Citation Nr: 21006576 Decision Date: 02/04/21 Archive Date: 02/04/21 DOCKET NO. 15-16 880 DATE: February 4, 2021 ORDER Entitlement to service connection for a cervical spine disorder, to include degenerative joint disease and degenerative disc disease, is denied. Entitlement to service connection for a respiratory disorder, to include asthma, is denied. FINDINGS OF FACT 1. The Veteran’s cervical spine disorder did not manifest in service or within one year thereafter and is not otherwise related to his military service, to include in-service chiropractic treatment. 2. The Veteran’s asthma did not manifest in service and is not otherwise related to his military service. CONCLUSIONS OF LAW 1. A cervical spine disorder was not incurred in active service, nor may arthritis be presumed to have been so incurred. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 2. A respiratory disorder was not incurred in active service. 38 U.S.C. §§ 1101, 1103, 1110, 1131; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Air Force from June 1977 to June 2000. These matters are before the Board of Veterans’ Appeals (Board) on appeal from a March 2011 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO), which is the Agency of Original Jurisdiction (AOJ). In a January 2019 decision, the Board denied the Veteran’s claims for service connection for a cervical spine disorder and a respiratory disorder. The Veteran appealed the decision to the United States Court of Appeals for Veterans Claims (Court). In a January 2020 Order, the Court granted a Joint Motion for Remand (Joint Motion) and vacated the January 2019 Board decision denying the issues listed above. In August 2020, the Board remanded the case to the AOJ for further development in accordance with the January 2020 Joint Motion directives. That development has been completed, and the case has since been returned to the Board for appellate review. Law and Analysis In the January 2020 Joint Motion, the parties agreed that the January 2019 Board decision should be vacated based on a failure to properly consider the Veteran’s lay statements, including a challenge of the competency of a July 2010 VA examiner’s qualifications, and based on a finding that the July 2010 VA spine examination was inadequate. Thereafter, in the August 2020 remand, the Board directed the AOJ to obtain outstanding post-service military treatment facility records and VA treatment records, qualifications of the July 2010 VA examiner, and a VA examination to address the etiology of the Veteran’s cervical spine disorder. In January 2021, the Veteran’s representative submitted a statement that included a citation to Stegall v. West, 11 Vet. App. 268, 270-271 (1998), indicating that a remand by the Board confers on the veteran, as a matter of law, the right to compliance with the remand orders and that a remand by the Board imposes upon the RO a noncomitant duty to ensure compliance with all of the terms of the remand. The representative did not make any specific assertions as to any failure to comply with the remand directives. The Board finds that, pursuant to the August 2020 remand directives, the Veteran was afforded a VA spine examination in October 2020 and a VA addendum opinion was obtained in December 2020, additional post-service military treatment facility and VA treatment records were requested and obtained, and the July 2010 VA examiner’s qualifications were obtained. Thus, the Board finds there has been substantial compliance with the remand directives. See Dyment v. West, 13 Vet. App. 141, 146-47 (1999) (remand not required under Stegall v. West, 11 Vet. App. 268 (1998) where there was substantial compliance with Board’s remand instructions). The Board also notes, that despite obtaining the July 2010 VA examiner’s qualifications, the Veteran’s representative has raised no further argument regarding the competency of the examiner. See January 2021 Informal Hearing Presentation. The Board concludes the Veteran has waived any objection to the examiner’s qualifications. Neither the Veteran nor his representative has raised any issues with the duty to notify or duty to assist with regard to the issues decided herein. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board... to search the record and address procedural arguments when the veteran fails to raise them before the Board.”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). As noted above, this case was appealed to the Court, yet no additional arguments have been made regarding the duty to notify and assist. See Carter v. Shinseki, 26 Vet. App. 534, 542-43 (2014) (where an attorney-represented appellant enters into a Joint Motion for Remand identifying specific Board errors, the terms of that remand can be considered a factor when determining the scope of the Board’s duty to search the record for other issues that are reasonably raised by that record). Service connection may be established for disability resulting from personal injury suffered or disease contracted in line of duty in the active military, naval, or air service. 38 U.S.C. §§ 1110, 1131. That an injury or disease occurred in service is not enough; there must be chronic disability resulting from that injury or disease. Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Under 38 C.F.R. § 3.303(b), an alternative method of establishing the second and third elements of service connection is through a demonstration of continuity of symptomatology. However, 38 C.F.R. § 3.303(b) applies to only those chronic diseases listed in 38 C.F.R. § 3.309(a). See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). 38 U.S.C. § 1101. With respect to the current appeal, this list includes arthritis. See 38 C.F.R. § 3.309(a). For the showing of a chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word “chronic.” Continuity of symptomatology after discharge is required where the condition noted during service is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. 38 C.F.R. § 3.303(b); see Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013) (the theory of continuity of symptomatology can be used only in cases involving those conditions explicitly recognized as chronic as per 38 C.F.R. § 3.309(a)). Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits. VA shall consider all information and lay and medical evidence of record in a case and when there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. To deny a claim on its merits, the weight of the evidence must be against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996). The Veteran’s VA medical records show that he has received treatment for his cervical spine and respiratory disorders at various times over the relevant years. Although the Board has an obligation to provide reasons and bases supporting its decision, there is no need to discuss, in detail, every piece of evidence of record. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (noting that VA must review the entire record, but does not have to discuss each piece of evidence). Hence, while the Board considered all evidence of record, in its decision below, the Board will summarize the relevant evidence as appropriate, and the analysis will focus specifically on what the evidence shows, or fails to show, as to the claims. Cervical Spine In considering the evidence of record under the laws and regulations as set forth above, the Board finds that the Veteran is not entitled to service connection for a cervical spine disorder. The Veteran has contended that he developed a cervical spine disorder during service. See, e.g., July 2010 VA examination report (Veteran reported that he experienced intermittent neck pain since 1998, during active duty service). Specifically, he has contended that his cervical spine disorder was caused by chiropractic manipulations during service to treat low back pain. See, e.g., July 2008 VA treatment record (Veteran reported his chronic low back pain was affecting the left side of his neck), May 2010 statement (Veteran stated that his current neck disorder was due to manipulation of his neck during chiropractic treatments for his low back disability), August 2014 private physical therapy evaluation (Veteran indicated his belief that frequent chiropractic manipulation contributed to his recurring neck pain over the years), April 2015 substantive appeal (Veteran related that it was not unreasonable to make a connection between cervical spine manipulations during treatment for low back disability), October 2020 VA examination report (Veteran reported that he had his neck manipulated as part of his chiropractic treatment for chronic low back pain). The Veteran’s service treatment records include one complaint of neck pain in January 1998. The Veteran presented with complaints of left shoulder pain that radiated to his back and the left side of his chest. An examination revealed decreased flexion and extension of the neck due to stiffness and left shoulder and right upper chest tenderness due to stiffness. The Veteran was diagnosed with a muscle spasm and prescribed pain medications and muscle relaxants. The remaining service treatment records include treatment of low back pain with several instances of prescribed chiropractic treatment; however, there are no indications that the Veteran was treated for his neck. Further, in an April 2000 separation examination, the Veteran complained of chronic back pain; however, he did not mention any complaints related to his neck. An examination of the neck revealed In regard to whether arthritis was shown during service or within a year of separation, the Board finds that such a diagnosis was not shown. To determine that a chronic disease was “shown in service,” the disease identity must be established and the diagnosis not subject to legitimate question. 38 C.F.R. § 3.303(b); Walker, 708 F.3d at 1331. In fact, the first documented diagnosis of degenerative disc disease of the cervical spine was revealed in a July 2009 military treatment facility radiology report, which was confirmed in a February 2010 magnetic resonance imaging (MRI) study. In addition, in a July 2008 VA treatment note, the Veteran reported some pain and stiffness in the left side of his neck for the first time. During an August 2014 private physical therapy consultation, the Veteran reported that his neck pain symptoms initially presented approximately ten years ago (in approximately 2004). Moreover, there was no objective evidence of arthritis in service. Therefore, chronicity is not established in service or within a year of separation. In addition to the lack of evidence showing that a cervical spine disorder manifested during active duty service or within close proximity thereto, the evidence of record does not relate a current disability to the Veteran’s military service or treatment during service for his service-connected low back disability. Rather, in the July 2008 VA treatment note, the Veteran presented for treatment of a flare-up of his chronic low back pain. He also noted that he was having some pain or stiffness in the left side of his neck for the first time and he denied any recent trauma. In a July 2009 military treatment facility note, the Veteran complained of left neck and shoulder pain for two weeks with no injury. He stated that he was previously provided steroids and pain medications, but he continued to have pain. He complained of tingling in his left arm and a history of low back pain. He also stated that he had no prior history of neck or shoulder problems. On examination, there was tenderness on palpation of the left trapezius and the cervical spine exhibited a muscle spasm in the left trapezius. The physician diagnosed the Veteran with cervicalgia. She noted that she placed a consultation for a trial of physical therapy and that she prescribed an MRI if the tingling in his left arm did not improve with medications. Thereafter, the July 2009 military treatment facility radiology report indicated that the study was conducted due to complaints of left trapezius tenderness, pain with neck range of motion, left shoulder pain, and a tingling right arm. At that time, the Veteran denied any injuries. The report showed degenerative disc disease diffusely throughout the cervical spine, worse at C5-C6 and C6-C7 where there was loss of intervertebral disc height, and anterior and posterior endplate osteophytes. The interpreter noted that if there was persistent neck pain and radiculopathy, a cervical spine MRI could be obtained for evaluation. Thereafter, the Veteran was provided a cervical spine MRI in February 2010 at a military treatment facility. The reason for the study was listed as left neck and shoulder pain. The MRI showed mild reversal of cervical lordosis in the lower cervical spine centered at approximately the C5-C6 level; some marginal osteophyte formation throughout the cervical spine, which was more prominent anteriorly from C5-C6 through C7-T1; disc bulges throughout the cervical spine; and varying degrees of disc space narrowing throughout the cervical spine. During a July 2010 VA examination, the Veteran reported that he first experienced neck pain, right shoulder pain, chest and arm pain and tingling in 1998 and that he was evaluated in the emergency room during service. He stated that he was told that his chest pain was not due to a cardiac problem, but that it was causes by a neck condition. He related that he was treated conservatively with pain medication, muscle relaxants, and physical therapy at that time. He stated that he also received relief from chiropractic adjustment treatment in 1998. The Veteran further reported that he had intermittent neck pain and right shoulder or arm pain since 1998. The examiner diagnosed the Veteran with degenerative disc disease or degenerative joint disease of the cervical spine based on the July 2009 radiology report and the February 2010 MRI report from the military treatment facility. The VA examiner indicated that he was unable to provide an opinion because the Veteran’s claims file was unavailable. In a November 2010 VA addendum opinion, the VA examiner indicated that he had reviewed the Veteran’s claims file. He opined that it was less likely than not that the Veteran’s current cervical spine degenerative disc disease or degenerative joint disease was related to his in-service low back pain or strain. He noted that the available service treatment records failed to show a chronic or recurrent cervical spine disorder. He also explained that degenerative changes occur when cartilage in the joints or bones wear down over time and usually gradually worsens with aging. During the August 2014 private physical therapy consultation, the Veteran reported that he had constant pain at the bilateral aspects of his neck. He indicated that his symptoms initially presented approximately ten years ago and that he sought chiropractic help at that time. He related that his symptoms were intermittent at that time and that he believed that frequent manipulation had contributed to his recurring pain over the years. In the August 2020 remand, the Board directed the AOJ to schedule the Veteran for a VA examination to address the etiology of his cervical spine disorder. The examiner was requested to provide an opinion as to whether it was at least as likely as not that the Veteran’s cervical spine disorder was caused by chiropractic adjustments that he received in service for his service-connected low back disability. During an October 2020 VA examination, the Veteran reported that he first developed non-traumatic right-sided shoulder pain in approximately 1992 during service, and that he was being treated by a chiropractor for chronic low back pain at that time. He stated that his neck was manipulated as part of his in-service chiropractic treatment for his low back disability. He reported constant, localized, right-sided neck and shoulder pain and numbness and paresthesia of both hands in a stocking glove distribution involving both the dorsal and palmar surfaces bilaterally. The VA examiner opined that the Veteran’s cervical disc disease was not related to his military service. The examiner noted that the Veteran’s history was inconsistent with the record as there were no service treatment notes that indicated a chronic neck disorder. Further, he indicated that the Veteran denied neck complaints in several service treatment notes. The VA examiner also noted that he was unable to find evidence of any chiropractic manipulations of the neck in the service treatment records. Rather, he noted that the Veteran first reported neck pain approximately eight years after he separated from service. He also explained that disc disease and accompanying arthritis are common age-related developments and that the conditions are present in approximately 40-percent of adults over the age of 35. He related that its incidence increases with age and is present in almost all individuals over the age of 60. In a November 2020 VA addendum opinion, the VA examiner related that he reviewed the Veteran’s service treatment records. He opined that the Veteran’s cervical disc disease was not secondary to chiropractic adjustments. He related that the Veteran did not have manipulations of the cervical spine during service and that he received clearly defined chiropractic treatment for his lower back from November 1995 to April 1996, which was consistent with never having treatment for his neck. In addition, the examiner noted that the Veteran denied cervical complaints at the onset of chiropractic treatment. There is no medical opinion otherwise relating a current cervical spine disorder to the Veteran’s military service. After weighing the evidence, the Board finds that the VA examiners’ opinions are highly probative. Specifically, the October 2020 VA examiner fully addressed the etiology of the cervical spine disorder and considered the medical evidence of record, as well as the Veteran’s lay statements. The October 2020 and November 2020 opinions specifically considered the Veteran contentions that his cervical spine disorder was caused by chiropractic manipulations during treatment for his low back disability during service. The Board affords substantial probative weight to these opinions, as they are based on a review of the claims file, to include the Veteran’s contentions and the medical evidence, and an accurate characterization of the evidence of record. The opinions are also supported by detailed rationale. See Nieves-Rodriguez, 22 Vet. App. at 304. The Board has also considered the contentions of the Veteran that his cervical spine disorder developed during service due to chiropractic treatment for his low back disability. Although lay persons are competent to provide opinions on some medical issues, Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), as to the specific issue in this case, the diagnosis and etiology of his current cervical spine disorder falls outside the realm of common knowledge of a lay person, particularly in light of the delayed onset. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Moreover, even assuming they are competent to opine on these matters, the Board finds that the specific, reasoned opinions of the VA examiners are of greater probative weight than the more general lay assertions in this regard. The medical providers have training, knowledge, and expertise on which they relied to form the opinions, and they each provided a detailed rationale. Because of this, the Board cannot give the Veteran’s assertions that the same disorder has been present since 1998 probative weight. The Board also finds the Veteran’s statements are insufficient to establish continuity of symptomatology. The Veteran relies on his recollection of persistent neck pain since service to establish that he is entitled to service connection. However, competent evidence demonstrating between any present disability and the continuity of symptomatology presented is required, whether lay or medical. Savage v. Gober, 10 Vet. App. 488, 494 (1997), overruled on other grounds by Walker, 708 F.3d at 1355 (noting that the Savage ruling as to continuity of symptomatology was not disturbed by the ruling on which disabilities constituted chronic diseases). The Veteran is competent to report ongoing neck pain, but not to diagnose arthritis, as discussed. The Veteran has offered no foundation in lay knowledge that would allow him to competently opine on whether and when subjective neck pain is an indicator of current or future arthritis in his circumstances. There is no medical evidence in support of such a proposition. The medical opinions on record regarding a nexus to service weigh against such a relationship. The Veteran recounted onset of symptoms beginning in 1998 when he sought treatment at an emergency room. See July 2010 VA examination report. This matches the 1998 medical record discussed above which indicates a diagnosis of muscle spasm, not a degenerative disorder. The distinction is significant in that the disorders are in the same anatomical region and produce symptoms that would be, to the Veteran, subjectively similar yet are different etiologically. The record does not reveal a foundation in lay knowledge that the Veteran could use to indicate that his ongoing pain was the result of his degenerative condition rather than another instance of muscle spasm or when or why he stopped having muscle spasms and began suffering from degenerative arthritis. Even if he was competent to relate his continuity of symptomatology to his current disability, he has not reported consistently when his symptoms became continuous. His statements while seeking medical treatment in 2008 and 2014 do not indicate the presence of symptoms continuously present since service. Statements made in the course of medical care are generally considered to be highly reliable. The Board finds the Veteran’s assertions regarding continuity of symptomatology not credible. In the absence of competent, credible evidence relating the current disability to symptoms continuously present since service, the Board finds the evidence is not at least in equipoise that the Veteran’s cervical arthritis has been productive of symptoms continuously since service. The Board concludes service connection is not warranted on this basis. 38 C.F.R. § 3.303(b). The Board also finds that a secondary service connection analysis is not appropriate in this case. The Veteran has alleged that his cervical spine disorder was caused by chiropractic manipulations to treat his low back disability during service. He has not specifically contended that his cervical spine disorder was caused or aggravated by his service-connected low back disability itself. Thus, further discussion of this theory of entitlement is unnecessary in this case. Based on the foregoing, the Board finds that a preponderance of the evidence is against the Veteran’s claim for service connection for a cervical spine disorder. Because the preponderance of the evidence is against the Veteran’s claim, the benefit of the doubt provision does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Accordingly, the Board concludes that service connection for a cervical spine disorder is not warranted. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Respiratory Disorder In considering the evidence of record under the laws and regulations as set forth above, the Board concludes that the Veteran is not entitled to service connection for a respiratory disorder, to specifically include asthma. The evidence of record does not show that the Veteran has asthma that manifested in service. His service treatment records documented treatment for bronchial pneumonia in October 1979 and for the flu and granulomas of the right lung in December 1982. In March 1999, a physician treating the Veteran for sinus congestion and slight chest congestion specifically noted that the Veteran did not have asthma or a history of sinus infections or bronchitis. Moreover, during an April 2000 separation examination, the Veteran did not mention asthma or any related pulmonary symptoms. Moreover, the post-service medical records are negative for any complaints, diagnosis, or treatment of asthma until at least 2003. See November 2010 (Veteran reported diagnosis of asthma in 2003). However, the medical evidence of record does not show a diagnosis of mild asthma until May 2008. See May 2008 private pulmonary record. An October 2006 private urgent care treatment note indicated that the Veteran was treated for complaints of nasal congestion and cough for three months. He was diagnosed with sinusitis and bronchitis. August 2007 and September 2007 private urgent care treatment notes showed that the Veteran was treated for bacterial pneumonia. He presented in August 2007 with complaints of sinus pain and pressure, chronic cough, congestion, and soreness in his chest for one week. During a November 2007 military treatment facility primary care visit, the Veteran had “no acute problems” and his pulmonary system was noted as normal. An April 2008 private chest x-ray showed no acute pulmonary process. In a May 2008 private pulmonary consultation, the physician noted that he evaluated the Veteran for complaints of dyspnea, cough, and wheezing. During the consultation, the Veteran stated that he had a cough associated with wheezing for one year. An examination showed normal pulmonary function, clear auscultation, and normal percussion. The physician diagnosed the Veteran with possible asthma with a one-year history of wheezing and cough. A May 2008 private pulmonary function test revealed mixed obstructive and restrictive lung disease, mild obstructive airway disease, mild restrictive lung disease, and significant bronchodilator response. The interpreting physician diagnosed the Veteran with mild asthma and mild restrictive lung disease consistent with obesity. In April 2009 correspondence, a private physician stated that he had treated the Veteran since May 2008. He noted that the Veteran had multiple episodes of bronchitis, fevers, and pneumonia that were documented in his service treatment notes dating back to October 1979. He indicated that since he last evaluated the Veteran, the Veteran was diagnosed with mild asthma. The physician also stated, “I suspect that [the Veteran] has always had a component of asthma which led to his frequent bronchitis and pneumonia symptoms.” In addition to the lack of evidence showing that the claimed disorder manifested during active duty service or within close proximity thereto, the evidence of record does not link any current diagnosis to the Veteran’s military service. The Veteran was afforded a VA examination in connection with his claim for service connection for a respiratory disorder in November 2010. During the examination, the Veteran reported that he was treated for bronchitis and pneumonia in 1982 while he was stationed in Korea. He stated that he had two to three episodes of bronchitis and pneumonia since he separated from service and that he was diagnosed with asthma in 2003 by a private physician. The VA examiner noted that the first private treatment record documenting treatment for dyspnea, cough and wheezing for one year was dated in May 2008 and, at that time, he was diagnosed with mild asthma. The examiner specifically reported that the Veteran’s service treatment records were silent for asthma or bronchitis, and that there was no documented record available that supported a history or treatment for asthma-related symptoms, such as recurrent cough, wheezing, etc. The examiner opined that it was less likely than not that the Veteran’s current asthma or bronchitis was related to his service. The examiner related that available service treatment records failed to document recurrent asthma or bronchitis-related symptoms or treatment. The Board acknowledges the private medical opinion provided in April 2009 by the Veteran’s treating pulmonologist, but finds that the opinion has limited probative value. In this regard, the physician indicated that he “suspected” that the Veteran has always had a component of asthma which led to his frequent bronchitis and pneumonia symptoms. The Board finds this opinion speculative in nature because it does not provide rationale based in accepted medical principles or an assessment of the probability of a nexus relationship. Medical opinions that are speculative, general, or inconclusive do not provide a sufficient basis upon which to decide a claim. See, e.g., McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006) (doctor’s opinion that “it is possible” and “it is within the realm of medical possibility” too speculative to establish medical nexus); Goss v. Brown, 9 Vet. App. 109, 114 (1996) (using the word “could not rule out” was too speculative to establish medical nexus); Warren v. Brown, 6 Vet. App. 4, 6 (1993) (medical opinion expressed only in terms such as “could have been” is not sufficient to reopen a claim of service connection); Tirpak v. Derwinski, 2 Vet. App. 609, 611 (1992) (medical opinion framed in terms of “may or may not” is speculative and insufficient to support an award of service connection for the cause of death); Beausoleil v. Brown, 8 Vet. App. 459, 463 (1996) (a generic statement about the possibility of a link between chest trauma and restrictive lung disease was “too general and inconclusive” to support an award of service connection). For these reasons, the Board finds that the private medical opinion submitted in April 2009 has limited probative value. In contrast, the Board finds the November 2010 VA examiner’s opinion to have more probative value. The VA examiner reviewed and considered the evidence of record, including the Veteran’s own statements and the April 2009 private medical opinion. He also provided rationale for the opinion. The Board does acknowledge the Veteran’s own statements asserting that his current asthma is related to his military service. Although lay persons are competent to provide opinions on some medical issues, Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), as to the specific issue in this case, the diagnosis and etiology of a current respiratory disorder and whether the delayed onset of such a disorder is related to military service, falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Moreover, even assuming the Veteran’s lay assertions regarding etiology were competent, the Board nevertheless finds the November 2010 VA examiner’s opinion to be more probative, as it was provided by a medical professional with knowledge, training, and expertise and is supported by rationale based on such knowledge. The VA examiner also reviewed pertinent evidence and considered the Veteran’s own reported history and lay statements. For the reasons outlined above, the Board concludes that the weight of the evidence is against a finding of entitlement to service connection for a respiratory disorder. As such, the benefit-of-the-doubt rule does not apply, and the claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. J. B. FREEMAN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Osegueda, 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.