Citation Nr: 21070329 Decision Date: 11/23/21 Archive Date: 11/23/21 DOCKET NO. 11-05 792 DATE: November 23, 2021 ORDER Service connection for a disability manifested as chest pain is denied. Service connection for a right knee disability is denied. Service connection for a skin disorder is denied. Service connection for a bilateral shoulder disorder is denied. Service connection for a right wrist disorder is denied. FINDINGS OF FACT 1. The weight of the evidence is against finding that a disability manifested by chest pain was incurred during active service or is due to a cardiovascular disorder manifested within a year of separation from service. 2. The Veteran's right knee disability clearly and unmistakably preexisted active service and was clearly and unmistakably not aggravated beyond its natural progression during service. 3. The weight of the evidence is against finding that a skin disorder was incurred during active service. 4. The weight of the evidence is against finding that any disability of the bilateral shoulders was incurred during active service or is due to arthritis manifested within a year of separation from service. 5. The weight of the evidence is against finding that any disability of the right wrist was incurred during active service or is due to arthritis manifested within a year of separation from service. CONCLUSIONS OF LAW 1. The criteria for service connection for a disorder manifested by chest pain, have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.309. 2. The criteria for service connection for a right knee disability have not been met. 38 U.S.C. §§ 1110, 1111, 1131, 5107; 38 C.F.R. §§ 3.102 , 3.303, 3.304, 3.306, 3.309. 3. The criteria for service connection for a skin disorder have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 4. The criteria for service connection for a bilateral shoulder disability, have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.309. 5. The criteria for service connection for a right wrist disorder manifested by chest pain, have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active military service from June 1984 to October 1984. He also had service in the Army National Guard and Army reserves, with periods of active duty for training (ACDUTRA) and inactive duty training (IDT). This matter comes before the Board of Veterans' Appeals (Board) on appeal from May 2008 and August 2009 rating decisions issued by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran, his wife, and his sister testified before a Decision Review Officer on January 31, 2011. The Veteran also testified before the undersigned at a Board videoconference hearing in December 2015. Transcripts of the hearings have been reviewed and associated with the claims file. This matter was previously before the Board and was remanded in February 2016, April 2017, and December 2017, December 2018, and February 2020. In the December 2018 decision, the Board disposed of an appealed issue of service connection for memory loss and anxiety. Additionally while the matter remained pending on remand the RO in an August 2021 rating decision granted service connection for a neck disability, thereby removing this matter from appellate status. The remaining issues are now returned to the Board for further consideration. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). Certain chronic diseases, including arthritis and cardiovascular disease, will be presumed related to service if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service, with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). 1. Chest pain The Veteran contends that service connection is warranted for chest pain. He has testified that while traveling en-route to report for Reserve training he was in a motor vehicle accident (MVA) and afterward had multiple medical problems. His representative conceded that the February 2, 1990 date of the MVA did not correlate with his time in service, but referred to a document dated April 19, 2010 showing he was employed by the Army around the time of the accident. His service personnel records contained some conflicting evidence regarding his periods of service, with one note reflecting service from June 11, 1984 to October 12, 1984 and from July 1, 1989 to January 31, 1993, which would encompass the time of the MVA in February 1990. Other records suggested his reserve service, including active service, was from June 1984 to October 1984 (See DD-214). Other records include a report of separation and record of service dated 7/01/89, while an October 1995 enlistment exam for reserves give a history of honorable discharge from the ARNG in March 1990. VA has essentially conceded that the February 1990 MVA was associated with a period of active duty per the Board's remands in December 2018 and February 2020. The development undertaken addressed whether any claimed disability including chest pain was related to this February 1990 MVA, without further directing for line of duty or other service personnel records to be obtained as had been requested in the multiple remands prior to December 2018. The RO's August 2021 grant of service connection for a cervical spine disability was based on the injuries sustained in this February 1990 MVA. Based on this, the Board finds it is not necessary to further discuss whether the February 1990 MVA was in the line of duty for service-connection purposes. Service treatment records (STRs) do not reveal any findings or complaints of chest pain, although his January 1984 enlistment examination noted evidence of heart murmur. He denied chest pain or other cardiovascular issues in an October 1995 examination and report of medical history for reserves. In February 1990 the Veteran was in a MVA and was treated for complaints of pain and tightening in the right neck and shoulder. He was a front seat passenger with seatbelt and was hit from front side. Although he had no initial injury, he later complained of a stiff neck with no other physical problems reported. No initial injury. The only diagnosis was of cervical strain. . Records dated in January 2010 showed treatment for left chest pain on and off for 4 to 5 months. Chest X-rays were unremarkable. Later in March 2010 he was seen again in the ER for chest pain, and was thought to have a malingering type of personality, as the chest pain began when he was arrested and stopped after he was released to the ER. He was described as having atraumatic chest pain for 35 years. EKG showed sinus rhythm with marked sinus arrhythmia with short PR. Minimal voltage criteria for LVH, may be normal variant. His diagnosis on release from the ER in March 2010 was atypical chest pain. In January 2011 the Veteran was treated for generalized body pains, myalgias, and chest pain, and was diagnosed with precordial pain. In additional to the precordial pain he was also diagnosed with other malaise, fatigue, unspecified myalgia, and myositis. chest pain and shoulder pain. Chest X-ray revealed that his heart was within normal limits, with no confluent pneumonia, pedal edema, or active process. In April 2013 the Veteran was followed for chest pain, with concerns that it was more musculoskeletal in nature. However, since nitro helped, he was felt to need additional cardiology workup. The chest pain was going on for the last 6 month. He was hospitalized in January for same type of pain. He was unsure of the outcome of testing. The impression was of chest pain, again with concerns that it is musculoskeletal. See 161 pg. SSA Records received 2/24/16 at pg. 70, 94, 96. In May 2013 the Veteran underwent cardiac consult for chest pain for over 3 years, described as midsternal non-exertional sharp chest pain with radiation into the right upper extremity. Symptoms were not typical for cardiac etiology with stress tests reportedly normal. In June 2013 he was again diagnosed with atypical chest pain with symptoms atypical for a cardiac etiology. Social Security evaluation records from March 2014 noted his ER visit from January 2013 for chest pain and nausea with systolic murmur and overall left ventricular systolic function, mild mitral and tricuspid regurgitation, as well as his April 2013 chest pain episode. A July 2014 case analysis noted a disability due in part to his heart. . Private treatment records showed that his diagnoses included chronic obstructive pulmonary disease (COPD) in September 2015. The Veteran was further treated for issues with chest pain in January 2013, again diagnosed as precordial chest pain of etiology to be determined and hypertension. ECG findings were noted to show marked sinus bradycardia. The records showed that he had been experiencing intermittent pain in the left lateral chest wall for a couple years. The pain ranged from sharp to nagging and a pressure discomfort. He had not previously sought treatment for this. Although prior VA examination in May 2016 did not address his chest pain, in August 2017 a VA opinion was obtained which in part addressed the etiology of the Veteran's claimed chest pain disorder. This included whether such is at all related to his military service or to a motor vehicle accident which allegedly occurred February 2, 1990. The examiner stated that review of the objective records does not relate any of his current medical conditions to his military service. The examiner did not see any objective evidence that a car wreck occurred on Feb 2, 1990. Nor were there any reported injuries in his medical records. The examiner noted that the service records appeared to be incomplete, and the Veteran denied any medical problems when he tried to re-enter the service in 1995. It was further noted that the Social Security documentation lists multiple injuries that started in 1999, and SSD awards him disability based on those facts. There has been no new medical evidence provided that would change this examiner's opinion since he offered the initial opinion in 2016. Evidence seen that affects this decision includes SS records, and PCP records reporting left chest pain for 4-5 months, no injury, dated 1-20-2010. The report of a July 2020 (entered in July 2021) VA examination diagnosed pleurisy with onset date reportedly in 2001. Symptoms were ongoing, and medications included an albuterol inhaler for the condition. He stated that he was diagnosed with COPD, but there is no objective evidence in the medical record at this time suggesting that condition. Medical records showed most of his evaluations for his chest pain involved evaluation of his heart and he has been put on nitroglycerin in the past for the condition, which typically did cause chest pain to subside. His breathing symptoms increased when he bent over, and his x-rays of the chest have been normal. There has been no pulmonary function testing, respiratory failure, or hospitalizations to note, and no requirement for oxygen or steroids in the present day. Symptoms were more pronounced with strenuous activity and include shortness of breath mild pain with inspiration. Symptoms were more pronounced with strenuous activity and include shortness of breath and mild pain with inspiration. Treatment included Albuterol inhaler and a past history of nitroglycerin. The examiner's medical opinion was that the chest pains were less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The rationale noted that there is no specific evidence gathered from his history or cited his medical records to show that the noted pleurisy, incurred in or was caused by the result of the motor vehicle accident on February 2, 1990 and/or his active duty during service. A July 2021 addendum confirmed that there is no specific evidence gathered from his history or cited in his medical records to show that the noted pleurisy was incurred in or caused by the result of the February 2, 1990 MVA and/or his active duty service. A MVA is a traumatic event, however, the trauma involved is usually specific to an area of the body and will present acutely as pain or discomfort. In his case, although there was trauma involved there was nothing that suggested an injury to the lung that may have caused a pleuritic condition as a result of the February 1990 MVA. There was also nothing in the record to suggest an ongoing pleuritic lung issue occurred as a result of military service. Having reviewed the evidence the Board finds that the preponderance of the evidence is against a claim of service connection for a disability manifested by chest pain. Although a current disability of pleurisy was diagnosed in the VA examination of July 2020, the unfavorable opinion from this examiner, coupled with the clarifying addendum of July 2021 both discussed above, are afforded the most probative weight by the Board. These opinions are supported by adequate rationale, which in part discussed the MVA and explained why the chest pain manifestations diagnosed as pleurisy were not related to this accident or of any other in-service origin. The Board notes that this opinion is supported by the evidence showing a lack of chest pain treated in service, with no evidence of a cardiovascular diagnosis treated in service, although the January 1984 enlistment examination noted evidence of heart murmur. Chest pain diagnosed as atypical was not treated until decades after service in 2010 and none of the records addressing chest pain symptoms or any disability manifested by chest pain are shown to clearly link such disability to any incident in service. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008) (holding that it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the probative value of a medical opinion). Moreover, the examiner offered clear conclusions with supporting data and reasoned medical explanations. Id; Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A]medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions"). The Board acknowledges that the Veteran himself has claimed his chest pain disorder is directly related to his active service including the February 1990 MVA. However, while the Veteran is competent to report (1) symptoms observable to a layperson, e.g., pain; (2) a diagnosis that is later confirmed by clinical findings; or (3) a contemporary diagnosis, he is not competent to independently render a medical diagnosis or opine as to the specific etiology of a condition. See Davidson v. Shinseki, 581 F.3d 1313 (2009). Consequently, his lay assertions of medical diagnosis or etiology are afforded little probative value and cannot constitute evidence upon which to grant the claim for service connection. Latham v. Brown, 7 Vet. App. 359, 365 (1995). In sum, the most probative evidence is against a finding of direct service connection for a disability manifested by chest pain under 38 C.F.R. § 3.303 as there is no probative evidence such disorder is directly related to service. The evidence further fails to show the onset of a cardiovascular disorder which could include chest pain symptoms within one year of his discharge of service, thus a grant under the presumptions under 38 C.F.R. § 3.307, 3.309 is not warranted. In reaching the above conclusions, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran's claim, that doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102 ; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). 2. Right knee injury The Veteran contends that service connection is warranted for a right knee disorder. He has testified that while traveling en-route to report for Reserve training he was in a motor vehicle accident (MVA) and afterward had multiple medical problems. As discussed above, the Board has conceded that the February 1990 MVA was associated with a period of active duty. He has testified that he had a pre-existing right knee disability that was aggravated in service including due to training exercises. He also cited the MVA alleging injury to his right side. A veteran is presumed to have been in sound condition when enrolled for service, except for any disease or injury noted at the time of enrollment, or where clear and unmistakable evidence demonstrates that the injury or disease existed before enrollment and was not aggravated by such service. Only such conditions as are recorded in examination reports are to be considered as noted. 38 U.S.C. § 1111; 38 C.F.R. § 3.304 (b); Wagner v. Principi, 370 F.3d 1089, 1096 (Fed. Cir. 2004). When no pre-existing medical condition is noted upon entry into service, a Veteran is presumed to have been sound upon entry. 38 U.S.C. § 1111 ; Wagner, 370 F.3d at 1096 ; Bagby v. Derwinski, 1 Vet. App. 225, 227 (1991). If the presumption of soundness applies, the burden then shifts to the Government to rebut the presumption by clear and unmistakable evidence that the disability was both preexisting and not aggravated by service. Wagner, 370 F.3d at 1096; Bagby, 1 Vet. App. at 227. As further explained in Horn v. Shinseki: once the presumption of soundness applies, the burden of proof remains with the Secretary on both the preexistence and the aggravation prong; it never shifts back to the claimant. In particular, even when there is clear and unmistakable evidence of preexistence, the claimant need not produce any evidence of aggravation in order to prevail under the aggravation prong of the presumption of soundness... the burden is not on the claimant to show that his disability increased in severity; rather, it is on VA to establish by clear and unmistakable evidence that it did not or that any increase was due to the natural progress of the disease. 25 Vet. App. 231, 235 (2012). When defects are noted upon entry the presumption of soundness does not apply and the presumption of aggravation is for application. See Gilbert v. Shinseki, 26 Vet. App. 49 (2012). When there is a pre-existing disease or injury and an increase in severity in service, the presumption is that the disease will be considered to have been aggravated by active service, unless there is a specific finding that the increase in disability is due to its natural progression. 38 U.S.C. § 1153; 38 C.F.R. § 3.306 (a), (b) (2015); see also Wagner v. Principi, 370 F.3d 1089 (Fed. Cir. 2004); Cotant v. Principi, 17 Vet. App. 116, 123-30 (2003). In other words, when the disability increases in severity in service, the burden is on VA to rebut the presumption by showing by clear and unmistakable evidence that any increase during service was due to the natural progression of the disease or injury. 38 C.F.R. § 3.306 (b); Wagner v. Principi, 370 F.3d at 1096. Mere temporary or intermittent flare-ups of a preexisting injury or disease are insufficient to be considered aggravation unless the underlying condition, as contrasted to symptoms, is worsened. Jensen v. Brown, 4 Vet. App. 304, 306-07 (1993); Hunt v. Derwinski, 1 Vet. App. 292 (1991). Additionally, 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. § 3.306; Falzone v. Brown, 8 Vet. App. 398, 402 (1995). Service treatment records (STRs) do not reveal any findings or complaints of knee pain or problems. The Veteran denied knee pain or other orthopedic issues in an October 1995 examination and report of medical history for reserve service. In February 1990 the Veteran was in a MVA and was treated for complaints of pain and tightening in the right neck and shoulder. He was a front seat passenger with seatbelt and was hit from front side. Although he had no initial injury, he later complained of a stiff neck with no other physical problems reported. No initial injury. The only diagnosis was of cervical strain. Post-service private treatment records showed that in September 2000 the Veteran was seen for a right knee clicking and popping. He had worked as a laborer doing welding and pipe fitting for the last couple years and had a history of right shoulder injury, which he believed was a hairline fracture; he had no follow-up. Examination of the knee showed full range of motion with some discomfort and 1+ effusion, as well as crepitus on valgus/varus stress and positive McMurray. He was assessed with degenerative disease of the right knee. In January 2007, he was seen for complaints that included right knee pain impacting him while walking. X-rays of the knee were normal. His personal history was of being a cook specialist in the military from 1994 on. He was there for about 5-7 years. Since service he worked as a mechanic until 2000. He tried to do sand blasting, but on day 3 his right upper extremity went into a cramp and he had to quit. Examination revealed he was using a cane and had a slight limp on the right leg and an inability to hop, squat or tandem walk, or heel-toe walk. He was diagnosed with right knee pain. In January 2010 he was seen for chest pain with incidental findings of pain in the lateral thigh and hip, which he said started after he hit it on the corner of the porch in the military. Also in March 2010 while treated for chest pain, he also reported right knee pain, chronic from previous injuries, but with no swelling or deformities noted on musculoskeletal examination and he was moving all extremities well. He was assessed with right knee pain, chronic from previous injuries. Social Security records included an analysis of evidence including a January 2006 denial of the right knee with X-rays showing DJD of the right knee. The report of a May 2016 VA examination diagnosed right knee joint osteoarthritis. He reported that he injured his right knee at age 13, when he fell into the corner of a concrete porch. He said that his knee was still bad when he joined the military in 1984. He said that he lied about his knee condition in order to gain entry into the service and had no knee pain until he started basic training. His knee pain returned, and then he reported that x-rays showed hairline fracture. The examiner had not seen any service treatment records (STR's) pertaining to any knee issues in service and his STR's appear incomplete. In 2000 he was seen by a medical provider for symptoms of right knee clicking and popping. The clinician diagnosed arthritis at that time. He reported his right knee pain only occurs during flareups; such was when he walks too much. On physical examination he had pain with right knee flexion and pain noted on exam and caused functional loss. There was no ankylosis, and joint stability tests were normal. He used a cane constantly. The examiner gave an opinion in May 2016 in response to a question of whether the Veteran had a disability to include right knee condition that is caused or incurred by the February 1990 motor vehicle accident, with a rationale that focused on neck and back problems but also pointed out on review of the records that none of the history correlates to any injuries in service. It was further noted that his service records are very limited, and it appears his service was also very short. He also was noted to have denied any medical problems at all in attempt to get back into the military in 1995, and the entrance examination clearly showed he denied any orthopedic issues at all, both at that time and in the past. The examiner did not see records that show any of the claimed disabilities are at all related to his military service. An addendum opinion in August 2016 stated that the claimed right knee disorder was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. It was reasoned that there is no objective evidence that any knee condition occurred during service, there were no knee pain complaints noted in the available seen by the examiner. The medical documentation during the February 2, 1990 ER visit (following the in-service MVA) did not mention any knee pain associated with his vehicle crash. His reported pre-service knee injury, and his post service occupations and injuries were the most likely contributes to his current knee issues. In August 2017, a VA opinion was obtained which in part addressed the etiology of the Veteran's claimed right knee disorder. The examiner stated that review of the objective records does not relate any of his current medical conditions to his military service. The examiner stated that he did not see any objective evidence that a car wreck occurred on Feb 2, 1990, and there were no reported injuries in his medical records. The examiner stated that the service records appeared to be incomplete and the Veteran denied any medical problems when he tried to re-enter the service in 1995. The Social Security documentation lists multiple injuries that started in 1999, and SSD awards him disability based on those facts. There has been no new medical evidence provided that would change this examiner's opinion since he offered the initial opinion in 2016. Evidence seen that affects this decision includes SS records, and PCP records showing normal knee X-ray in 2007, and right leg hurting 2-3 years, started after he hit it on the corner of a porch. The examiner stated that there are certainly multiple reported injuries that would more likely be the cause of his current medical conditions, these injuries are detailed in the original examination and medical opinion. these post service injuries are still the most likely causes of his medical conditions. The report of a July 2020 (entered in July 2021) VA examination diagnosed right knee tendonitis/tendinosis with onset date reportedly in 2000. The Veteran gave a history of pain in the right knee that has progressed over the years. He did have a history of knee fracture at the age of 13 when he slipped on concrete, and he had a compensation and pension examination in 2000 showing osteoarthritis. No knee brace was required. He used hydrocodone for his knee pain. On examination, his right knee range of motion was 0-140 degrees (same as left knee), with no pain on motion and no additional loss on repetitive use. He reported additional factors of weakened movement due to muscle injury or peripheral nerves injury, and that range of motion of the joint and associated pain causes weakened movement of the joint. His muscle strength was 4/5 on flexion and extension. There was no atrophy and no ankylosis. Joint stability tests were all normal and no other significant findings were reported. The examiner opined that that the right knee disability was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The rationale noted that there is no specific evidence gathered from his history, or cited in the medical records to show that the noted right knee joint osteoarthritis, incurred in or was caused by the result of the MVA on February 2, 1990 and/or his active duty during service. The addendum of July 2021 confirmed that there is no specific evidence gathered from his history or cited in his medical records to show that the noted right knee tendonitis was incurred in or caused by the result of the February 2, 1990 MVA and/or his active duty service. A MVA is a traumatic event however the trauma involved is usually specific to an area of the body and will present acutely as pain or discomfort. In his case, although there was trauma involved, there was nothing that suggested an injury to the right knee at the time of injury, although knee pain can occur days or weeks after trauma. To suggest that this occurred in this instance would be mere speculation and not something definitively caused as a result of the February 1990 MVA. There was also nothing in the record to suggest an ongoing right knee issue occurred as a result of military service. Given that there are reports by the Veteran of having injured his knee prior to service in the May 2016 examination and again in the July 2020 VA examination, it is necessary to address whether the presumption of soundness applies in this matter. In this instance, although he reported in these examinations that he injured this knee around the age of 13 when he reportedly struck it in a fall, his credibility regarding the history of the knee disorder is negatively impacted by his own admission that he lied about his knee condition in order to gain entry into the service. Additionally, there has been an inconsistent history of the knee injury itself. Of note, he reported striking his leg in the military in January 2010 when he described the same type of accident that allegedly happened prior to service (fell against a porch). Further his May 2016 report of a sustaining a hairline fracture to this knee prior to service is not supported by the STRs, which are completely negative for any right knee issues or disability. The Board notes that he is not shown to be competent to independently render a medical diagnosis or opine as to the specific etiology of a condition. See Davidson v. Shinseki, 581 F.3d 1313 (2009). Given the above, there is not clear and unmistakable evidence of a knee disability that has pre-existed service, and the presumption of soundness and the analysis of this matter under pre-existing disability does not apply in this matter. See 38 C.F.R. §§ 3.304, 3.306. In any case, there was no mention of knee problems in the service treatment records, thus aggravation of any pre-existing disorder is not shown. Furthermore, the Board finds that the preponderance of the evidence is against a claim of service connection for a right knee disability. Although a current disability of right knee is shown, diagnosed as osteoarthritis in the records and in the May 2016 VA examination and as tendonitis/tendinosis in the VA examination of July 2020, the unfavorable opinion from the July 2020 examiner, coupled with the clarifying addendum of July 2021 both discussed above, are afforded the most probative weight by the Board. These opinions are supported by adequate rationale, which in part discussed the MVA and explained why the right knee manifestations were not related to this accident or of any other in-service origin. The Board notes that this opinion is supported by the evidence showing a lack of knee pain or any knee disability treated in service. Right knee osteoarthritis was not treated until at least a decade after service in September 2000 and none of the records addressing right knee symptoms or any disability of the right knee are shown to clearly link such disability to any incident in service. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008) (holding that it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the probative value of a medical opinion). Moreover, the examiner offered clear conclusions with supporting data and reasoned medical explanations. Id; Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A]medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions"). The Board acknowledges that the Veteran himself has claimed his right knee disorder is directly related to his active service including the February 1990 MVA. However, while the Veteran is competent to report (1) symptoms observable to a layperson, e.g., pain; (2) a diagnosis that is later confirmed by clinical findings; or (3) a contemporary diagnosis, he is not competent to independently render a medical diagnosis or opine as to the specific etiology of a condition. See Davidson v. Shinseki, 581 F.3d 1313 (2009). Consequently, his lay assertions of medical diagnosis or etiology are afforded little probative value and cannot constitute evidence upon which to grant the claim for service connection. Latham v. Brown, 7 Vet. App. 359, 365 (1995). In sum, the most probative evidence is against a finding of direct service connection for a right knee disability under 38 C.F.R. § 3.303 as there is no probative evidence such disorder is directly related to service. The evidence further fails to show the onset of arthritis within one year of his discharge of service, thus a grant under the presumptions under 38 C.F.R. § 3.30, 3.309 is not warranted. In reaching the above conclusions, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran's claim, that doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107 ; 38 C.F.R. § 3.102 ; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). 3. Skin disorder The Veteran contends that service connection is warranted for a skin disorder. He has testified that while traveling en-route to report for Reserve training he was in a motor vehicle accident (MVA) and afterward had multiple medical problems. As discussed above when addressing the chest issue, the Board has conceded that the February 1990 MVA was associated with a period of active duty. The Veteran has further alleged that he has a skin disorder, including psoriasis, related to service, including an incident throwing grenades and being covered in dust after they detonated. He has alleged having similar skin issues ever since then. Service treatment records (STRs) do not reveal any findings or complaints of skin problems. He denied skin diseases or other skin issues in an October 1995 examination and report of medical history for reserves. In February 1990 the Veteran was in a MVA and was treated for complaints of pain and tightening in the right neck and shoulder. He was a front seat passenger with seatbelt and was hit from front side. Although he had no initial injury, he later complained of a stiff neck with no other physical problems reported. No initial injury. The only diagnosis was of cervical strain. Private treatment records in SSA records from January 2007 give a history of the Veteran having been seen for skin problems for many years. He had a skin biopsy done but was not sure of diagnosis. He had a severe silvery plaques all over his body, hands, and scalp. He was diagnosed with a severe skin disorder possibly psoriasis, generalized. Private records in SSA records from July 2013, September 2013 and November 2013 noted diagnoses of possible psoriasis with findings of scattered lesions on his arms in July 2013, and described as large psoriatic plaques. He was recommended to see a rheumatologist for possible psoriatic arthritis in July 2013. Social Security records included an analysis of evidence in March 2014, which noted issues with psoriasis treated with cream in September 2013 In August 2017 a VA opinion was obtained regarding the etiology of the Veteran's claimed skin disorder including whether such skin disorder is at all related to his military service, or a motor vehicle accident which allegedly occurred February 2, 1990 or possibly due to hazardous chemicals or grenade exposure in service. The examiner opined that as far as the skin condition related to handling a grenade, there is no evidence of any skin issues in service. Moreover, simply handling a grenade would not cause a skin disease. There was no evidence of any hazardous chemical exposures, and the examiner cannot speculate as to why the Veteran has a skin condition. He has been chronically homeless for years, and it is not uncommon for homeless people to have skin issues related to lack of resources to bath and keep warm and dry. One can only speculate as to the cause of his skin condition. The report of a July 2020 (entered in July 2021) VA examination diagnosed dermatitis, hands with onset date reportedly in 1984. The Veteran gave a history of skin changes going back to 1984 that occurred on the ears, face, elbows, knees, and hands. He was on clobetasol for the condition that helps. The rash caused mild itching and irritation. Medical records showed no evidence of this skin condition being treated during military service. Physical examination showed a dermatitis covering less than 5 percent of the total body area and exposed area. The examiner opined that that the skin disorder was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The rationale stated that there is no specific evidence, gathered from this Veteran's history, or cited in his medical records to show that the noted dermatitis was incurred in or was caused by the result of the motor vehicle accident on February 2, 1990 and/or his active duty during service. The addendum of July 2021 confirmed that there is no specific evidence gathered from his history or cited in his medical records to show that the noted right knee tendonitis was incurred in or caused by the result of the February 2, 1990 MVA and/or his active duty service. A MVA is a traumatic event. However, the trauma involved is usually specific to an area of the body and will present acutely as pain or discomfort. The skin can become involved in an accident but usually by a caustic agent touching the skin by an abrasion or laceration from the trauma. In the Veteran's case although there was trauma involved, there was noting that suggested that an injury to the skin caused a rash as a result of the MVA in February 1990. There also was nothing in the record to suggest that a skin condition occurred during service. The Board finds that the preponderance of the evidence is against a finding of service connection for a skin disorder. Although a current disability of psoriasis is shown, in the records and dermatitis was diagnosed in the most recent VA examination of July 2020, the unfavorable opinion from the July 2020 examiner, coupled with the clarifying addendum of July 2021 and the August 2017 opinion all discussed above, are afforded the most probative weight by the Board. These opinions are supported by adequate rationale, which in part discussed the MVA and the reported grenade explosion incidents alleged by the Veteran to be possible causations of his skin disorder and explained why the skin disorder not related to this accident, caustic chemical including from the grenade incident, or of any other in-service origin. The Board notes that these opinions are supported by the evidence showing a lack of skin problems treated in service. Skin problems were not noted until SSA records from January 2007 suggested a history of skin problems for "years" and none of the records addressing any diagnosed skin disorder are shown to clearly link such disorder to any incident in service. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008) (holding that it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the probative value of a medical opinion). Moreover, the examiner offered clear conclusions with supporting data and reasoned medical explanations. Id; Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A]medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions"). The Board acknowledges that the Veteran himself has claimed his skin disorder is directly related to his active service including the February 1990 MVA or any incident involving a grenade. However, while the Veteran is competent to report (1) symptoms observable to a layperson, e.g., pain; (2) a diagnosis that is later confirmed by clinical findings; or (3) a contemporary diagnosis, he is not competent to independently render a medical diagnosis or opine as to the specific etiology of a condition. See Davidson v. Shinseki, 581 F.3d 1313 (2009). Consequently, his lay assertions of medical diagnosis or etiology are afforded little probative value and cannot constitute evidence upon which to grant the claim for service connection. Latham v. Brown, 7 Vet. App. 359, 365 (1995). In sum, the most probative evidence is against a finding of direct service connection for a skin disorder under 38 C.F.R. § 3.303 as there is no probative evidence such disorder is directly related to service. In reaching the above conclusions, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran's claim, that doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107 ; 38 C.F.R. § 3.102 ; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). 4. Bilateral shoulder condition The Veteran contends that service connection is warranted for a bilateral shoulder disorder. He has testified that while traveling en-route to report for Reserve training he was in a motor vehicle accident (MVA) and afterwards had multiple medical problems. As discussed above, the Board has conceded that the February 1990 MVA was associated with a period of active duty. He has testified including in his January 2011 DRO hearing and December 2015 Travel Board hearing that he has bilateral shoulder disabilities due to the in-service MVA. Service treatment records (STRs) do not reveal any findings or complaints of shoulder issues. He denied shoulder pain or other orthopedic issues in an October 1995 examination and report of medical history for reserves. In February 1990 the Veteran was in a MVA and was treated for complaints of pain and tightening in the right neck and shoulder. He was a front seat passenger with seatbelt and was hit from front side. Although he had no initial injury, he later complained of a stiff neck with no other physical problems reported. No initial injury. The only diagnosis was of cervical strain. No shoulder disorder was diagnosed despite the notation of pain and tightening in the shoulder. Post service private treatment records showed the Veteran was treated for a right shoulder pain in September 2000, with history of being a laborer doing welding and pipe fitting for the last couple years and history of right shoulder injury which he believed was a hairline fracture but no followup. Examination of the shoulder showed decreased range of motion, with abduction to about 100 degrees with noted discomfort. He was assessed with degenerative disease of the right shoulder. In January 2007 he was seen for complaints that included right shoulder pain and limited range of motion (ROM) of the right shoulder. He reported that he injured right shoulder picking up a car engine a few years earlier. X-rays of the shoulder showed degenerative changes in right AC joint. His personal history was of being a cook specialist in the military from 1994 on. He was there about 5-7 years. Since service he worked as a mechanic until 2000. He tried to do sand blasting, but on day 3 his right upper extremity went into a cramp and he had to quit doing that. Examination revealed his ROM of right shoulder was reduced and that he could raise his right arm to only 90 degrees and was unable to raise his arm above his head. He was diagnosed with right shoulder pain. In March 2010 while treated for chest pain, he also reported right shoulder pain, chronic from previous injuries, but with no swelling or deformities noted on musculoskeletal examination and he was moving all extremities well. He was assessed with right shoulder pain, chronic from previous injuries. Incidental findings of shoulder pain were noted in January 2011 records addressing chest pain and unspecified myalgias and myositis. He underwent a chest X-ray for chest and shoulder pain with no findings pertaining to the shoulder. Social Security records included an analysis of evidence including a January 2006 denial of the right knee with X-rays showing DJD of the right shoulder. The report of a May 2016 VA examination diagnosed acromioclavicular (AC) joint osteoarthritis in both shoulders. The Veteran gave a history of injury to his right shoulder while sandblasting in 2000 and denied having a right shoulder injury in service. Recently he began having left shoulder pain and reduced motion. He reports his left shoulder causes him pain daily. He denied a left shoulder injury. However he reported having in 5 car wrecks. He also reported that he was kicked by a bull twice, although he denies any of those injuries caused his shoulder pain. He felt that his left shoulder pain, which started a couple months ago, was caused by the alleged MVA in 1990. He currented reported daily left shoulder pain and weakness. Regarding flareups and functional loss, any lifting of his arms above shoulder level caused immediate flare-up, with increased pain and decreased range of motion. His range of motion was abnormal in the left and right shoulders, and he winced with any palpation of his shoulders, back, neck. He was quite jumpy when these areas were palpated. However, the examiner was unable to perform an evaluation of his bilateral shoulders other than measuring range of motion. Other findings were of decreased muscle strength 4/5 in the right and left shoulders. No ankylosis or atrophy was present. He had no rotator cuff conditions on the right. For the left shoulder he was unable to perform tests for rotator cuff pathology including empty can test and Hawkins impingement test. He had positive external rotation test and was unable to perform lift off subscapularis test. For the left shoulder he was unable to perform crank apprehension and relocation test. X-rays of both shoulders showed moderate bilateral changes of AC joint osteoarthritis. The examiner gave an opinion in May 2016 in response to a question of whether the Veteran had a disability to include bilateral shoulders that is caused or incurred by the February 1990 motor vehicle accident. It was reasoned that a review of the records showed no history that correlates to any injuries in service; his service records are very limited, and it appears his service was also very short. He also denied any medical problems at all in attempt to get back into the military in 1995, and the entrance examination clearly showed he denied any orthopedic issues at all, both at that time and in the past. The examiner did not see records that show any of the claimed disabilities are at all related to his military service. An addendum opinion in August 2016 stated that the claimed bilateral shoulder disability was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The rationale stated that there are no shoulder complaints noted in records, aside from mild shoulder tightness with his neck strain as a result of his MVA. The Veteran gave a history of post service shoulder pain and injuries. The current shoulder issues are not in any way related to his military service or his MVA on 2/2/1990. The veteran reports to the examiner that he injured his right shoulder in 2000, and only recently began having left shoulder discomfort. These issues clearly were not present when he discharged from service. All the available PHS's show he clearly denied joint issues of any kind throughout his service and when he tried to re-enlist. In August 2017, a VA opinion was obtained, which in part addressed the etiology of the Veteran's claimed bilateral shoulder disorder. The examiner stated that review of the objective records does not relate any of his current medical conditions to his military service. The examiner did not see any objective evidence that a car wreck occurred on Feb 2, 1990, nor were there any reported injuries in his medical records. The service records appeared to be incomplete and the Veteran denied any medical problems when he tried to re-enter the service in 1995, the Social Security documentation lists multiple injuries that started in 1999, and SSD awards him disability based on those facts. There has been no new medical evidence provided that would change this examiner's opinion since he offered the initial opinion in 2016. Evidence seen that affects this decision includes SS records, and PCP records. The examiner stated that there are certainly multiple reported injuries that would more likely be the cause of his current medical conditions, these injuries are detailed in the original exam and medical opinion. these post service injuries are still the most likely causes of his medical conditions. The report of a July 2020 (entered in July 2021) VA examination diagnosed bilateral acromioclavicular (AC) joint arthritis with onset date reportedly in 2000 for the right shoulder and 2016 for the left shoulder. The Veteran gave a history of bilateral shoulder pain for several years and thought it dates back to about 1985 with a car accident. He also described doing some sandblasting with injury to the right shoulder in 2000. Imaging studies have shown some arthritic changes. He had no injections or physical therapy and treated the pain with hydrocodone. Current symptoms included bilateral shoulder pain. Medical evidence included a prior C&P examination noting osteoarthritis of the left shoulder from May 2016 and of the right shoulder from 2000. On examination his ranges of motion of both shoulders were slightly reduced with the decreased motion resulting in a weaker joint. There were no additional losses of motion after three repetitions. For both shoulders, pain and weakness caused functional loss after repetitive use over time. Typically, he had daily pain and discomfort depending on how much that he does with the shoulder joints. The pain triggered by this could vary widely from several hours to several days depending on shoulder usage. Typically overusing his shoulder over time can trigger the pain onset and can be due to any activity where he puts too much strain on the joints. On further examination his muscle strength of the right and left shoulder 4/5 without atrophy or ankylosis. There were rotator cuff conditions for either shoulder, nor shoulder instability, dislocation, or labral pathology. He did have AC joint osteoarthritis of both shoulders. The examiner opined that the bilateral shoulder disabilities were less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The rationale noted that there is no specific evidence gathered from his history, or cited his veteran's medical records to show that the noted right and left shoulder AC joint osteoarthritis, incurred in or was caused by the result of the MVA on February 2, 1990 and/or his active duty during service. The addendum of July 2021 confirmed that there is no specific evidence gathered from his history or cited in his medical records to show that the bilateral AC joint osteoarthritis was incurred in or caused by the result of the February 2, 1990 MVA and/or his active duty service. A MVA is a traumatic event. However, the trauma involved is usually specific to an area of the body and will present acutely as pain or discomfort. In his case, although there was trauma involved, there was nothing that suggested an injury to the shoulder at the time of injury, although shoulder pain can occur days or weeks after trauma. To suggest that this occurred in this instance would be mere speculation and not something definitively caused as a result of the February 1990 MVA. There was also nothing in the record to suggest an ongoing shoulder issue occurred as a result of military service. The Board finds that the preponderance of the evidence is against a claim of service connection for a disability of the bilateral shoulders. Although a current disability of bilateral AC joint osteoarthritis is shown in the records and examination reports including in the VA examination of July 2020, the unfavorable opinion from the July 2020 examiner, coupled with the clarifying addendum of July 2021 both discussed above, are afforded the most probative weight by the Board. These opinions are supported by adequate rationale, which in part discussed the MVA and explained why the bilateral shoulder disabilities were not related to this accident or of any other in-service origin. The Board notes that this opinion is supported by the evidence showing a lack of shoulder pain or any shoulder disability treated in service. Right shoulder osteoarthritis was not treated until at least a decade after service in September 2000 and left shoulder osteoarthritis is not shown until 2016, and none of the records addressing bilateral shoulder symptoms or any disability of the shoulders are shown to clearly link such disability to any incident in service. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008) (holding that it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the probative value of a medical opinion). Moreover, the examiner offered clear conclusions with supporting data and reasoned medical explanations. Id; Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A]medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions"). The Board acknowledges that the Veteran himself has claimed his bilateral shoulder disorder is directly related to his active service including the February 1990 MVA. However, while the Veteran is competent to report (1) symptoms observable to a layperson, e.g., pain; (2) a diagnosis that is later confirmed by clinical findings; or (3) a contemporary diagnosis, he is not competent to independently render a medical diagnosis or opine as to the specific etiology of a condition. See Davidson v. Shinseki, 581 F.3d 1313 (2009). Consequently, his lay assertions of medical diagnosis or etiology are afforded little probative value and cannot constitute evidence upon which to grant the claim for service connection. Latham v. Brown, 7 Vet. App. 359, 365 (1995). In sum, the most probative evidence is against a finding of direct service connection for a bilateral shoulder disability under 38 C.F.R. § 3.303 as there is no probative evidence such disorder is directly related to service. The evidence further fails to show the onset of arthritis within one year of his discharge of service, thus a grant under the presumptions under 38 C.F.R. § 3.30, 3.309 is not warranted. In reaching the above conclusions, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran's claim, that doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102 ; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). 5. Right wrist disorder The Veteran contends that service connection is warranted for a right wrist disorder. He has testified that while traveling en-route to report for Reserve training he was in a motor vehicle accident (MVA) and afterwards had multiple medical problems. As discussed above when addressing the chest issue, the Board has conceded that the February 1990 MVA was associated with a period of active duty. He has testified including in his January 2011 DRO hearing and December 2015 Travel Board hearing that he has a right wrist injury due to the in-service MVA which injured his right side. Service treatment records (STRs) do not reveal any findings or complaints of right wrist pain or problems. He denied right wrist pain or other orthopedic issues in an October 1995 examination and report of medical history for reserves. In February 1990 the Veteran was in a MVA and was treated for complaints of pain and tightening in the right neck and shoulder. He was a front seat passenger with seatbelt and was hit from front side. Although he had no initial injury, he later complained of a stiff neck with no other physical problems reported. No initial injury. The only diagnosis was of cervical strain. The report of a May 2016 VA examination of the right wrist indicated that the Veteran does not have a current diagnosis associated with any claimed condition listed (right wrist condition). The Veteran also denied any wrist injuries ever, but he reported right wrist have aching pain occasionally. He also reported dull achy right wrist pain occasionally. Regarding functional loss, he had right wrist aching pain occasionally, which caused reduced function. On examination his range of motion and all other findings all within normal limits. X-ray was also within normal limits. The examiner gave an opinion in May 2016 in response to a question of whether the Veteran had a disability to include right wrist condition that is caused or incurred by the February 1990 motor vehicle accident, with a rationale that focused on neck and back problems, but also pointed out on review of the records that none of the history correlates to any injuries in service, his service records are very limited, and it appears his service was also very short. He also was noted to have denied any medical problems at all in attempt to get back into the military in 1995, and the entrance examination clearly showed he denied any orthopedic issues at all, both at that time and in the past. The examiner did not see records that show any of the claimed disabilities are at all related to his military service. An addendum opinion in August 2016 stated that the claimed right wrist disorder was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The rationale stated that there are no wrist complaints noted in records. The current wrist issues are not in any way related to his military service or his MVA on 2/2/1990. All the available PHS's show he clearly denied joint issues of any kind throughout his service and when he tried to re-enlist. In August 2017, a VA opinion was obtained, which in part addressed the etiology of the Veteran's claimed right wrist disorder, to include whether such is at all related to his military service, or a motor vehicle accident which allegedly occurred February 2, 1990. The examiner stated that review of the objective records does not relate any of his current medical conditions to his military service. The examiner stated that he did not see any objective evidence that a car wreck occurred on Feb 2, 1990. Nor were there any reported injuries in his medical records. The examiner stated that the service records do appear incomplete, and the Veteran denied any medical problems when he tried to re-enter the service in 1995, the Social Security documentation lists multiple injuries that started in 1999, and SSD awards him disability based on those facts. There has been no new medical evidence provided that would change this examiner's opinion since he offered the initial opinion in 2016. Evidence seen that affects this decision includes SS records, and PCP records. The examiner noted that in the May 2016 VA examination, the Veteran denied any wrist injuries, ever. The examiner stated that there are certainly multiple reported injuries that would more likely be the cause of his current medical conditions, these injuries are detailed in the original exam and medical opinion. these post service injuries are still the most likely causes of his medical conditions. The report of a July 2020 (entered in July 2021) VA examination diagnosed right wrist sprain with onset date reportedly in 1985. The Veteran gave a history of right wrist pain for multiple years. He reported that he injured it back in the military while doing push-ups. He also injured it in a car accident in 1985. He had pain and discomfort especially with repetitive use. He currently treated it with over the counter medications. He describes weakness in the grip on the right wrist as well. On examination the range of motion of the right wrist was completely normal with no evidence of pain with weight bearing, or on repetitive motion. He reported flareups that cause functional loss with mild pain. Overusing this wrist over time could trigger the pain onset. This could be due to any activity where he puts too much strain on the joint. Resting the affected joint alleviated discomfort. His muscle strength of the right wrist was is 4/5 without ankylosis. The examiner opined that that the right wrist disability was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The rationale noted that there is no specific evidence gathered from his history, or cited his veteran's medical records to show that the noted chronic sprain right wrist, incurred in or was caused by the result of the MVA on February 2, 1990 and/or his active duty during service. The addendum of July 2021 confirmed that there is no specific evidence gathered from his history or cited in his medical records to show that the chronic sprain right wrist was incurred in or caused by the result of the February 2, 1990 MVA and/or his active duty service. A MVA is a traumatic event however the trauma involved is usually specific to an area of the body and will present acutely as pain or discomfort. In his case although there was trauma involved there was nothing that suggested an injury to the right wrist at the time of injury, although a wrist condition can occur days or weeks after trauma. To suggest that this occurred in this instance would be mere speculation and not something definitively caused as a result of the February 1990 MVA. There was also nothing in the record to suggest an ongoing right wrist issue occurred as a result of military service. Furthermore, having reviewed the evidence the Board finds that the preponderance of the evidence is against a claim of service connection for a right wrist disability. Although a current disability of right wrist sprain is diagnosed in the VA examination of July 2020, the unfavorable opinion from the July 2020 examiner, coupled with the clarifying addendum of July 2021 both discussed above, are afforded the most probative weight by the Board. These opinions are supported by adequate rationale, which in part discussed the MVA and explained why the right wrist disability was not related to this accident or of any other in-service origin. The Board notes that this opinion is supported by the evidence showing a lack of wrist pain or any disability treated in service. There is also no wrist disability shown in the post service records or examination reports prior to the diagnosis of right wrist sprain made in July 2020. and none of the records addressing right wrist symptoms or any disability of the right wrist are shown to clearly link such disability to any incident in service. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008) (holding that it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the probative value of a medical opinion). Moreover, the examiner offered clear conclusions with supporting data and reasoned medical explanations. Id; Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A]medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions"). The Board acknowledges that the Veteran himself has claimed his right wrist disorder is directly related to his active service including the February 1990 MVA. However, while the Veteran is competent to report (1) symptoms observable to a layperson, e.g., pain; (2) a diagnosis that is later confirmed by clinical findings; or (3) a contemporary diagnosis, he is not competent to independently render a medical diagnosis or opine as to the specific etiology of a condition. See Davidson v. Shinseki, 581 F.3d 1313 (2009). Consequently, his lay assertions of medical diagnosis or etiology are afforded little probative value and cannot constitute evidence upon which to grant the claim for service connection. Latham v. Brown, 7 Vet. App. 359, 365 (1995). In sum, the most probative evidence is against a finding of direct service connection for a right wrist disability under 38 C.F.R. § 3.303 as there is no probative evidence such disorder is directly related to service. The evidence further fails to show the onset of arthritis within one year of his discharge of service, thus a grant under the presumptions under 38 C.F.R. § 3.30, 3.309 is not warranted. In reaching the above conclusions, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran's claim, that doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107 ; 38 C.F.R. § 3.102 ; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Eric S. Leboff Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Eckart 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.