Citation Nr: 21070306 Decision Date: 11/23/21 Archive Date: 11/23/21 DOCKET NO. 16-13 878 DATE: November 23, 2021 ORDER Entitlement to an increased evaluation in excess of 10 percent for degenerative joint disease of the left knee, limitation of flexion is denied. Entitlement to a compensable evaluation for degenerative joint disease of the left knee, limitation of extension is denied. Entitlement to an increased evaluation in excess of 10 percent for degenerative joint disease of the right knee is denied. Entitlement to service connection for degenerative arthritis of the lumbar spine, claimed as back injuries, is denied. FINDINGS OF FACT 1. During the period on appeal, the Veteran's degenerative joint disease of the left knee manifested by flexion to 105 degrees. 2. During the period on appeal, the Veteran's degenerative joint disease of the left knee manifested by extension to 5 degrees. 3. During the period on appeal, the Veteran's degenerative joint disease of the right knee manifested by flexion to 120 degrees, and extension to 0 degrees. 4. The Veteran's degenerative arthritis of the lumbar spine was not aggravated by service-connected bilateral knee disabilities, and is not otherwise related to an in-service injury or disease. CONCLUSIONS OF LAW 1. The criteria for entitlement to an increased evaluation in excess of 10 percent for degenerative joint disease of the left knee, limitation of flexion, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Codes 5003, 5260. 2. The criteria for entitlement to a compensable evaluation for degenerative joint disease of the left knee, limitation of extension, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Codes 5003, 5261. 3. The criteria for entitlement to an increased evaluation in excess of 10 percent for degenerative joint disease of the right knee have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Codes 5003, 5010, 5261. 4. The criteria for entitlement to service connection for degenerative arthritis of the lumbar spine have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from July 1984 to May 1987. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2014 rating decision. The Veteran originally requested a hearing before the Board in his April 2016 VA Form 9. A hearing was scheduled for June 2019. However, prior to the hearing date, the Veteran cancelled the hearing via written correspondence. See June 2019 Statement in Support of Claim. Thus, the Board considers the hearing request withdrawn. 38 C.F.R. § 20.704. In August 2019, the Board remanded the issues for further development. That development was completed, and the case has since been returned to the Board for appellate review. Increased Rating Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (rating schedule), found in 38 C.F.R. Part 4. The Board attempts to determine the extent to which a veteran's service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, and the assigned rating is based, as far as practicable, upon the average impairment of earning capacity in civil occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.10. When a reasonable doubt arises regarding the degree of disability, such doubt will be resolved in favor of the claimant. 38 C.F.R. § 4.3. If there is a question as to which evaluation to apply to a veteran's disability, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. A Veteran's entire history is to be considered when making disability evaluations. See 38 C.F.R. 4.1, 4.2; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Where the issue involves the assignment of a disability rating following the initial award of service connection for that disability, as is the case here, the entire history of the disability must be considered, and separate ratings can be assigned for separate periods of time based on the facts found, a practice known as "staged" ratings. Fenderson v. West, 12 Vet. App. 119, 126 (1999). When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) ("[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran's disability, after which a rating is determined based on the § 4.71a criteria."). Under 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis; however, 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. See Burton v. Shinseki, 25 Vet. App. 1 (2011). In Correia v. McDonald, 28 Vet. App 158 (2016), the Court held that the final sentence of 38 C.F.R. § 4.59 requires that the examiner record the results of range of motion testing "for pain on both active and passive motion [and] in weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint." In Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court held that VA examiners must obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment of flares from the veterans themselves, when a flare-up is not observable at the time of examination. In making all determinations, the Board must fully consider the lay assertions of record. A Veteran is competent to report on that of which he or she has personal knowledge. Layno v. Brown, 6 Vet. App. 465, 469 (1994). When considering whether lay evidence is competent, the Board must determine on a case-by-case basis whether a veteran's particular disability is the type of disability for which lay evidence may be competent. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011); see also Jandreau v. Nicholson, 492 F.3d 1372, 1376 -77 (Fed. Cir. 2007). The Board must assess the credibility and weight of all the evidence, including the medical evidence, to determine its probative value, accounting for evidence that it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. See Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992); Hatlestad v. Derwinski, 1 Vet. App. 164 (1991). Equal weight is not necessarily accorded to each piece of evidence contained in the record; not every item of evidence necessarily has the same probative value. 1. Entitlement to an increased evaluation in excess of 10 percent for degenerative joint disease of the left knee, limitation of flexion 2. Entitlement to a compensable evaluation for degenerative joint disease of the left knee, limitation of extension The Veteran contends that he is entitled to a higher rating for his service-connected degenerative joint disease of the left knee because pain and functional limitations of the left knee have worsened. Knee disabilities can be rated under Diagnostic Codes 5003, 5256-5263. 38 C.F.R. § 4.71a. The Veteran's degenerative joint disease of the left knee (left knee DJD) is rated under 38 C.F.R. § 4.71a, Diagnostic Codes 5003-5260 and 5003-5261. Under Diagnostic Code 5003, degenerative arthritis established by X-ray findings is evaluated based on the limitation of motion under the appropriate Diagnostic Codes for the specific joint involved. When, however, the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate Diagnostic Codes, a rating of 10 percent is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added, under Diagnostic Code 5003. A 20 percent evaluation is authorized if there is X-ray evidence of involvement of two or more major joints or two or more minor joint groups and there are occasional incapacitating exacerbations. 38 C.F.R. § 4.71a, Diagnostic Codes 5003, 5010. Any limitation of motion must be confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. For these purposes, VA regulations consider the knees to be major joints. 38 C.F.R. § 4.45 (f). The limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. 38 C.F.R. § 4.71a, Diagnostic Code 5003. The normal range of motion for the knee is from 0 degrees extension to 140 degrees flexion. See 38 C.F.R. § 4.71, Plate II. Under Diagnostic Code 5260, a noncompensable rating is warranted for flexion limited to 60 degrees. A 10 percent rating is warranted for flexion limited to 45 degrees. A 20 percent rating is warranted for flexion limited to 30 degrees. A 30 percent rating is warranted for flexion limited to 15 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5260. Under the criteria for limitation of extension, a noncompensable rating is assigned for a limitation of extension to 5 degrees. When extension is limited to 10 degrees, a 10 percent rating is assigned. A 20 percent rating is appropriate where extension is limited to 15 degrees. A 30 percent rating is assigned in the case of extension limited to 20 degrees. A 40 percent rating is appropriate where extension is limited to 30 degrees. A 50 percent rating is assigned for limitation of extension to 45 degrees. See 38 C.F.R. § 4.71a, Diagnostic Code 5261. The Veteran was afforded a VA knee examination in July 2014. The Veteran reported he experiences flare-ups in cold or wet weather. Initial range of motion noted flexion to 105 degrees with objective evidence of painful motion at 90 degrees, and extension to 5 degrees with no objective evidence of painful motion. The Veteran's functional loss was due to less movement than normal, pain on movement, and disturbance of locomotion. Muscle strength testing was 4/5 upon extension and flexion. The Veteran uses a brace on his left knee when outside the home. June 2014 and July 2014 VA treatment records note the Veteran's left knee range of motion was to 105 degrees upon flexion and limited to 5 degrees upon extension. A December 2018 VA treatment record reflects the Veteran's knee lacks full extension. The Veteran was afforded a VA knee examination in January 2020. The Veteran related that pain and functional limitations have worsened. He reported no flare-ups but has difficulty sitting down, standing up, walking, bending, lifting, squatting, and kneeling. Initial range of motion was to 120 degrees upon flexion and to 0 degrees upon extension. Pain was exhibited upon flexion and extension. There were no additional factors contributing to the Veteran's left knee DJD. The Veteran's left knee muscle strength was 5/5 upon flexion and extension. The Veteran does not have ankylosis and joint stability testing was normal. The Veteran regularly uses a brace and constantly uses a cane. Based on this evidence, the Board finds that increased ratings under Diagnostic Codes 5260 and 5261, are unwarranted. Even with consideration of pain, repetitive use over time, and flare-ups, range of motion testing and estimated range of motion did not meet the criteria for compensable ratings. While the January 2020 VA examiner noted that the Veteran has difficulty sitting down, standing up, walking, bending, lifting, squatting, and kneeling, the Veteran clearly is able to perform ordinary tasks and maintains almost full strength. Also, while the Veteran complained of flare-ups in 2014, he denied the same in 2020. Thus, the frequency, length, or duration of such flare-ups are not productive of functional impairment that would warrant a higher rating. Indeed, the Veteran indicated that such flare-ups occurred in winter or cold weather. The 2020 examination was conducted in the winter and range of motion was still noncompensable. Thus, the Board finds that the Veteran's functional impairment is adequately compensated by the 10 percent rating under DC 5003-5260. The Board has also considered the other Diagnostic Codes pertaining to the knee and leg. Other disability ratings may be assigned only if the symptomatology for a disability is not duplicative or overlapping with the symptomatology of any other disability. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994); Lyles v. Shulkin, 29 Vet. App. 107 (2017) (holding that 38 C.F.R. § 4.14 prohibits paying compensation twice for the same symptoms or functional impairment). The Board has also considered whether it may be appropriate to rate the Veteran's left knee DJD under other diagnostic codes but finds that no higher or separate ratings are warranted. The Board notes that there is no evidence or allegation suggesting the Veteran's knees are productive of ankylosis, joint instability, dislocated or symptomatic of semilunar cartilage removal, impairment of the tibia or fibula, or genu recurvatum. Therefore, higher or separate ratings under the corresponding diagnostic codes (5256, 5257, 5258, 5259, 5262, and 5263) are not warranted. In so finding, the Board notes that the Veteran is competent to report on symptoms and sincere in his belief that he is entitled to a higher rating. His lay evidence, however, is outweighed by competent and credible medical evidence that evaluates the true extent of the knee impairment based on objective data coupled with the lay complaints. In this regard, the Board notes that the VA examiners have the training and expertise necessary to administer the appropriate tests for a determination of the type and degree of the impairment associated with the Veteran's complaints. For these reasons, greater evidentiary weight is placed on the examination findings in regard to the type and degree of impairment. In conclusion, the Board finds that the preponderance of the evidence is against the Veteran's claim for a rating in excess of 10 percent for left knee DJD under DC 5003-5260 or a compensable rating under DC 5003-5261. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. 3. Entitlement to an increased evaluation in excess of 10 percent for degenerative joint disease of the right knee The Veteran contends that he is entitled to a higher rating for his service-connected degenerative joint disease of the right knee because pain and functional limitations of the right knee have worsened. Knee disabilities can be rated under Diagnostic Codes 5003, 5256-5263. 38 C.F.R. § 4.71a. The Veteran's degenerative joint disease of the right knee (right knee DJD) is rated under 38 C.F.R. § 4.71a, Diagnostic Code 5010-5260. Under Diagnostic Code 5010, traumatic arthritis is rated under the same criteria as degenerative arthritis, Diagnostic Code 5003. 38 C.F.R. § 4.71a. Under Diagnostic Code 5003, degenerative arthritis established by X-ray findings is evaluated based on the limitation of motion under the appropriate Diagnostic Codes for the specific joint involved. When, however, the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate Diagnostic Codes, a rating of 10 percent is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added, under Diagnostic Code 5003. A 20 percent evaluation is authorized if there is X-ray evidence of involvement of two or more major joints or two or more minor joint groups and there are occasional incapacitating exacerbations. 38 C.F.R. § 4.71a, Diagnostic Codes 5003, 5010. Any limitation of motion must be confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. For these purposes, VA regulations consider the knees to be major joints. 38 C.F.R. § 4.45 (f). The limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. 38 C.F.R. § 4.71a, Diagnostic Code 5003. The normal range of motion for the knee is from 0 degrees extension to 140 degrees flexion. See 38 C.F.R. § 4.71, Plate II. Under Diagnostic Code 5260, a noncompensable rating is warranted for flexion limited to 60 degrees. A 10 percent rating is warranted for flexion limited to 45 degrees. A 20 percent rating is warranted for flexion limited to 30 degrees. A 30 percent rating is warranted for flexion limited to 15 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5260. The Veteran was afforded a VA knee examination in July 2014. The Veteran reported he experiences flare-ups in cold or wet weather. Initial range of motion noted flexion to 120 degrees with no objective evidence of pain, and extension to 0 degrees with no objective evidence of painful motion. The Veteran was able to perform repetitive use testing without any additional loss of range of motion. The Veteran's functional loss was due to less movement than normal. Muscle strength testing was 5/5 upon extension and flexion. Joint stability tests were normal. June 2014 and July 2014 VA treatment records note the Veteran's right knee range of motion was to 120 degrees upon flexion and to 0 degrees upon extension. A December 2018 VA treatment record reflects the Veteran's knee lacks full extension. The Veteran was afforded a VA knee examination in January 2020. The Veteran related that pain and functional limitations have worsened. He reported no flare-ups but has difficulty sitting down, standing up, walking, bending, lifting, squatting, and kneeling. Initial range of motion was to 120 degrees upon flexion and to 0 degrees upon extension. Pain was exhibited upon flexion and extension. There were no additional factors contributing to the Veteran's right knee DJD. The Veteran's left knee muscle strength was 5/5 upon flexion and extension. The Veteran does not have ankylosis and joint stability testing was normal. The Veteran constantly uses a cane. Based on this evidence, the Board finds that an increased rating under Diagnostic Codes 5260 is unwarranted. Even with consideration of pain, repetitive use over time, and flare-ups, range of motion testing and estimated range of motion did not meet the criteria for compensable ratings. While the January 2020 VA examiner noted that the Veteran has difficulty sitting down, standing up, walking, bending, lifting, squatting, and kneeling, the Veteran clearly is able to perform ordinary tasks and maintains full strength. Also, while the Veteran complained of flare-ups in 2014, he denied the same in 2020. Thus, the frequency, length, or duration of such flare-ups are not productive of functional impairment that would warrant a higher rating. Indeed, the Veteran indicated that such flare-ups occurred in winter or cold weather. The 2020 examination was conducted in the winter and range of motion was still noncompensable. Thus, the Board finds that the Veteran's functional impairment is adequately compensated by the 10 percent rating under DC 5010-5260. The Board has also considered the other Diagnostic Codes pertaining to the knee and leg. Other disability ratings may be assigned only if the symptomatology for a disability is not duplicative or overlapping with the symptomatology of any other disability. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994); Lyles v. Shulkin, 29 Vet. App. 107 (2017) (holding that 38 C.F.R. § 4.14 prohibits paying compensation twice for the same symptoms or functional impairment). The Board has also considered whether it may be appropriate to rate the Veteran's right knee DJD under other diagnostic codes but finds that no higher or separate ratings are warranted. The Board notes that there is no evidence or allegation suggesting the Veteran's knees are productive of ankylosis, joint instability, dislocated or symptomatic of semilunar cartilage removal, impairment of the tibia or fibula, or genu recurvatum. Therefore, higher or separate ratings under the corresponding diagnostic codes (5256, 5257, 5258, 5259, 5262, and 5263) are not warranted. Moreover, the Veteran does not have extension limited to 10 degrees to warrant a compensable evaluation under DC 5261. In so finding, the Board notes that the Veteran is competent to report on symptoms and sincere in his belief that he is entitled to a higher rating. His lay evidence, however, is outweighed by competent and credible medical evidence that evaluates the true extent of the knee impairment based on objective data coupled with the lay complaints. In this regard, the Board notes that the VA examiners have the training and expertise necessary to administer the appropriate tests for a determination of the type and degree of the impairment associated with the Veteran's complaints. For these reasons, greater evidentiary weight is placed on the examination findings in regard to the type and degree of impairment. In conclusion, the Board finds that the preponderance of the evidence is against the Veteran's claim for a rating in excess of 10 percent for right knee DJD under DC 5010-5260. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. Service Connection Under applicable law, service connection is warranted where the evidence of record establishes that a particular injury or disease resulting in disability was incurred in the line of duty in active military service or, if pre-existing such service, was aggravated thereby. 38 U.S.C. § 1110; 38 C.F.R. § 3.303 (a). Establishing service connection generally requires competent evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); see Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999). Regulations also provide that service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303 (d). Service connection may be granted for a disability that is proximately due to, or aggravated by, service-connected disease or injury. 38 C.F.R. § 3.310. In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). A lay witness is competent to testify as to the occurrence of an in-service injury or incident where such issue is factual in nature. Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). In some cases, lay evidence will also be competent and credible on the issues of diagnosis and etiology. Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Specifically, lay evidence may be competent and sufficient to establish a diagnosis where (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d at 1377; see also Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). A layperson is competent to identify a medical condition where the condition may be diagnosed by its unique and readily identifiable features. Barr v. Nicholson, 21 Vet. App. 303, 307 (2007). Additionally, where symptoms are capable of lay observation, a lay witness is competent to testify to a lack of symptoms prior to service, continuity of symptoms after in-service injury or disease, and receipt of medical treatment for such symptoms. Charles v. Principi, 16 Vet. App. 370, 374 (2002). Additionally, where a veteran served ninety days or more of active service, and certain chronic diseases become manifest to a degree of 10 percent or more within one year after the date of separation from such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309(a). While the disease need not be diagnosed within the presumption period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. Id. 4. Entitlement to service connection for degenerative arthritis of the lumbar spine, claimed as back injuries The Veteran contends that his back injury is due to a muscle strain during service. Alternatively, he contends that his service-connected knee disabilities aggravated his back. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has a current diagnosis of degenerative arthritis of the spine (back disability), and evidence shows that the Veteran suffered a muscle strain during active service, the preponderance of the evidence weighs against finding that the Veteran's diagnosis of back disability began during service or is otherwise related to an in-service injury, event, or disease. Private treatment records show the Veteran was not diagnosed with a back disability until February 2013, approximately 26 years after his separation from service. While the Veteran is competent to report having experienced symptoms of back pain intermittently over the years, he is not competent to provide a diagnosis in this case or determine that these symptoms were manifestations of the back disability. The issue is medically complex, as it requires knowledge of interpretation of complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Further, the July 2014 VA examiner opined that the Veteran's back disability is not at least as likely as not related to an in-service injury, event, or disease, including suffering a muscle strain during service. The rationale was the Veteran's strain resolved during active duty. There is no follow up until 2012 after the Veteran was in a motor vehicle accident. The examiner's opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The Veteran also asserts that his back disability was aggravated by his service-connected bilateral knee disabilities. The December 2019 VA examiner opined that the Veteran's back disability was less likely than not aggravated by the Veteran's service-connected bilateral knee disabilities. The rationale was that the Veteran did not complain of a back condition until a motor vehicle accident in 2013. By that time, the Veteran was 52 years old with arthritic changes. According to the history of the conditions and the physical examination findings, there is no clinical evidence to warrant aggravation of the spine by the knee conditions. There is no leg length discrepancy or chronic gait changes. There is no clinical evidence for a cause and effect or aggravation. There are comorbid conditions without a cause-and-effect relationship. The Veteran believes his back disability is related to an in-service injury, event, or disease or service connected disability. The Veteran in this case is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires knowledge of anatomical relationships, pathology, and interpretation of complicated diagnostic medical testing. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the VA medical opinions. There is also no persuasive medical evidence or persuasive credible lay evidence that the Veteran's claimed disorder manifested to a compensable degree within a year of his separation from service or had its onset in service and continued ever since service. Therefore, service connection based on presumptive service connection for a chronic disease or based on a theory of continuity of symptomatology is not warranted. Therefore, the Board finds that entitlement to service connection for degenerative arthritis of the lumbar spine is not warranted. TANYA SMITH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Alexia E. Palacios-Peters, 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.