Citation Nr: 21077231 Decision Date: 12/29/21 Archive Date: 12/29/21 DOCKET NO. 17-38 437 DATE: December 29, 2021 ORDER Entitlement to service connection for asthma, manifested by shortness of breath is denied. Entitlement to service connection for degenerative arthritis of the spine is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that the Veteran's asthma began during active service, or is otherwise related to an in-service injury or disease. 2. The Veteran's degenerative arthritis of the spine was not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disability is not otherwise etiologically related to an in-service injury or disease. CONCLUSIONS OF LAW 1. The criteria for service connection for asthma are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for degenerative arthritis of the spine are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from November 1962 to August 1964. This matter is before the Board of Veterans' Appeals (Board) on appeal from an April 2015 rating decision by a Department of Veteran's Affairs (VA) Regional Office (RO). A February 2021 Board decision found new and material evidence to reopen the claims of entitlement to service connection for asthma and degenerative arthritis of the spine. The Board then remanded the claims in February 2021 for further development. The issues were returned to the Board and remanded again for further development in September 2021. The Veteran testified at a Board hearing before the undersigned in January 2021. The transcript is of record. Service Connection Service connection is established on a direct basis when there is competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a), (d). Where a Veteran served continuously for ninety days or more during a period of war, or during peacetime service after December 31, 1946, and arthritis becomes manifest to a degree of 10 percent within one year from the date of termination of active duty, 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. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. 1. Entitlement to service connection for asthma, manifested by shortness of breath. The Veteran asserts his current asthma, manifested by shortness of breath, began in service as a result of exposure to lead paint, asbestos, parasites in the water, and blunt force trauma to his chest. Specifically, the Veteran asserts while onboard his ship, he was exposed to lead paint and asbestos. He asserts he was then exposed to parasites in the water around the ship while participating in man overboard drills. Finally, the Veteran asserts the duties of his military occupational specialty (MOS) included securing pallets of supplies during harsh weather conditions. During one instance of bad weather, the Veteran was stuck in the chest by a swaying pallet which he asserts resulted in a diaphragm condition. The Veteran was diagnosed with asthma in May 2016. This was confirmed in a May 2021 VA examination. No other medical diagnosis of lung conditions is found in the Veteran's record. Additionally, no evidence of a reported diaphragm condition is found in the record. However, as the Veteran was diagnosed with asthma in May 2021, the first element to service connection, a current disability, is met. As stated above, the Veteran asserts his current asthma condition is a result of lead paint exposure, asbestos exposure, parasite exposure, and/or blunt force trauma to his chest. The Veteran's MOS is listed as correspondence clerk. The Veteran's records also indicate he served on the USS Paricutin AE-18 from May 1963 to May 1964 and the USS Mt Baker in August 1964. The Veteran is competent to report on the experiences he had in service such as being struck in the chest with a pallet. 38 C.F.R. § 3.159 (a)(2). As the Veteran has consistently reported these occurrences for the entirety of the period on appeal, the Board finds no reason to doubt his credibility. The second element of service connection has been met. The question remaining before the Board is whether the Veteran's current asthma condition manifested by a shortness of breath is a result of his active-duty service. The Veteran's March 1962 "final for entrance USNA" examination notes his chest and lungs to be normal. Additionally, the Veteran reported no history of shortness of breath or asthma in his November 1962 entrance examination and the 1962 examiner noted his lungs and chest to be normal. X rays taken in November 1962 of the Veteran's chest also show no abnormalities. In December 1962, the Veteran was noted to have, "marked respiratory distress and [was] hardly arousable, possible respiratory spasm" at which point he was taken to the hospital for treatment. The Veteran's August 1964 separation examination noted his lungs and chest to be normal. No additional notations regarding shortness of breath nor respiratory distress were found while in service. As noted in the Board's September 2021 remand, "the February 2021 Board decision stated that the Veteran's service treatment records reflected x-ray evidence of calcification of the lungs during his separation from service. This is not accurate. Upon further review of the record, there is no such x-ray evidence showing calcification of the lungs in the Veteran's record." Rather, in an August 2010 statement from the Veteran, he asserts that after his discharge physical, he was notified by the Navy that calcification of the lungs was present on his most recent x ray. The Veteran was told it could be from parasites encountered during his man overboard drills or while swimming off the side of the ship at sea. There is no medical evidence of record showing that the Veteran had calcification of the lungs at any time during or directly after service. The Veteran is competent to report what his providers told him about his condition. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The Board also finds the Veteran to be credible in his assertions as they have remained consistent throughout the entirety of the appeal period. However, the Veteran's medical records do not show any calcification in the lungs until May 2016 in which his VA provider noted "old granulomatous disease." No indication of the cause nor age of this condition was provided. Additionally, to the extent the Veteran believes his asthma is a result of calcifications found in the lungs directly after service, he is not medically competent to provide an opinion in this regard. While the Veteran is competent to report on certain medical issues, he is not competent in this case to link his current asthma condition to his active service to include the undocumented reports of calcification found in the lungs during service. An opinion of that nature requires medical expertise that is outside the realm of common knowledge of a layperson and the Veteran does not have relevant medical training, experience, or education. Kahana v. Shinseki, 24 Vet. App. 428 (2011); Jandreau, 492 F.3d 1372. In August 2010 the Veteran submitted copies of his private medical records. In a January 1993 radiology report, the Veteran's provider noted his lung fields were clear and his chest was normal. In February 1993, the Veteran's lung sounds were noted as clear. There were no additional notations of respiratory issues asserted in this record spanning from February 1993 to December 1999. In the Veteran's January 2016 notice of disagreement, he made a number of contentions regarding the denial of his claim. In summary the Veteran asserts that the "lung infection" while in service was the start of his current lung condition which was then further aggravated by his service. The Veteran's VA treatment records show the Veteran began reporting respiratory issues in July 2014. The Veteran reported "chronic obstructive lung disease" but no pulmonary functioning testing was provided to confirm such a diagnosis. In March 2016 the Veteran also reported a history of asbestos exposure and a history of sandblasting. However, in May 2016, the Veteran's VA provider noted that his computed tomography (CT) scans do "not show ILD [interstitial lung disease] or pleural plaques/thickening to suggest asbestos-related pleural disease." Prior to the official results being associated with the Veteran's medical records, his VA provider sent the Veteran a letter explaining the results. The Veteran was told that, "overall it looks good, there is no sign of lung scarring or fibrosis also no sign of pleural plaques which can be typically associated with asbestos." The provider then stated this did not rule out asthma as a cause of the Veteran's respiratory issues and also noted a 4-millimeter nodule in the left lower lobe, "that can be from a number of causes...." The Veteran was diagnosed with asthma in May 2016. In February 2017, the Veteran's lungs were noted as clear with a dry cough with inspiration. The Veteran reported exercise-induced shortness of breath relieved with the use of an albuterol inhaler as prescribed by his provider. The Veteran was afforded a hearing in January 2021. The Veteran asserts that he was responsible for helping get heavy pallets off the ship and when the ship was moving the pallets would move resulting in the Veteran getting "knocked around." The Veteran further asserts he has had inconsistent diagnosis regarding his breathing condition and that no medical provider had considered whether or not his condition was due to external "trauma." The Veteran asserts he was struck in the chest with a pallet while onboard and the trauma from the impact could have resulted in his current breathing condition. Additionally, the Veteran again asserts he was exposed to asbestos and lead paint while onboard. The Veteran underwent a VA examination for his breathing condition in May 2021. Here the examiner stated the Veteran's breathing condition was less likely than not related to his active-duty service. The examiner noted the Veteran had reported an onset of his breathing condition in approximately 2013. The examiner stated that the Veteran's CT scan did not show, "any interstitial disease or pleural plaques consistent with asbestos exposure." In reference to the Veteran's asserted blow to the chest, the examiner concluded in reference to the available medical literature that external trauma does not cause a chronic lung condition such as asthma. The examiner then stated that there was no way to know the, "degree to which the [Veteran] was exposed to chemicals or lead paint" but that the exposure would not result in the development of asthma. In a June 2021 correspondence from the Veteran, he asserts he told the examiner his breathing condition had been gradually worsening for decades but began to significantly affect his quality of life in 2013. He further asserts that the examiner failed to consider his in service hospitalization for breathing issues and the Veteran's assertion of a "probable diaphragm muscle strain." As the June 2021 examiner did not provide a rationale for his statements concerning chemical and lead paint exposure, as well as mischaracterized the onset of the Veteran's condition, the Board remanded the issue for clarification in September 2021. In September 2021, the Veteran was provided an additional VA examination in which the examiner again stated the Veteran's current breathing condition was not a result of his active-duty service. The examiner first stated the Veteran's breathing condition was not a result of any chemical nor lead paint exposure. The examiner reasoned that there is no evidence of record showing the Veteran was exposed to chemicals that would result in an asthma diagnosis while onboard the ship. The examiner then cited to the available medical literature and stated that to definitively state there was a connection between chemical exposure and asthma, the examiner would need some sort of documentation of the exposure and medical literature that such exposure could result in an asthma diagnosis 52 years later. The examiner then stated the Veteran's in service notation of breathing issues did not result in his current asthma condition. The examiner reasoned that the Veteran's 1962 in service breathing issues were a result of an, "acute febrile illness and creates no nexus to present day condition of asthma." The Veteran's lungs and chest were then noted as normal in 1964. The examiner considered the Veteran's assertion of an in-service onset; however, the examiner stated the evidence of record does not show the issue in 1962 was continuous but rather related to a high fever. The examiner further stated that the 1962 in service shortness of breath was not a chronic lung condition. As a result, the examiner found that his current breathing condition was not a result of his in-service shortness of breath as that was attributed to his fever which eventually dissipated. The September 2021 examiner then stated that the Veteran's assertion of a pallet hitting him in the chest also did not cause the Veteran's current breathing condition. The examiner considered the Veteran's assertion regarding a "probable chronic diaphragm muscle strain" however the examiner then states an external trauma to the body would not result in a chronic lung condition. The examiner cites to medical literature to support this assertion. Finally, the examiner stated he considered the Veteran's assertion regarding exposure to parasites during the man overboard drills. The examiner reasoned that this was likely a misunderstanding on the Veteran's part and was more likely a possible explanation for his old granulomatous disease noted on his chest and lungs imaging in March 2016. The examiner stated that, "old granulomatous disease typically results from previous mycotic infection such as histoplasmosis and does not result in a long term chronic respiratory condition." As a result, the examiner concluded that the Veteran's current breathing condition was not a result of chemical exposure, lead paint exposure, a blow to the chest, nor did the Veteran's in service notations of breathing issues result in his current breathing condition. The Board finds that when read together the Veteran's May 2021 and September 2021 VA examinations consider all assertions made by the Veteran and are collectively adequate. The Board finds these rationales are consistent with the record and these opinions are highly probative, as they provided clear conclusions with supporting data, and reasoned medical explanations connecting the two. Stefl v. Nicholson, 21 Vet. App. 120, 124-25 (2007); Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). As such, the Board's duty to assist by providing an adequate examination under 38 C.F.R. § 3.159 has been fulfilled and there has been substantial compliance with prior Board remand directives. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). In a November 2021 correspondence from the Veteran, he contends that the June 2021 VA examiner limited the scope of his condition to asthma when making all of his determinations. The Board acknowledges this contention but the only current diagnosis of record for the Veteran's breathing condition is asthma. Neither the examiner nor the Veteran's VA treatment records note any other current breathing condition. As such, the Veteran's current disability for adjudication in this appeal is asthma. The Veteran also states the June 2021 VA examiner's opinion regarding chemical exposure is inadequate as it did not consider the work environment onboard the ship. The May 2021 VA examiner and the Veteran's VA outpatient records both definitively state that there are no signs of asbestos exposure in the Veteran's lungs. The Veteran credibly testified that he was exposed to lead paint while chipping and repainting the ship; his reports of exposure to chemicals is vague and nonspecific. This is the only evidence indicating chemical exposure to the Veteran while he was in service. The examiner reviewed the entire record to include the Veteran's lay statements, cited to medical literature to support his opinion, and concluded that chemical exposure generally, does not lead to an asthma diagnosis. Therefore, the examiner did consider exposure to chemicals and lead paint and provided an opinion addressing this contention supported by citation to medical literature. As a result, the Board continues to find the May 2021 and September 2021 VA examinations adequate when read together. Id. All of the Veteran's lay assertions have been considered in making the above determinations. The Veteran is competent to report on the observable symptoms of his claimed asthma condition to include the onset of such symptoms. See 38C.F.R. §3.159(a)(2). He is also credible as his assertions have been consistent throughout the entirety of the appeal period. However, the record does not suggest he is a trained medical professional and as a result, he is not medically competent to provide a medical etiology opinion for his asthma as it relates to his active-duty service, including chemical or paint exposures, no matter how sincere. While a lay person is competent to provide opinions on some medical issues, the specific disability in this case falls outside the realm of common knowledge of a lay person. Kahana, 24 Vet. App. 428; Jandreau, 492 F.3d at 1377. The claimant has the burden to "present and support a claim for benefits;" the benefit of the doubt standard in 38 U.S.C. § 5107 (b) is not applicable based on pure speculation or remote possibility. Fagan v. Shinseki, 573 F.3d 1282, 1286 (Fed. Cir. 2009). Here, the only nexus evidence in support of the Veteran's claim is his own lay evidence. As a result, the only competent nexus evidence of record are the May 2021 and September 2021 VA examiner's opinions, which the Board has found highly probative. Thus, the only probative nexus evidence weighs against the claim, and it must be denied. In arriving at this decision, the Board considered the doctrine of reasonable doubt. That doctrine is only invoked, however, where there is an approximate balance of evidence which neither proves nor disproves the claim. In this case, the preponderance of the evidence is against the Veteran's claim for entitlement to service connection for asthma. Therefore, the doctrine of reasonable doubt is not applicable. 38U.S.C. §5107 (b); 38 C.F.R. § 3.102. The claim is denied. 2. Entitlement to service connection for degenerative arthritis of the spine. The Veteran asserts his current back condition is a result of his active-duty service. Specifically, the Veteran asserts his back condition began in service due to falling down a ladder during underway watch in high seas due to his "floppy foot" and a pallet striking him in the chest, knocking him onto the "hutch cover." This resulted in the Veteran being pinned between a railing the pallet, leading to his current back condition. The Veteran was diagnosed with intervertebral disk syndrome (IVDS) of the lumbar spine with bilateral sciatic nerve impairment, status post lumbar laminectomy, and degenerative joint disease of the spine during a November 2012 VA examination. The Veteran was then diagnosed with degenerative arthritis of the spine, spinal stenosis, and facet pain syndrome in a September 2016 VA examination. In a May 2021 VA examination, the Veteran was again diagnosed with degenerative disk disease other than IVDS, spondylolisthesis, and scoliosis. As a result, the first element of service connection, a current disability, has been met. The Veteran asserts his current back condition is a result of falling down a ladder and attempting to stabilize pallets on a moving ship when he was hit in the chest. The Veteran is competent to report on the experiences he had in service to include being struck in the chest with a pallet and falling down a ladder. 38 C.F.R. § 3.159 (a)(2). As the Veteran has consistently reported these occurrences for the entirety of the period on appeal, the Board finds no reason to doubt his credibility. The second element of service connection has been met. The question remaining before the Board is whether or not the Veteran's current back condition is a result of his active-duty service. The Veteran's service treatment records show that in his March 1962 and November 1962 entrance examinations, no issues regarding the Veteran's spine were noted. In October 1963, the Veteran reported lumbar back pain that had onset three weeks prior. Approximately 2 weeks later the Veteran again reported low back pain stating he had been experiencing back pain since 1961. In an undated note, the Veteran was diagnosed with a lumbar strain. The Veteran's August 1964 separation examination also noted the Veteran's spine as normal. There were no notations made regarding issues with the Veteran's foot nor any instances of "floppy foot." In August 2010, the Veteran submitted a series of private medical records. The Veteran noted lumbar pain in February 1992. Only a few days later in February 1992, the Veteran reported "very little lower back pain." In December 1992, the Veteran's provider noted that the Veteran had fallen while on a business trip at the end of 1991. The provider noted that the Veteran, "subsequently developed radiculopathy, predominantly on the left side but he also has pain on the right side" as well as an injury to his back. The examiner noted the back injury had improved. Despite the improvement the Veteran still experienced stiffness and some range of motion issues. The Veteran reported experiencing "floppy foot," or feeling like his foot is not connected to his leg. No assertions of an injury to his back in service was made during this appointment. In January 1993 the Veteran was diagnosed with "L3-4 herniated nuclear pulposus and lateral recess stenosis." There is a lapse in the Veteran's submitted medical records from February 1993 to December 1999. In December 1999, the Veteran reported that he was, "at a full stop in his Tahoe, fully restrained, when he was hit by a Toyota Corolla travelling at an unknown rate of speed." The Veteran reported that while there was minimal damage to his car, the other driver's car sustained significant damage. The Veteran then reported neck and back pain at the time of the incident with continued back pain at the time of the appointment. The Veteran was then diagnosed with a lumbosacral strain status post motor vehicle accident. The Veteran underwent a VA examination in November 2012. The examiner noted that there were no vertebral fractures found on the Veteran. The examiner then noted a November 2012 scan of the Veteran's back that showed "mild compression fractures of T12, L1, and L2." The examiner did not state the cause of the fractures nor how old the fractures were. The examiner conducted the examination based on the belief that the Veteran had been diagnosed with scoliosis prior to his time in service. The Veteran did not assert nor does the record reflect that the Veteran was diagnosed with scoliosis prior to his time in service. As this examination was conducted on an inaccurate summation of the facts as presented by the record, the Board finds it is inadequate for VA purposes and thus affords it no probative weight. Reonal v. Brown, 5 Vet. App. 458, 461 (1993). The Veteran submitted a statement with his January 2016 notice of disagreement. The Veteran asserted he did not have a preexisting condition of scoliosis but rather his back was hurt on multiple occasions while in service. He asserts having to move pallets, position pallets, handle fuel hoses, reposition pallets in rough seas, and falling down a 20-foot ladder resulted in his current back condition. The Veteran further states that he was sharply pushed into the bulwark and knocked down when the loaded 500-to-1,000-pound pallets began to swing. He did not go to sick bay when he was hit as he wanted to prove he was "tough." However, the Veteran's record reflects he did actively go to sick bay to report lower back pain while in service, as stated above. He further asserts the scoliosis diagnosis came after and as a result of his spinal surgeries. The Veteran asserts he had two surgeries in 1989 and 1990 however, the record reflects the Veteran had spinal surgery in February 1993. The Veteran was not diagnosed with scoliosis until February 2016 in a VA outpatient note. The Board also acknowledges the Veteran's contentions regarding the adequacy of the November 2012 VA examination. However, as the Board has found this examination to be inadequate, the contentions regarding the adequacy of the November 2012 VA examination are now moot. The Veteran's VA outpatient records show he underwent MRI scans of his lumbar spine in March 2016 where the examiner noted, "no evidence of acute fractures." The Veteran underwent an additional VA examination in September 2016 in which the examiner noted he had reviewed the Veteran's entire record prior to providing an opinion. The examiner opined that the Veteran's current back condition was not a result of his active-duty service. The examiner reasoned that the record reflects the Veteran's back issues did not begin until the fall noted in his medical records in 1991. The examiner then notes an additional injury to the spine in the 1999 motor vehicle accident noted in the Veteran's private medical records. The examiner then stated it would be difficult to relate the Veteran's current back condition to reported back pain 55 years ago. It is more likely that the Veteran's back condition began with his fall in 1991 and was then aggravated by the motor vehicle accident in 1999. The Veteran was afforded a hearing in January 2021. Here the Veteran reports that he was helping get heavy pallets out of the ship, when the ship was moving, he would have to steady the pallets by hand which often resulted in him being struck by the pallets. The Veteran asserts he was hit with a pallet, pinning him between a railing and the pallet, injuring his back. He was reassigned as a "yeoman" and put in charge of clerical and personnel security matters after this incident. The Veteran then asserted he also injured his back after falling down the ladder when his foot gave way. The Veteran's service treatment records do not indicate the Veteran reported being struck with a pallet nor falling down a 20-foot ladder resulting in low back pain. In reference to the 1999 motor vehicle accident, the Veteran asserts the car that stuck his vehicle from behind was moving slowly and did not make his injury worse. However, the medical note shortly after the incident occurred shows the Veteran did not recall how fast the vehicle that struck him was moving but that it caused significant damage to the other driver's car. He also asserted neck and back pain during that appointment. The Veteran's wife testified that the Veteran experienced back pain prior to the 1991 fall and 1999 motor vehicle accident. The Veteran underwent an additional VA examination in May 2021 in which the examiner stated his current back condition was not a result of his active-duty service. The examiner noted he had reviewed the Veteran's record and considered his lay assertions regarding the onset of his back pain. The examiner noted the Veteran did not "have a foot drop on exam today" nor were any fractures in the spine noted. The examiner then stated there was no evidence of record indicating an injury to the spine due to being hit with a pallet, falling down a ladder, nor "being smashed between a pallet and a railing that is significant enough to establish a nexus from service to later events including lumbar spine surgery 25 years later." The examiner also noted the hearing testimony from the Veteran and his wife but concluded that the Veteran's current arthritis did not begin during service nor did it manifest within one year of separation. The Veteran underwent an additional VA examination in September 2021. Here the examiner again stated the Veteran's current back condition was not a result of his active-duty service. The examiner reasoned that, even in considering the Veteran's lay assertions, there was no medical evidence of record indicating that the Veteran's current back condition began in service. The examiner stated the Veteran was seen in service for a back strain with no subsequent visits for back pain during or directly after service. As a result, the examiner stated that a back strain sustained in service with no additional treatment would not result in the back issues the Veteran experienced later in life to include a surgery 25 years after service. The Board finds that when read together the Veteran's September 2016, May 2021, and September 2021 VA examinations consider all assertions made by the Veteran and are collectively adequate. The Board finds these rationales are consistent with the record and these opinions are highly probative, as they provided a clear conclusion with supporting data, and a reasoned medical explanation connecting the two. Stefl, 21 Vet. App. 120; Nieves-Rodriguez, 22 Vet. App. 295. The Board acknowledges the many contentions made by the Veteran throughout the period on appeal. In the Veteran's July 2017 VA Form 9, the Veteran asserts all of the service duties he was required to do, his previously noted spinal fractures, and continuity of symptomatology were not adequately addressed by the June 2017 statement of the case. The Veteran's service duties, as reported by the Veteran, include going up and down ladders, securing pallets in high seas, and loading supplies on and off the ship. These duties have been considered by the Board, the September 2016, May 2021, and September 2021 VA examiners. Additionally, in reference to the Veteran's spinal fractures noted in a November 2012 VA examination, the record does not reflect the Veteran's spine was fractured at any point prior to 2012. There is also no indication from the record as to what caused those fractures or how old they are. The Board notes that in a November 2021 correspondence from the Veteran he asserts the fractures are "decades old;" however, that assertion was corroborated by neither his private nor VA medical records. Additionally, an MRI from May 2016 show no current fractures in the Veteran's spine. In reference to continuity of symptomatology, the first complaints and objective evidence of a back condition was in in service in 1962. However, after the Veteran's separation from service the first assertion of back pain was nearly 28 years after service in February 1992 after he fell down while on a business trip in 1991. Additionally, the Veteran reported his pain was improving in February 1992. The Veteran continued to report some back pain but was then reinjured in a motor vehicle accident in 1999. While the Veteran testified at the January 2021 hearing that the car was going slowly, the Veteran's medical records show that directly after the accident the Veteran could not recall how fast the car that hit him was moving. The Veteran's back condition in service was not noted to be chronic but was rather diagnosed as a lumbar spine strain. In a June 2021 correspondence from the Veteran, he further contends that the May 2021 VA examination was not conducted in the "spirit of best interest of the Veteran," that the examination was only 10 minutes long, and that the examiner did not discuss the Veteran's prior history with him. The Veteran also asserts the examiner failed to consider his in-service reports of back pain. However, as stated above, the Board has found that when read together the sum of the September 2016, May 2021, and September 2021 VA examinations is adequate. The length of time the examiner spends with a Veteran is not a factor considered when assessing the adequacy of the provided opinion. Additionally, there is no evidence to suggest the May 2021 VA examiner did not conduct the examination in the light most favorable to the Veteran. He reviewed the Veteran's file and in connection with his medical training and expertise provided an opinion consistent with the Veteran's record. Finally, in November 2021, the Veteran asserted that the September 2021 VA examiner did not consider an evaluation stating he had decades old injuries to his spine. There is no medical record in the Veteran's file that states the 2012 fractures to the spine were decades old. There is no indication from that note that shows the age nor cause of those factures. All of the Veteran's lay assertions have been considered in making the above determinations. The Veteran and his wife are competent to report on the observable symptoms of his claimed back condition to include the onset of such symptoms as pain. See 38C.F.R. §3.159(a)(2). However, the record does not suggest they are trained medical professionals and as a result, they are not medically competent to diagnose arthritis or fractures of the spine, nor to provide a medical etiology opinion for his back condition as it relates to his active-duty service, no matter how sincere. While a lay person is competent to provide opinions on some medical issues, the specific disability in this case falls outside the realm of common knowledge of a lay person. Kahana, 24 Vet. App. 428; Jandreau, 492 F.3d 1372. As a result, the preponderance of the evidence shows that the Veteran's back condition did not begin in service and continue to the present time; nor did it manifest within one year of the Veteran's separation of service. The Veteran's back condition was not noted as chronic in service and the first assertion of lower back pain was not until 28 years after his separation from service. Service connection on a presumptive basis is not warranted. 38 U.S.C. §§ 1101, 1112, 1137; 38 C.F.R. §§ 3.307, 3.309. Rather, the probative evidence shows that the Veteran's back condition had its onset years after service, and there is no competent evidence of record to link the Veteran's back condition with an incident of service. As there is not a balance of evidence both for and against the claim, the benefit of the doubt doctrine is not for application. Accordingly, the Board finds that the preponderance of the evidence is against the claim and entitlement to service connection for the Veteran's back condition is not warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. The claim is denied. LAURA E. COLLINS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Associate Counsel, S. Conti 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.