Citation Nr: A21020067 Decision Date: 12/16/21 Archive Date: 12/15/21 DOCKET NO. 190521-16902 DATE: December 16, 2021 ORDER The reduction of the disability rating for service-connected shin splints, right, from 10 percent disabling to noncompensable effective March 22, 2019, was proper and the appeal is denied. Entitlement to service connection for groin pain to include as secondary to service-connected low back strain is denied. Entitlement to service connection for headaches to include as secondary to glaucoma, is denied. Entitlement to service connection for a neck condition (also claimed as neck/upper back, cervical spine stenosis, cervical spondylosis, cervical radiculopathy, chronic neck pain, cervical spine disc, degeneration above the fusion, C4-5 broad based disc osteophyte complex, C6-7 Mild canal stenosis. mild bilateral foraminal narrowing, C6-7 ACDF level minimal residual broad-based disc osteophyte, there is mild spurring along the anterior inferior aspect of C4 again seen, straightening of the cervical spine, mild facet arthrosis and arthrodesis status) to include as secondary to service-connected right shoulder strain is denied. FINDINGS OF FACT 1. The Veteran received proper notice of the reduction in rating for his service-connected shin splints, and improvement in the Veteran's ability to function due to service-connected shin splints is shown by a preponderance of the evidence. 2. Groin pain is not shown to be causally or etiologically related to any disease, injury, or incident in service, did not manifest within one year of service discharge, and was not caused or aggravated by the Veteran's service-connected low back strain. 3. Headaches are not shown to be causally or etiologically related to any disease, injury, or incident in service, did not manifest within one year of service discharge, and were not caused or aggravated by any of the Veteran's service-connected disabilities. 4. A neck condition (also claimed as neck/upper back, cervical spine stenosis, cervical spondylosis, cervical radiculopathy, chronic neck pain, cervical spine disc, degeneration above the fusion, C4-5 broad based disc osteophyte complex, C6-7 Mild canal stenosis. mild bilateral foraminal narrowing, C6-7 ACDF level minimal residual broad-based disc osteophyte, there is mild spurring along the anterior inferior aspect of C4 again seen, straightening of the cervical spine, mild facet arthrosis and arthrodesis status) is not shown to be causally or etiologically related to any disease, injury, or incident in service, did not manifest within one year of service discharge, and was not caused or aggravated by the Veteran's service-connected right shoulder strain. CONCLUSIONS OF LAW 1. The criteria for reduction of the disability rating for shin splints, right, effective March 22, 2019, were met, and the reduction was proper. 38 U.S.C. §§ 1155, 5107, 5112; 38 C.F.R. §§ 3.105 (e), 3.344, 4.97, Diagnostic Codes 5299-5262. 2. The criteria for service connection for groin pain to include as secondary to service-connected low back strain have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1154, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. 3. The criteria for service connection for headaches to include as secondary to glaucoma have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1154, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. 4. The criteria for service connection for a neck condition (also claimed as neck/upper back, cervical spine stenosis, cervical spondylosis, cervical radiculopathy, chronic neck pain, cervical spine disc, degeneration above the fusion, C4-5 broad based disc osteophyte complex, C6-7 Mild canal stenosis. mild bilateral foraminal narrowing, C6-7 ACDF level minimal residual broad-based disc osteophyte, there is mild spurring along the anterior inferior aspect of C4 again seen, straightening of the cervical spine, mild facet arthrosis and arthrodesis status) to include as secondary to service-connected right shoulder strain have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1154, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Navy from August 1995 to August 1998 and in the Army from May 1999 to April 2006. The Board notes that the rating decision on appeal was issued in April 2019. In May 2019 the Veteran submitted a VA Form 10182 notice of disagreement in which he selected the Appeals Modernization Act (AMA) hearing lane. In March 2021 the Veteran testified before a Veterans Law Judge. A transcript of the hearing is of record. The reduction of the disability rating for service-connected shin splints, right, from 10 percent disabling to noncompensable effective March 22, 2019, was proper and the appeal is denied. For reductions where the reduction in evaluation of a service-connected disability is considered warranted and the lower evaluation would result in a reduction or discontinuance of compensation payments currently being made, 38 C.F.R. § 3.105 (e) requires the AOJ to issue a rating decision proposing the reduction and setting forth all material facts and reasons, notify the beneficiary of the contemplated action and furnish detailed reasons therefore, and allow 60 days for the presentation of additional evidence to show that payments should continue at the present level. If a reduction is found to be warranted upon consideration of any additional evidence submitted, a final rating decision will be issued, and compensation will be reduced effective the last day of the month in which a 60-day period from the date of notice of the final action expires. See Stelzel v. Mansfield, 508 F.3d 1345, 1347-49 (Fed. Cir. 2007); VAOPGCPREC 71-91 (Nov. 7, 1991). Here, however, the Board notes that the Veteran's rating reduction did not result in a reduction of the Veteran's overall compensation payments. Prior to the reduction, the Veteran was in receipt of a 10 percent disability rating for his shin splints and a 100 percent combined overall rating. Subsequent to the reduction, the Veteran is in receipt of a noncompensable disability rating for his service-connected shin splints, but still in receipt of a 100 percent combined overall rating. Therefore, the notice requirements are not applicable. The Veteran's rating was reduced following an examination in March 2019 and review in conjunction with the Veteran's claim for patellofemoral pain syndrome. The Veteran was notified of the rating reduction and its effective date and the negligible impact on his overall rating. Therefore, the Board finds that the procedural requirements for notice were satisfied. See 38 C.F.R. § 3.105 (e), 38 C.F.R. § 3.501. In any rating-reduction case, VA must determine (1) whether the evidence reflects an actual change in the disability based upon review of the entire recorded history of the condition; (2) whether the examination reports reflecting such change are based upon thorough and adequate examinations; and (3) whether any improvement actually reflects an improvement in the veteran's ability to function under the ordinary conditions of life and work. Murphy v. Shinseki, 26 Vet. App. 510, 516-17 (2014) (citing Brown v. Brown, 5 Vet. App. 413, 421 (1993); 38 C.F.R. §§ 4.1, 4.2, 4.10. The reduction of a rating generally must have been supported by the evidence on file at the time of the reduction, but pertinent post-reduction evidence favorable to restoring the rating must also be considered. Dofflemeyer v. Derwinski, 2 Vet. App. 277, 280-81 (1992). Here, additional provisions from 38 C.F.R. § 3.344 apply because the Veteran's 10 percent rating for shin splints, right, was in place for more than five years, but less than 20. See May 2015 rating decision (granting service connection for shin splints, right, and assigning a 10 percent rating effective May 1, 2006); Cf. 38 C.F.R. § 3.951 (b) (providing for protection of disability ratings in effect for 20 years or more). Accordingly, VA must review the entire record of examinations and medical-industrial history to determine whether the examination used to determine the reduction was at least as full and complete as the examination upon which the prior rating was assigned. 38 C.F.R. § 3.344 (a). In addressing whether improvement is shown, the comparison point generally is the last examination on which the rating at issue was assigned or continued. Hohol v. Derwinski, 2 Vet. App. 169, 172 (1992) ("The regulation provides that VA must compare the examination which purports to show that the veteran's condition has materially improved, with the last examination continuing his 100% rating. The basis for comparison is not the examination on which the veteran was first awarded total disability."). If there is an approximate balance of positive and negative evidence regarding any material issue, all reasonable doubt shall be resolved in favor of the Veteran. In other words, a rating reduction must be supported by a preponderance of the evidence. 38 U.S.C. § 5107 (a); see also Brown, 5 Vet. App. at 421. Disability evaluations are determined by the application of the facts presented to VA's Schedule for Rating Disabilities (Rating Schedule) at 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and the residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Prior to March 22, 2019, the Veteran's shin splints, right, were evaluated as 10 percent disabling under Diagnostic Codes 5299-5262, and noncompensable thereafter. When a veteran is diagnosed with an unlisted disease, the condition must be rated under an analogous Diagnostic Code. 38 C.F.R. §§ 4.20 and 4.27. Here, the AOJ has rated the Veteran's shin splints, right under Diagnostic Codes 5299-5262, which represents an unlisted musculoskeletal disability evaluated by analogy to nonunion or malunion of fracture of the tibia or fibula. See 38 C.F.R. § 4.115b, Diagnostic Code 5262. See generally 38 C.F.R. §§ 4.20, 4.27 (providing that unlisted disabilities requiring rating by analogy will be coded as the first two numbers of the most closely related body part and "99"). Under Diagnostic Code 5262 nonunion or malunion of a fracture of the tibia or fibula results in a 10 percent rating for symptomatic malunion with either more than 10 degrees of angulation in the varus-valgus plan or more than 15 degrees of angulation in the anterior-posterior plane. A 20 percent rating is warranted for symptomatic malunion with either more than 10 degrees of angulation in the varus-valgus plane or more than 15 degrees of angulation in the anterior-posterior plane. A 30 percent rating is warranted fr asymptomatic nonunion. And a 40 percent rating is warranted for nonunion, with loose motion, requiring a brace. The Veteran is competent to report symptoms and experiences observable by his senses. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); 38 C.F.R. § 3.159 (a). Based on review of the record, the Board finds that a reduction in evaluation for shin splints, right, effective March 22, 2019, was proper. The Board finds that a brief review of the case's procedural history would be beneficial. In a May 2015 rating decision the RO granted service connection for shin splints, right, and assigned a 10 percent rating effective May 1, 2006. In August 2018 the Veteran filed a claim for, in pertinent part, service connection for patellofemoral joint disorder or patellofemoral pain syndrome. In April 2019 the RO in conjunction with evaluating the Veteran's claim for service connection for patellofemoral pain syndrome also reevaluated the severity of his shin splints. As a result, the RO decreased the Veteran's rating from 10 percent disabling to noncompensable. The RO however noted that the reduction did not impact the Veteran's overall combined rating. In June 2006 the Veteran underwent a VA General Medical examination. The Veteran reported that he first developed shin pain as a result of prolonged running during service. He denied any history of osteomyelitis, current pain, weakness, dizziness, swelling, heat, redness, drainage, or instability. Furthermore, the Veteran reported no knee involvement. Upon examination, the examiner noted that there was no objective evidence of deformity, angulation, false motion, shortening, non-union, or lose motion or false joint. He found no tenderness, edema, weakness, redness, or heat. He noted no constitutional signs of bone disease, anemia, weight loss, fever, or clinical signs of amyloid liver. The examiner found that the Veteran's shins were normal upon examination and therefore provided no diagnosis. In July 2012 the Veteran underwent a VA Orthopedic examination. The Veteran reported that he developed a right shin condition while on active duty due to prolonged physical activity. In addition, the Veteran reported that he continued to have moderate intermittent right shin pain which occurred once daily. However, he did not note any weakness, stiffness, swelling, heat, redness, drainage, or instability. He also did not complain of giving way, locking or abnormal motion. The Veteran also reported that he took OTC medication for the pain which helped. Upon examination, the examiner found a normal orthopedic physical examination of the right shin. The examiner stated that in regard to the requested medical opinion, such did not apply as the Veteran's right shin was normal upon examination. In August 2014 the Veteran underwent a VA Knee and Lower Leg examination with an accompanying disability benefits questionnaire (DBQ). The examiner noted that the Veteran suffered from right shin splints. The Veteran reported that his shin splints began around 2000 after prolonged physical activity. Upon examination, the examiner again noted the Veteran's shin splints and found that such resulted in pain and discomfort. The examiner also opined that it was as likely as not that physical activity caused or contributed to the Veteran's knee and lower leg disabilities. In April 2015 an additional medical opinion was obtained. The examiner noted a review of x-ray evidence and found that there was no evidence of any abnormality of the tibia/fibula bone. Furthermore, the examiner stated that a bone scan was not needed for rating shin splints and that a "bone island" noted in the distal tibia was a benign bone variation and did not cause symptoms. In June 2016 the Veteran underwent a VA Knee and Lower Leg Conditions examination with an accompanying DBQ. The examiner noted that the Veteran had bilateral shin splints and that such impacted the range of motion of his knee but not his ankle. Furthermore, the examiner noted that the Veteran's shin pain improved with shoe inserts while he was in the service. The Veteran's right knee flexion was 0 to 90 degrees and his extension was 90 to 0 degrees. In July 2016 the Veteran underwent another VA Knee and Lower Leg Conditions examination with an accompanying DBQ. The examiner noted that the Veteran had bilateral shin splints and that such impacted the range of motion of his knee, but not his ankle. Furthermore, the examiner noted that the Veteran's tibia pain improved with the use of orthotics. The Veteran's right knee flexion was 0 to 100 degrees and his extension was 100 to 0 degrees. In October 2018 the Veteran underwent an additional VA Knee and Lower Leg Conditions examination with an accompanying DBQ. The examiner noted that the Veteran had bilateral shin splints but that such did not impact his knee or ankle range of motion. Upon examination, the Veteran's right knee flexion was 0 to 140 degrees and his extension was 140 to 0 degrees. The examiner noted that the Veteran had a bilateral tibial stress reaction on November 14, 2001 but that such had improved as the Veteran no longer ran and used orthotic shoes. In March 2019 the Veteran underwent another VA Knee and Lower Leg Conditions examination with an accompanying DBQ. The examiner noted that the Veteran had bilateral shin splints, but that such did not impact either his knee or ankle range of motion. Rather the examiner found that the Veteran's knee range of motion was decreased by his associated degenerative joint disease. In light of the foregoing, the Board finds that the preponderance of the evidence demonstrates actual improvement in the severity of the Veteran's shin splints, right, symptoms. Initially, the Board notes that the March 2019 examination upon which the reduction was based revealed that while the Veteran had shin splints, such did not impact his range of motion of either his knee or ankle. Furthermore, the prior examination in October 2018 also indicates that not only did the Veteran's shin splints not impact his range of motion, but as a result of his decreased activity and his use of orthotics, his shin splints appeared to be asymptomatic. Finally, none of the examinations of record found that the Veteran had any trouble conducting his activities of daily living or that his shin splints would impede his ability to perform either physical or sedentary work. The Board acknowledges that the Veteran has reported leg pain with prolonged physical activity, specifically running for more than 30 minutes. Regarding such symptoms, the Board finds that the severity described has little probative value on ability to function under the ordinary conditions of life and work. Furthermore, the Veteran seems to contend that his symptoms while exacerbated by strenuous activity, are easily alleviated by OTC medications, rest, and use of orthotics, and avoided altogether if he refrains from running for extended periods of time. Accordingly, the Board finds that the weight of the competent and probative evidence preponderates in favor of finding improvement in the Veteran's ability to function under the ordinary conditions of life and work due to shin splints. Finally, the Board finds that the March 2019 examination on which the reduction was based is as thorough and adequate as the August 2014 VA examination on which the original grant and assignment of the 10 percent rating was based. Specifically, the Board finds that the examination was viewed in relation to the whole recorded history, and there is evidence that the examiner assessed the Veteran's employability. The March 2019 VA examination indicated that the examiner reviewed the Veteran's VA treatment records, the examination reflects the medical history as provided by the Veteran, and the examiner did not find that the Veteran's shin splints would result in occupational limitations with sedentary or physical employment. Accordingly, the Board finds that the March 2019 VA examination on which the reduction was based is as thorough and complete as the August 2014 VA examination on which the grant of service connection and assignment of the 10 percent rating was based. In light of the foregoing, the Board finds that an improvement in the Veteran's ability to function under the ordinary conditions of life and work is shown by a preponderance of the competent and probative evidence. See Brown, 5 Vet. App. at 421. Accordingly, the reduction for shin splints, right, effective March 22, 2019, was proper. See 38 U.S.C. § 1155; 38 C.F.R. § 3.105. In arriving at its decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence shows an actual improvement and a proper reduction, that doctrine is not applicable. See 38 C.F.R. §§ 3.105 (e), 4.3; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § §§ 1110, 1131; 38 C.F.R. § § 3.303 (a). Service connection may also be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § § 3.303 (d). Direct service connection may not be granted without evidence of a current disability; in-service incurrence or aggravation of a disease or injury; and a nexus between the claimed in-service disease or injury and the present disease or injury. Id.; also Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff'd, 78 F.3d 604 (Fed. Cir. 1996) [(table)]. Where a Veteran served for at least 90 days during a period of war or after December 31, 1946, and manifests certain chronic diseases to a degree of 10 percent within one year, from the date of termination of such service, such disease shall be presumed to have been incurred or aggravated in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. § §§ 1101, 1112, 1137; 38 C.F.R. § §§ 3.307, 3.309. Alternatively, when a disease at 38 C.F.R. § § 3.309 (a) is not shown to be chronic during service or the one-year presumptive period, service connection may also be established by showing continuity of symptomatology after service. See 38 C.F.R. § § 3.303 (b). However, the use of continuity of symptoms to establish service connection is limited only to those diseases listed at 38 C.F.R. § § 3.309 (a) and does not apply to other disabilities which might be considered chronic from a medical standpoint. See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Service connection may also be established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury. 38 C.F.R. § 3.310 (a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). Furthermore, service connection may not be awarded on the basis of aggravation without establishing a pre-aggravation baseline level of disability and comparing it to the current level of disability. 38 C.F.R. § 3.310 (b). When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § § 5107 (b); 38 C.F.R. § § 3.102. When all of the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a fair preponderance of the evidence is against the claim, in which case the claim is denied. Gilbert, 1 Vet. App. at 55. Entitlement to service connection for groin pain to include as secondary to service-connected low back strain is denied. The Veteran contends that service connection is warranted for his groin pain as a result of his active-duty service. In the alternative, he has alleged that his groin pain is secondary ot his service-connected low back strain. The Veteran's service treatment records reflect one instance in May 2002 where the Veteran reported groin discomfort. However, a follow up treatment note at the end of May 2002 indicated that the Veteran's problem was resolving. A treatment note in February 2006 mentioned 2 bladder infections and a small hernia, but no mention of the Veteran's prior groin pain. Furthermore, at the Veteran's separation examination in February 2006, the Veteran's genitourinary system was normal and his prior discomfort was not mentioned. The remainder of the Veteran's service records are silent for any complaints, treatment, or diagnosis of a genitourinary disability. Post-service treatment records reflect the Veteran's reports of groin pain. The Veteran reported intermittent sharp pains approximately once per month. The Veteran noted that his pain generally occurred while sitting. Finally, the Veteran was diagnosed with perineal pain. See January 2019 VA Male Reproductive System Conditions DBQ. As noted, the Veteran underwent a VA Male Reproductive System Conditions examination with an accompanying DBQ in January 2019. The examiner diagnosed the Veteran with perineal pain. Upon examination, the examiner only found a small complex right hydrocele. However, the remainder of the Veteran's examination was normal. The examiner opined that the Veteran's groin pain was less likely than not incurred in or caused by the complaints during service. The examiner provided the rationale that no abnormality was found on examination. His physical examination at separation was also normal. And while the Veteran's service notes mention "bladder infection 2 times. Had a small hernia," the Veteran currently points to an area in the upper perineum that would be unaffected by either a bladder infection or a hernia. Furthermore, the examiner noted that while the Veteran was seen in service in May 2002 for groin pain, such was noted to be resolving later that same month with no subsequent sequelae or complaints. Finally, the examiner noted that while his examination did reveal a small hydrocele such was not palpable on physical examination and would not be expected to produce any symptoms. Throughout the appeal the Veteran has submitted statements in which he alleges that his groin pain was the result of the May 2002 incident in service. However, at the Veteran's subsequent Board hearing in March 2021, he testified that he thought it was possible that his groin pain was the result of his service-connected low back strain. However, the Veteran failed to provide any medical evidence to support his contention. After a thorough review of the record, the Board finds that service connection for groin pain is not warranted on any basis to include presumptive, direct, or secondary service connection. As an initial matter, the Board finds the evidence clearly shows the Veteran has symptoms related to groin pain, but as previously noted while there was one report of groin pain or groin injury in service, such appears to have resolved shortly thereafter. However, the first element of service connection either presumptive, direct, or secondary has been met. In regard to presumptive service connection, the Board initially notes that groin pain is not a condition listed at 38 C.F.R. § 3.309 and therefore is not subject to such form of service connection. Furthermore, the Board notes that the clinical evidence of record fails to show that the Veteran manifested groin pain within the one year following his discharge from service in February 2006. There is simply no medical evidence suggesting that this occurred. Rather the earliest record of any complaints or diagnosis of groin pain were in 2019, approximately 13 years after the Veteran's discharge. As such, presumptive service connection is not warranted. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309. In regard to direct service connection, the Board again notes that the Veteran's current groin pain or perineal pain was not diagnosed during his military service, or as noted previously, for many years thereafter. Furthermore, while the Veteran's service treatment records reflect one instance of groin pain or groin injury, such appears to have resolved quickly. Finally, the January 2019 VA examiner opined that the Veteran's perineal pain was less likely than not incurred in or caused by the claimed in-service injury, event or illness and was not otherwise related to the Veteran's active-duty service. As the January 2019 examiner provided sound medical explanations and rationales for his opinion, the Board finds it very probative. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). Additionally, there are no contrary opinions of record. Furthermore, the contemporary medical evidence does not support a finding that the Veteran's condition began in service or supports chronicity of such symptoms. The Veteran's post-service medical record is negative for any complaints, treatment, or diagnosis of groin pain until 2019. The Board acknowledges the Veteran's allegation that his disability began in or is the result of his service. However, he is not competent to diagnose or speak to the etiology of complex medication conditions. As a fundamental element of direct service connection, the nexus element, is missing, the Board finds that direct service connection is not warranted for the Veteran's claim for service connection for groin pain. As for secondary service connection, as the Veteran's claim is on the AMA docket and as he did not raise the theory of secondary service connection until his March 2021 hearing (well after the issuance of the rating decision on appeal) and he failed to provide any medical documentation to support the theory during the 90 days following his hearing, the Board is under no obligation to provide the Veteran with a medical opinion to address the theory or assist in further development of the theory. However, the Board's finding on this issue does not preclude the Veteran from pursing a supplemental claim. The Board has also considered the Veteran's statements that his groin pain is related to his service or his service-connected low back strain. In this regard, a layperson is competent to report on that of which he or she has personal knowledge. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). A lay person may speak to etiology in some limited circumstances in which nexus is obvious merely through observation, such as a fall leading to a broken leg. Jandreau, 492 F.3d at 1376-77. However, the question of causation or aggravation of groin pain involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship. In this regard, such an opinion requires specialized knowledge of several internal bodily systems. There is no indication that the Veteran possesses such specialized knowledge. As such, the question of etiology in this case may not be competently addressed by lay evidence, and the Veteran's opinion regarding the etiology of his groin pain is non-probative evidence. See Jandreau, supra; Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). Moreover, the Veteran has offered only conclusory statements regarding the relationship between his groin pain and his service and service-connected low back strain. Therefore, the Board affords it little, if any, probative weight. Consequently, the Board finds that the Veteran's groin pain is not shown to be causally or etiologically related to a disease or injury incurred in or aggravated during active service and is not caused or aggravated by any of the Veteran's service-connected disabilities, to include his low back strain. Therefore, service connection for such claimed disability is not warranted. In reaching this decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, the preponderance of the evidence is against the Veteran's claim of entitlement to service connection for groin pain. As such, that doctrine is not applicable in the instant appeal, and his claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert, supra. Entitlement to service connection for headaches to include as secondary to glaucoma, is denied. The Veteran contends that service connection is warranted for his headaches as a result of his active-duty service or in the alternative as secondary to his bilateral glaucoma. The Veteran's service treatment records are silent for any complaints, treatment, or diagnosis of headaches. Furthermore, upon examination in February 2006, prior to the Veteran's discharge, there was no mention of his headaches or any head injuries. However, post-service treatment records reflect the Veteran's complaints of headaches beginning in 2018. Throughout the appeal the Veteran has submitted statements in which he alleges that his headaches are the result of his service. In addition, during his March 2021 hearing he testified that he believed his headaches could be caused by his bilateral glaucoma. After a thorough review of the record, the Board finds that service connection for headaches is not warranted on any basis to include presumptive, direct, or secondary service connection. As an initial matter, the Board finds the evidence clearly shows the Veteran has symptoms related to headaches, but as previously noted there was no report of any complaints, treatment or diagnoses related to such in service. However, the first element of service connection either presumptive, direct, or secondary has been met. In regard to presumptive service connection, the Board notes that the clinical evidence of record fails to show that the Veteran manifested headaches within the one year following his discharge from service in February 2006. There is simply no medical evidence suggesting that this occurred. Rather the earliest record of any complaints of headaches were in 2018, approximately 12 years after the Veteran's discharge. As such, presumptive service connection is not warranted. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309. In regard to direct service connection, the Board again notes that the Veteran's headaches were not diagnosed during his military service, or as noted previously, for many years thereafter. As was noted above, the Veteran's service treatment records are silent for any complaints, diagnosis or treatment for headaches or any incident or injury related to such. As there is no credible evidence that the Veteran was diagnosed with or exhibited symptoms of headaches during his military service, no examination or opinion is necessary to decide such aspect of his claim. See Bardwell v. Shinseki, 24 Vet. App. 36 (2010) (holding that VA is not required to provide a medical examination when there is not credible evidence of an event, injury, or disease in service). Furthermore, the contemporary medical evidence does not support a finding that the Veteran's condition began in service or supports chronicity of such symptoms. The Veteran's post-service medical record is negative for any complaints, treatment, or diagnosis of headaches until 2018. The Board acknowledges the Veteran's allegation that his disability began in or is the result of his service. However, he is not competent to diagnose or speak to the etiology of complex medication conditions. As fundamental elements of direct service connection, the in-service and nexus elements, are missing, the Board finds that direct service connection is not warranted for the Veteran's claim for headaches. As for secondary service connection, as the Veteran is not service connected for glaucoma, the Board finds that under the law, the Veteran lacks legal grounds to establish entitlement to service connection for headaches on a secondary basis. See Sabonis v. Brown, 6 Vet. App. 426 (1994). In Sabonis, the Court held that in cases in which the law and not the evidence is dispositive, a claim for entitlement to VA benefits should be denied or the appeal to the Board terminated because of the absence of legal merit or the lack of entitlement under the law. Insofar as service connection is not in effect for the disability claimed by the Veteran to have proximally caused his headaches, service connection on a secondary basis is not applicable under the law. The Board has also considered the Veteran's statements that his headaches are related to his service or his glaucoma. In this regard, a layperson is competent to report on that of which he or she has personal knowledge. See Layno, 6 Vet. App. at 469. A lay person may speak to etiology in some limited circumstances in which nexus is obvious merely through observation, such as a fall leading to a broken leg. Jandreau, 492 F.3d at 1376-77. However, the question of causation or aggravation of headaches involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship. In this regard, such an opinion requires specialized knowledge of several internal bodily systems. There is no indication that the Veteran possesses such specialized knowledge. As such, the question of etiology in this case may not be competently addressed by lay evidence, and the Veteran's opinion regarding the etiology of his headaches is non-probative evidence. See Jandreau, supra; Woehlaert, 21 Vet. App. at 456. Moreover, the Veteran has offered only conclusory statements regarding the relationship between his headaches and his service and glaucoma. Therefore, the Board affords his opinions, little, if any, probative weight. Consequently, the Board finds that the Veteran's headaches are not shown to be causally or etiologically related to a disease or injury incurred in or aggravated during active service, and are not caused or aggravated by any of the Veteran's service-connected disabilities. Therefore, service connection for such claimed disability is not warranted. In reaching this decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, the preponderance of the evidence is against the Veteran's claim of entitlement to service connection for headaches. As such, that doctrine is not applicable in the instant appeal, and his claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert, supra. Entitlement to service connection for a neck condition (also claimed as neck/upper back, cervical spine stenosis, cervical spondylosis, cervical radiculopathy, chronic neck pain, cervical spine disc, degeneration above the fusion, C4-5 broad based disc osteophyte complex, C6-7 Mild canal stenosis. mild bilateral foraminal narrowing, C6-7 ACDF level minimal residual broad-based disc osteophyte, there is mild spurring along the anterior inferior aspect of C4 again seen, straightening of the cervical spine, mild facet arthrosis and arthrodesis status) to include as secondary to service-connected right shoulder strain is denied. The Veteran contends that service connection is warranted for his neck condition as a result of his active-duty service. In the alternative, he has alleged that his neck condition is secondary ot his service-connected right shoulder strain. The Veteran's service treatment records are silent for any complaints, treatment or diagnosis of a neck condition or disability. Furthermore, upon examination in February 2006, prior to the Veteran's discharge, there was no mention of his neck or any related injuries or pain. However, post-service treatment records reflect the Veteran's complaints of pain beginning in 2016. Throughout the appeal the Veteran has submitted statements in which he alleges that his neck disability is the result of his service. However, at the Veteran's subsequent Board hearing in March 2021, he testified that he thought it was also possible that his neck condition was the result of his service-connected right shoulder strain. However, the Veteran failed to provide any medical evidence to support his contention. After a thorough review of the record, the Board finds that service connection for a neck condition or disability is not warranted on any basis to include presumptive, direct, or secondary service connection. As an initial matter, the Board finds the evidence clearly shows the Veteran has symptoms related to a neck disability, but as previously noted there was no report of any complaints, treatment or diagnoses related to such in service. However, the first element of service connection either presumptive or direct has been met. In regard to presumptive service connection, the Board notes that the clinical evidence of record fails to show that the Veteran manifested a neck disability within the one year following his discharge from service in February 2006. There is simply no medical evidence suggesting that this occurred. Rather the earliest record of any complaints of neck pain were in 2016, approximately 10 years after the Veteran's discharge. As such, presumptive service connection is not warranted. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309. In regard to direct service connection, the Board again notes that the Veteran's neck disability was not diagnosed during his military service, or as noted previously, for many years thereafter. As was noted above, the Veteran's service treatment records are silent for any complaints, diagnosis or treatment for a neck disability or any incident or injury related to such. As there is no credible evidence that the Veteran was diagnosed with or exhibited symptoms of a neck disability during his military service, no examination or opinion is necessary to decide such aspect of his claim. See Bardwell, 24 Vet. App. at 36. Furthermore, the contemporary medical evidence does not support a finding that the Veteran's condition began in service or supports chronicity of such symptoms. The Veteran's post-service medical record is negative for any complaints, treatment, or diagnosis of neck problems until 2016. The Board acknowledges the Veteran's allegation that his disability began in or is the result of his service. However, he is not competent to diagnose or speak to the etiology of complex medication conditions. As fundamental elements of direct service connection, the in-service and nexus elements, are missing, the Board finds that direct service connection is not warranted for the Veteran's claim for a neck disability. As for secondary service connection, as the Veteran's claim is on the AMA docket and as he did not raise the theory of secondary service connection until his March 2021 hearing (well after the issuance of the rating decision on appeal) and he failed to provide any medical documentation to support the theory during the 90 days following his hearing, the Board is under no obligation to provide the Veteran with a medical opinion to address the theory or assist in further development of the theory. However, the Board's finding on this issue does not preclude the Veteran from pursing a supplemental claim. The Board has also considered the Veteran's statements that his neck disability is related to his service or his service-connected right shoulder strain. In this regard, a layperson is competent to report on that of which he or she has personal knowledge. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). A lay person may speak to etiology in some limited circumstances in which nexus is obvious merely through observation, such as a fall leading to a broken leg. Jandreau, 492 F.3d at 1376-77. However, the question of causation or aggravation of a neck disability involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship. In this regard, such an opinion requires specialized knowledge of several internal bodily systems. There is no indication that the Veteran possesses such specialized knowledge. As such, the question of etiology in this case may not be competently addressed by lay evidence, and the Veteran's opinion regarding the etiology of his neck disability is non-probative evidence. See Jandreau, supra; Woehlaert, 21 Vet. App. at 456. Moreover, the Veteran has offered only conclusory statements regarding the relationship between his neck disability and his service and service-connected right shoulder strain. Therefore, the Board affords it little, if any, probative weight. Consequently, the Board finds that the Veteran's neck disability is not shown to be causally or etiologically related to a disease or injury incurred in or aggravated during active service, and is not caused or aggravated by any of the Veteran's service-connected disabilities, to include his right shoulder strain. Therefore, service connection for such claimed disability is not warranted. In reaching this decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, the preponderance of the evidence is against the Veteran's claim of entitlement to service connection for a neck condition or disability. As such, that doctrine is not applicable in the instant appeal, and his claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert, supra. L. M. BARNARD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Unger, Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.