297 (1991). 1. Entitlement to service connection for residuals of a low back condition The Veteran's service treatment records show that he fell on stairs in October 1969 and hit the small of his back. On examination the Veteran had full range of motion. An X-ray showed normal lumbosacral spine. The impression was muscular strain, left trapezius. The service separation examination in November 1970 noted normal spine examination. An X-ray in November 2015 noted moderate lumbar spondylosis. A January 2016 VA treatment record noted that the Veteran reported bilateral buttock pain for about 4 months. He noted that he had hurt his lower back about eight years ago "involving L3-L5." An August 2017 MRI of the lumbar spine noted disc pathology at L2-3 through L5-S1, with significant spinal stenosis at L2-3 through L4-5; and foraminal stenosis significant bilaterally at L4-5, L3-4. An August 2019 statement from a private physician noted that the Veteran was "an active patient of this office being treated over the years for several musculo-skeletal conditions. Hx: initially treated in the office for lower back pain as well as right knee pain. The low back pain was from a lifting injury he sustained while in active duty." Records from this provider noted that the Veteran was first seen in 2011 and had been treated since that time for lumbago with sciatica and muscle spasm of the back. A VA examination was conducted in January 2020. The examiner noted diagnoses of degenerative arthritis of the spine, intervertebral disc syndrome, and spinal stenosis. The examiner noted that the Veteran reported a "history of back pain. However 2015, patient was cleaning his rim in his car. The next day had significant pain. Initially had back pain. Went to his chiropractor which helped with that pain. However he started developing numbness and pain in the legs, particularly the thighs. This resolved, had increase again 2017 while bending over, had MRI showed Stenosis and DDD, had steroid injection. Currently pain is localized to the buttock and posterior thigh. Also feels stiff in the morning and with sitting." The examiner opined that the Veteran's current back condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event or illness, to include the October 1969 fall down the stairs during which the Veteran hit the small of his back. In summary, the examiner explained that any injuries in the service were minor, soft tissue injuries which resolved and could not cause any chronic conditions. There were no major or severe injuries which would cause his current condition. The examiner also indicated that the Veteran's back pain is age-related degenerative disc disease/stenosis, which is seen in the majority of his age group. Finally, the examiner indicated that the Veteran's lumbar spine arthritis found on examination or noted in the medical records, did not begin during active service, manifest within one year after discharge from service, and was not noted during service with continuity of the same symptomatology since service. As noted above, the service treatment records note only a muscle strain of the back, with negative x-rays at that time, and no spine abnormalities noted at separation from service. The Veteran's earliest post-service back complaints were not noted until 2011, decades after his separation from service. The Board finds the January 2020 VA opinion probative and persuasive as the VA provider explained the reasons for his conclusions and the opinion was based on an accurate characterization of the evidence. Thus, the opinion is entitled to substantial probative weight. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The August 2019 statement of the private provider does not contain any rationale for attributing the current complaints to the Veteran's service, nor does it reflect any review of the service treatment records to include the X-ray findings therein. The Board finds this statement less probative than the VA examination report. The Board acknowledges the Veteran's lay assertions in support of his appeal; however, a determination as to whether the current lumbosacral spine pathology is etiologically related to service, including an injury therein, is a complex medical question. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Thus, the Veteran's lay statements asserting such a nexus exists are not competent as he is not shown to have medical training or expertise. As there is no evidence showing initial manifestations of arthritis in service, or to any degree within one year of separation from service, the one-year presumption for arthritis under 38 C.F.R. §§ 3.307 and 3.309 is not an avenue for service connection, nor are the provisions of 38 C.F.R. § 3.303 (b) pertaining to chronicity or continuity of symptomatology. See 38 C.F.R. §§ 3.303 (b), 3.307, 3.309. In short, the probative evidence weighs against finding a causal nexus between the current lumbosacral spine disorders and service. As such, the benefit of the doubt doctrine does not apply, and service connection is not warranted. See 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 2. Entitlement to service connection for an acquired psychiatric disorder, to include major depressive disorder On his report of medical history in November 1968 the Veteran checked yes to whether he had experienced depression or excessive worry. A November 1968 letter from a treating physician noted that the Veteran: has been under our care from Jan. 30, 1967 through March 20, 1967 for a sprain of the cervical spine, which responded well to conservative care, in that his objective findings soon diminished. However, the patient continued to express anxiety and concern over multiple symptoms, which were completely out of keeping with the injury. The patient was referred for neurological examination and no definitive findings were expressed. The patient -was last seen here, at his request, on the 21st of November with multiple complaints again, including blurred vision, chest pain and neck pain. He was referred to a psychiatrist last year but he had not followed up. Again, this time, the need for psychiatric care was expressed. In December 1968 the Veteran was evaluated for anxiety syndrome. The Veteran was noted to have multiple somatic complaints and anxiety responses to pain. The Veteran's pre-induction examination report noted that he was evaluated for anxiety and was deemed acceptable for service. The service treatment records do not note any psychiatric complaints. The November 1970 service separation examination noted normal psychiatric examination. The Veteran testified before the undersigned that he had constant depression during service and that he talked to the chaplain about it. He stated that he had received treatment for depression over the years including at King of Hearts. The record contains copies of invoices for psychotherapy treatment during 2018 from the King of Hearts Clinic. As noted above, the Veteran did not provide the requested VA Form 21-4142 to allow VA to obtain the treatment records from that facility. VA treatment records dated from December 2016 to August 2020 noted consistently negative depression screen results. An April 2019 VA treatment record noted that the Veteran denied depression and anxiety. As noted, the Veteran's pre-induction examination report notes a history of anxiety, and there is a November 1968 private physician's letter that describes his anxiety symptoms in 1967. Therefore, he is not presumed sound upon entrance as it relates to his psychiatric condition. 38 C.F.R. § 3.304. As noted above, a preexisting injury or disease will be considered to have been aggravated by active service where there is an increase in disability during service, unless there is a specific finding that the increase in disability is due to the natural progress of the disease. 38 C.F.R. § 3.306. However, the evidence shows there was no increase in the severity of the preexisting anxiety disability during service. The service treatment records do not include any complaints or findings related to anxiety. The separation examination report in November 1970 shows he was found to be psychiatrically normal at discharge. Thus, the competent and contemporaneous evidence does not demonstrate an increase in the Veteran's preexisting anxiety disability in service. Although the Veteran can report what he saw or experienced firsthand, he has not been shown to possess the education, training, and experience to offer medical opinions on complex matters such as the ability determining the severity of a psychiatric disorder, or to attest to the natural progression of it. Further, the notation of anxiety at entrance (but not at discharge) weighs against any lay assertion that his condition worsened during service. Accordingly, any contention by the Veteran would not be competent or probative evidence that his anxiety was permanently aggravated in service. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). In short, the competent and credible evidence of record does not reflect a permanent aggravation of the preexisting anxiety during service. The Board acknowledges the Veteran's assertions that he has a depressive disorder that is related to his military service. However, as this issue is medically complex, he is not competent to provide a nexus opinion in this case. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Since the competent and probative evidence of record fails to indicate that the Veteran has a depressive disorder or other psychiatric disorder that had onset in, or is otherwise related to service, service connection is not warranted. As the preponderance of the evidence is against the claim, the benefit of the doubt rule does not apply. 38 U.S.C. § 5107 (b). 3. Entitlement to service connection for a right knee condition 4. Entitlement to service connection for a left knee condition The Veteran testified before the undersigned that he injured his knees in service when he fell down some stairs. He stated that he was given Ace bandages and pain medications for his knees at that time and that he continued to have pain in his knees after service. On his pre-induction report of medical history completed in November 1968, the Veteran reported injuries to his knees. The pre-induction report noted that he had full range of motion of the knees. A November 1968 letter from a treating physician noted that the Veteran had: repeatedly sustained right geniculate sprains of traumatic origin with resultant cartilage impairment. Radiographic examination of the right knee on 6/21/68 revealed reduction of the medial geniculate space of the right knee. In view of this history, physical activity is contraindicated. An April 1969 induction record noted that the Veteran had "torn ligaments in both knees." The service treatment records do not note any knee injuries or complaints while on active duty. The Veteran was seen in October 1969 after falling on stairs, however he only reported neck and back complaints at that time. The November 1970 separation examination noted normal lower extremities examination. An August 2013 VA treatment record noted right knee arthritic complaints for greater than one year. X-rays of both knees in September 2013 found no acute osseous abnormality and no definite arthritic changes. An August 2019 statement from a private physician noted that the Veteran was "an active patient of this office being treated over the years for several musculo-skeletal conditions...The right knee pain started back in 1970 by a slip and fall also during active duty in the army." Records from this provider noted that the Veteran was first seen for knee complaints in 2011. As noted, the Veteran's pre-induction examination report notes a history of ligament tears in both knees, and there is a November 1968 private physician's letter that describes his knee pathology. Therefore, he is not presumed sound upon entrance as it relates to his knees. 38 C.F.R. § 3.304. As noted above, a preexisting injury or disease will be considered to have been aggravated by active service where there is an increase in disability during service, unless there is a specific finding that the increase in disability is due to the natural progress of the disease. 38 C.F.R. § 3.306. However, the evidence shows there was no increase in the severity of the preexisting left or right knee disability during service. The service treatment records do not include any complaints or findings related to the knees. The separation examination report in November 1970 shows he was found to have normal lower extremities at discharge. Thus, the competent and contemporaneous evidence does not demonstrate an increase in the Veteran's preexisting left or right knee disability in service. Although the Veteran can report what he saw or experienced firsthand, he has not been shown to possess the education, training, and experience to offer medical opinions on complex matters such as the ability determining the severity of a knee disorder, or to attest to the natural progression of it. Further, the notation of knee pathology at entrance (but not at discharge) weighs against any lay assertion that his condition worsened during service. Accordingly, any contention by the Veteran would not be competent or probative evidence that his left or right knee disability was permanently aggravated in service. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). The August 2019 statement of the private provider is not persuasive evidence as it does not contain any acknowledgement that the Veteran was noted to have bilateral knee pathology prior to service. It does not reflect any review of the service treatment records to include the November 1968 physician's statement, or the October 1969 treatment record that does not contain any reference to knee injury. The Board finds this statement is not probative on the question of whether a preexisting knee disability was aggravated by service. In short, the competent and credible evidence of record does not reflect a permanent aggravation of the preexisting left or right knee disability during service. As the preponderance of the evidence is against the claim, the benefit of the doubt rule does not apply. 38 U.S.C. § 5107 (b). 5. Entitlement to service connection for a right shoulder condition On his report of medical history in November 1968, the Veteran checked yes to whether he had a painful or "trick" shoulder or elbow. A notation of occasionally painful shoulder was made. The Veteran testified before the undersigned that he injured his right rotator cuff lifting a teletype machine in service. He reported that he was treated for this injury in service. The service treatment records do not show any complaints or treatments related to a shoulder injury. The November 1970 separation examination noted normal upper extremities examination. There is no evidence of a diagnosis of a right shoulder disability in the medical records associated with the claims file. There is no diagnosis of a right shoulder disability by a medical professional at any time during or since service, and the Veteran is not shown to be competent to diagnose such disability. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The Veteran has not been afforded a VA medical examination or opinion to aid in substantiating his claim, but the Board finds that one is not warranted because the evidence does not establish an in-service incurrence or a current disability. 38 U.S.C. § 5103A (d); McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). The Veteran has not asserted that he experiences any specific right shoulder pain symptoms that cause impaired earning capacity. See Saunders v. Wilkie, 886 F.3d 1356, 1364-65 (Fed. Cir. 2018). In the absence of proof of a present disability there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The requirement of a current disability is satisfied when the Veteran has a disability at the time he files his service connection claim or during the pendency of that claim, even if the disability resolves prior to adjudication of the claim. McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). However, when the record contains a recent diagnosis of disability prior to the Veteran's filing of a claim for benefits based on that disability, the report of the diagnosis is relevant evidence that the Board must address in determining whether a current disability existed at the time the claim was filed or during its pendency. Romanowsky v. Shinseki, 26 Vet. App. 289 (2013). The preponderance of the evidence is against the claim for service connection for a right shoulder disability; there is no doubt to be resolved; and service connection is not warranted. 38 U.S.C. § 5107 (b). 6. Entitlement to service connection for traumatic brain injury The Veteran testified that he suffered a concussion when a mortar went off close to him at Fort Dix in 1969. He stated that he was treated with aspirin at that time. He testified that he was later treated at Brick Hospital in the 1980s for brain swelling. As noted above, the Veteran did not provide the requested VA Form 21-4142 to allow VA to obtain the treatment records from that facility. The service treatment records do not show any complaints or treatment for a head injury or concussion. They do not note any mortar-related injury. In October 1969 the Veteran was noted to have fallen on stairs and hit his back and neck. He did not have any loss of consciousness at that time. He reported a headache for several days after. On the service separation examination in November 1970, neurologic and head examinations were normal. There is no evidence of a diagnosis of residuals of a TBI in the medical records associated with the claims file. There is no diagnosis of residuals of a TBI by a medical professional at any time during or since service, and the Veteran is not shown to be competent to diagnose such disability. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The Veteran has not been afforded a VA medical examination or opinion to aid in substantiating his claim, but the Board finds that one is not warranted because the evidence does not establish an in-service incurrence or a current disability. 38 U.S.C. § 5103A (d); McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). In the absence of proof of a present disability there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The requirement of a current disability is satisfied when the Veteran has a disability at the time he files his service connection claim or during the pendency of that claim, even if the disability resolves prior to adjudication of the claim. McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). However, when the record contains a recent diagnosis of disability prior to the Veteran's filing of a claim for benefits based on that disability, the report of the diagnosis is relevant evidence that the Board must address in determining whether a current disability existed at the time the claim was filed or during its pendency. Romanowsky v. Shinseki, 26 Vet. App. 289 (2013). The preponderance of the evidence is against the claim for service connection for a TBI; there is no doubt to be resolved; and service connection is not warranted. 38 U.S.C. § 5107 (b). 7. Entitlement to service connection for migraine headaches The Veteran testified before the undersigned that he developed migraine headaches after a mortar explosion in service. On his pre-induction report of medical history completed in November 1968, the Veteran checked yes to having experienced frequent or severe headaches. The pre-induction report noted that he had migraine headaches with occasional dizziness. A November 1968 letter from a treating physician noted that the Veteran "suffers from chronic migraine syndrome which began in 1963 and still incapacitates him." An April 1969 induction record noted that the Veteran had "chronic migraine headaches." The service treatment records note that in October 1969 the Veteran fell on stairs and hit his back and neck. He did not have any loss of consciousness at that time. He reported a headache for several days after. On the service separation examination in November 1970, neurologic and head examinations were normal. On VA treatment records dated from 2013 to 2020, the Veteran consistently denied experiencing headaches. As noted, the Veteran's pre-induction examination report notes a history of migraine headaches, and there is a November 1968 private physician's letter that describes his having chronic migraine syndrome since 1963. Therefore, he is not presumed sound upon entrance as it relates to headaches. 38 C.F.R. § 3.304. As noted above, a preexisting injury or disease will be considered to have been aggravated by active service where there is an increase in disability during service, unless there is a specific finding that the increase in disability is due to the natural progress of the disease. 38 C.F.R. § 3.306. However, the evidence shows there was no increase in the severity of the preexisting migraine disability during service. The service treatment records do not include any complaints or findings related to migraines. The Veteran reported headache for several days following a fall on the stairs in October 1969, however there are no further headache complaints noted in the remainder of the service treatment records, and the separation examination report in November 1970 shows he was found to have normal head and neurologic findings at discharge. Thus, the competent and contemporaneous evidence does not demonstrate an increase in the Veteran's preexisting migraine headache disability in service. Although the Veteran can report what he saw or experienced firsthand, he has not been shown to possess the education, training, and experience to offer medical opinions on complex matters such as the ability determining the severity of a headache disorder, or to attest to the natural progression of it. Further, the notation of migraines at entrance (but not at discharge) weighs against any lay assertion that his condition worsened during service. Accordingly, any contention by the Veteran would not be competent or probative evidence that a headache disability was permanently aggravated in service. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). In short, the competent and credible evidence of record does not reflect a permanent aggravation of the preexisting migraine headache disability during service. As the preponderance of the evidence is against the claim, the benefit of the doubt rule does not apply. 38 U.S.C. § 5107 (b). 8. Entitlement to service connection for a right ankle condition The Veteran testified before the undersigned that he injured his right ankle knees in service when he fell down some stairs. He stated that he was given an Ace bandage, an ice pack, and aspirin for his ankle at that time and that he continued to have pain in his ankle after service. On his pre-induction report of medical history completed in November 1968, the Veteran reported a history of "ligament tear in ankles." The pre-induction report noted that he had full range of motion of the ankles. The service treatment records do not note any ankle injuries or complaints while on active duty. The Veteran was seen in October 1969 after falling on stairs, however he only reported neck and back complaints at that time. The November 1970 separation examination noted normal lower extremities examination. The post-service treatment records do not show complaints or treatments related to the right ankle. As noted, the Veteran's pre-induction examination report notes a history of ligament tears in the ankles. Therefore, he is not presumed sound upon entrance as it relates to his right ankle. 38 C.F.R. § 3.304. As noted above, a preexisting injury or disease will be considered to have been aggravated by active service where there is an increase in disability during service, unless there is a specific finding that the increase in disability is due to the natural progress of the disease. 38 C.F.R. § 3.306. However, the evidence shows there was no increase in the severity of the preexisting right ankle disability during service. The service treatment records do not include any complaints or findings related to the right ankle. The separation examination report in November 1970 shows he was found to have normal lower extremities at discharge. Thus, the competent and contemporaneous evidence does not demonstrate an increase in the Veteran's preexisting right ankle disability in service. Although the Veteran can report what he saw or experienced firsthand, he has not been shown to possess the education, training, and experience to offer medical opinions on complex matters such as the ability determining the severity of an ankle disorder, or to attest to the natural progression of it. Further, the notation of ankle pathology at entrance (but not at discharge) weighs against any lay assertion that his condition worsened during service. Accordingly, any contention by the Veteran would not be competent or probative evidence that his right ankle disability was permanently aggravated in service. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). In short, the competent and credible evidence of record does not reflect a permanent aggravation of the preexisting right ankle disability during service. As the preponderance of the evidence is against the claim, the benefit of the doubt rule does not apply. 38 U.S.C. § 5107 (b). 9. Entitlement to service connection for a heart condition The Veteran testified that he was found to have a heart murmur in service. He reported that he received treatment for a heart disability from VA. The service treatment records do not note any heart problems or complaints. The November 1970 separation examination noted normal heart. A March 1971 chest X-ray noted normal heart. An August 2013 VA treatment record noted a 2/6 murmur. A July 2014 VA treatment record noted the Veteran had no heart murmur. A February 2014 VA treatment record noted that the Veteran denied chest pain, shortness of breath, palpitations, dizzy spells, syncope, edema of legs, and claudication. June 2016 and December 2016 treatment records noted systolic murmur. A stress test in December 2016 found "adequate stress. Good exercise tolerance. Hypertensive response. Negative study for evidence of myocardial ischemia." VA treatment records in January 2018 and September 2019 found no murmur. The cornerstone of a claim for disability compensation is the existence of a current disability. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). However, the Board has reviewed the record on appeal and can find no indication that the Veteran currently has a heart disability for which service connection can be granted. The Board acknowledges that the Veteran has been noted to have a systolic heart murmur. However, such condition is merely a clinical finding and not a disability for VA purposes. VAOPGCPREC 82-90, 61 Fed. Reg. 20,440, 20, 445 (May 7, 1996). Further, there is currently no provision in the rating schedule to compensate for a heart murmur. 38 C.F.R. §§ 4.9, 4.104 (2019). Cf. Marcelino v. Shulkin, No. 16-2149, 2018 U.S. App. Vet. Claims LEXIS 64, at (Vet. App. Jan. 23, 2018). A review of his service treatment records also does not reflect that he complained of or was treated for any heart condition in service. There is also no evidence that he was diagnosed with any heart disability in service. The Veteran's heart murmur has not resulted in a disability upon which service connection may be granted. The Veteran has denied complaints of chest pain, shortness of breath, and palpitations, and the December 2016 stress test found no evidence of myocardial ischemia. The Board has further considered the Veteran's lay statements regarding the onset of his heart murmur. However, as previously stated, a heart murmur in and of itself, is not a disability. VAOPGCPREC 82-90, 61 Fed. Reg. 20,440, 20,445 (May 7, 1996). Moreover, he has not demonstrated any specialized knowledge or expertise to indicate he is capable of rendering a competent diagnosis of a disability related to his heart murmur. As such, the determination of a diagnosis falls outside the realm of common knowledge of a lay person. Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). Consequently, in the absence of proof of a present disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). For these reasons, the preponderance of the evidence of record is against a finding that the Veteran's heart murmur has resulted in a disability as defined by VA regulation. As such, entitlement to service connection for a heart disability is denied. D. JOHNSON Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. G. Mazzucchelli, 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.