Citation Nr: 21007784 Decision Date: 02/10/21 Archive Date: 02/10/21 DOCKET NO. 17-30 422 DATE: February 10, 2021 ORDER Entitlement to service connection for hearing loss is granted. Entitlement to service connection for a back disorder is denied. Entitlement to service connection for a spinal hemangioma is denied. Entitlement to service connection for sinusitis is denied. Entitlement to service connection for hypothyroidism is denied. FINDINGS OF FACT 1. There is an approximate balance of positive and negative evidence as to whether the Veteran’s bilateral hearing loss is related to acoustic trauma during her period of active duty training (ADT) in March 1974. 2. The Veteran’s thoracic scoliosis, which preexisted her period of ADT in March 1974, was not aggravated during that period of service. 3. The Veteran’s current back disorders including multilevel degenerative disc disease and spinal hemangioma were not present during her period of ADT or manifest to a compensable degree within one year of service discharge and are not related to any incident of that service. 4. The Veteran’s sinusitis, which preexisted her period of ADT in March 1974, was not aggravated during that period of service. 5. The Veteran’s hypothyroidism was not present during her period of ADT in March 1974 and is not related to any incident of service. CONCLUSIONS OF LAW 1. The criteria for service connection for bilateral hearing loss are met. 38 U.S.C. §§ §§ 101(21), (24), 1112, 1113, 1131, 1154(a), 5107(b); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.385. 2. The criteria for service connection for thoracic scoliosis, claimed as a back disorder are not met. 38 U.S.C. §§ 101(21), (24), 1112, 1113, 1131, 1153, 5103, 5103A, 5107(b); 38 C.F.R. §§ 3.6, 3.303, 3.304(b), 3.306, 3.307, 3.309. 3. The criteria for service connection for a spinal hemangioma are not met. 38 U.S.C. §§ 101(21), (24), 1131, 5103, 5103A, 5107(b); 38 C.F.R. §§ 3.6, 3.303. 4. The criteria for service connection for sinusitis are not met. 38 U.S.C. §§ 101(21), (24), 1112, 1113, 1131, 1153, 5103, 5103A, 5107(b); 38 C.F.R. §§ 3.6, 3.303, 3.304(b), 3.306. 5. The criteria for service connection for hypothyroidism, claimed as a thyroid disorder are not met. 38 U.S.C. §§ 101(21), (24), 1112, 1113, 1131, 1153, 5103, 5103A, 5107(b); 38 C.F.R. §§ 3.6, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served with the Air National Guard from December 1973 to December 1985 with a period of active duty training (ADT) from March 15, 1974 to July 14, 1974. She did not otherwise serve a period of active duty and there is no official documentation of any other periods of ADT or inactive duty for training (IDT). In November 2020, she testified at a teleconference Board hearing held before a Veterans Law Judge (VLJ). A transcript of the hearing is of record. Service Connection The Veteran is seeking service connection for hearing loss, a back disorder, spinal hemangioma, sinusitis, and a thyroid disorder. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). To establish a right to compensation for a present disability, a Veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service - the so-called “nexus” requirement. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Certain chronic diseases are subject to presumptive service connection if manifest to a compensable degree within one year from separation from service even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1112, 1113; 38 C.F.R. §§ 3.307 (a)(3), 3.309(a). However, this presumption is not applicable to periods of ADT or IDT. Smith v. Shinseki, 24 Vet. App. 40, 47 (2010). Continuity of symptomatology may also provide a basis for a grant of service connection for those diseases defined as “chronic” by VA. 38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Continuity of symptomatology may also provide a basis for a grant of service connection for those diseases defined as “chronic” by VA. 38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013); Fountain v. McDonald, 27 Vet. App. 258 (2015). “Active service” includes active duty, a period of ADT active duty training (ADT) in which the individual was disabled from a disease or injury incurred or aggravated in the line of duty, and a period of inactive duty training (IDT) in which the individual was disabled from an injury incurred or aggravated in the line of duty. 38 U.S.C. § 101(21), (24)(B); 38 C.F.R. § 3.6(a). See also Brooks v. Brown, 5 Vet. App. 484 (1994). ADT includes full-time duty performed for training purposes by members of the Reserves or National Guard. 38 U.S.C. § 101(22); 38 C.F.R. § 3.6 (c). IDT is generally duty (other than full-time duty) prescribed for Reserves or duty performed by a member of the National Guard of any State (other than full-time duty). 38 U.S.C. § 101(23); 38 C.F.R. § 3.6 (d). Annual training is an example of ADT, while weekend drills are IDT. Because the Veteran is alleging injuries or diseases incurred or aggravated during her National Guard service, she must establish that she was disabled from disease or injury incurred or aggravated in the line of duty during a period of ADT or disabled from an injury incurred or aggravated in the line of duty during a period of IDT service. 38 C.F.R. § 3.1(a), (d); Bowers v. Shinseki, 26 Vet. App. 201, 206 (2013); Harris v. West, 13 Vet. App. 509 (2000); Paulson v. Brown, 7 Vet. App. 466 (1995). Unless and until “veteran” status is established for his ADT, an appellant cannot use the many presumptions in the law that are available in trying to establish entitlement to service connection. For example, presumptive periods allowing for the presumed incurrence of a condition in service do not apply to ADT or IDT, and neither do the presumptions of soundness and aggravation. See Donnellan v. Shinseki, 24 Vet. App. 167, 171 (2010); Smith v. Shinseki, 24 Vet. App. 40 (2010); Acciola v. Peake, 22 Vet. App. 320, 324 (2008) (holding that a presumption of service connection is inapplicable without previously established veteran status (citing Biggins v. Derwinski, 1 Vet. App. 474 (1991)). In other words, if the evidence reflects that a disease had its onset prior to a period of ADT, a claimant seeking benefits based on aggravation has the burden, without the advantage of the presumption of aggravation, of demonstrating both that the preexisting condition permanently worsened during ADT and that the worsening was beyond the natural progression of the disease (i.e., such worsening was caused by ADT). Donnellan, 24 Vet. App. at 174. In this case veteran status has been established based on the grant of service connection for tinnitus incurred during the period of ADT beginning in March 1974. See Hill v. McDonald, 28 Vet. App. 243 (2016). Service connection may be granted for any disease initially 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). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, any reasonable doubt is resolved in favor of the Veteran. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. hearing loss The Veteran asserts that her hearing loss is the result of exposure to excessive noise during her military service from rifle firings on the shooting range during 6 weeks of basic combat training sessions. She also reported noise from office equipment including teletype machines, hard drive wall computer systems, and aircraft noise from being out in the field. See April 2016 VA examination and November 2020 hearing transcript (T.). For the purposes of applying the laws administered by VA, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz (Hz) is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. The threshold for normal hearing is from zero to 20 decibels, and higher threshold levels indicate some degree of hearing loss. Id.; Hensley v. Brown, 5 Vet. App. 155, 157 (1993); McKinney v. McDonald, 28 Vet. App. 15, 24-5 (2016). The absence of in-service evidence of a hearing disability during service (i.e., one meeting the requirements of 38 C.F.R. § 3.385) is not always fatal to a service connection claim. Ledford v. Derwinski, 3 Vet. App. 87, 89 (1992). Evidence of a current hearing loss disability and a medically sound basis for attributing that disability to service may serve as a basis for a grant of service connection for hearing loss where there is credible evidence of acoustic trauma due to significant noise exposure in service, post-service audiometric findings meeting the regulatory requirements for a hearing loss disability for VA purposes, and a medically sound basis upon which to attribute the post-service findings to the injury in service (as opposed to intercurrent causes). See Hensley, 5 Vet. App. at 159. The Veteran’s DD-214 shows that she served as an administrative specialist, a military occupational specialty (MOS) not typically associated with routine exposure to hazardous noise levels. However, the Board has also considered her assertions that she was exposed to in-service noise from the rifle range during basic training and thus, it is plausible that she had some acoustic trauma in service. 38 U.S.C. § 1154(a). Moreover, the Board notes that the Agency of Original Jurisdiction (AOJ) has already conceded the Veteran’s in-service noise exposure in its May 2018 grant of service connection for tinnitus based on such exposure. In addition, VA audiograms in April 2016 and November 2017 confirm she currently has bilateral hearing loss disability for VA purposes. After carefully reviewing and weighing the competent medical evidence of record, the Board is satisfied that it is in at least approximate balance as to whether the Veteran’s hearing loss is related to her period of ADT. The unfavorable evidence consists of service treatment records, which are entirely negative for hearing complaints, as well as the many years after that period of service during which she did not seek or require any form of treatment or evaluation for pertinent complaints. In addition, VA audiologists have acknowledged the Veteran’s in-service noise exposure but still concluded the hearing loss did not result from it. The 2016 examiner explained that the Veteran’s service treatment records indicated normal hearing thresholds upon entering the military and that inservice audio examinations in 1974, 1979, 1981 and 1983 also indicated normal hearing thresholds in both ears. A second VA examiner in 2017 explained that since the Veteran’s hearing thresholds were within normal limits throughout service with no significant changes, the current hearing loss occurred after military service and is not related to military noise exposure. See VA Hearing Loss and Tinnitus Disability Benefits Questionnaire (DBQ). However, the record also contains favorable evidence, primarily the Veteran’s likely exposure to some degree of acoustic trauma during service, as is confirmed by her basic training experiences (assertions that she is considered competent to make). Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006) (addressing lay evidence as potentially competent to support presence of disability even where not corroborated by contemporaneous medical evidence). This supporting evidence places the pertinent record in relative equipoise. The Board finds that it is not possible to determine to what extent her hearing loss may be attributed to noise exposure in service versus some other etiology. Also, because the Veteran has already been granted compensation for tinnitus, this fact adds weight to this claim that her hearing loss is also related to service. In this case, any doubt that remains as to whether at least some of the hearing loss is attributable to service, as opposed to some other cause, is resolved in favor of the Veteran and service connection is granted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. back disorder spinal hemangioma The Board notes that there is similar medical history and evidence related to the back disorder and spinal hemangioma claims, as well as similar disposition of the issues, therefore they will be addressed together. At her November 2020 hearing, the Veteran maintains that she injured her back during an operation readiness inspection while on ADT. She testified that she was evaluated in a resting area on base after falling from a chair and was told to rest before continuing to work. (T. at pgs. 3-5). She also testified that she only first learned about her spinal hemangioma a few years ago, but still believes it is related to service since she had been in a lot of pain at that time. (T. at pgs. 10-11). However, in this case, there is a question as to whether her back disorder preexisted her ADT from March 1974 to July 1974. See Enlistment Report of Medical Examination, dated October 13, 1973 (showing slight thoracic scoliosis to right with 1 cm deviation). In Wagner v. Principi, 370 F.3d 1089, 1096 (2004), the United States Court of Appeals for the Federal Circuit held if a preexisting disorder is noted upon entry into service, the veteran cannot bring a claim for service connection for that disorder, but the veteran may bring a claim for service-connected aggravation of that disorder. In that case, 38 U.S.C. § 1153 applies and the burden falls on the veteran to establish an increase in disability during service. If the presumption of aggravation attaches, the burden shifts to the government to show by clear and unmistakable evidence that there has been no increase in the severity of the preexisting condition or that any increase was the result of natural progression. Id; see also 38 C.F.R. § 3.306(b). As noted above service treatment records show slight thoracic scoliosis was noted at enlistment in1974. Thus, the Board needs next to determine whether an increase in disability occurred during service. Thus, the presumption of soundness at entrance does not attach and the Board needs next to determine whether the pre-existing disorder was aggravated during service. Here there is no evidence that the preexisting thoracic scoliosis increased in severity during service. The remaining service treatment records are negative for evidence of any measured worsening of the thoracic scoliosis or any back difficulties in general. Of record is a June 1974 report of medical history which shows the Veteran specifically denied recurrent back pain and clinical evaluation of the spine was normal. The lack of findings/problems weighs against a finding of worsening (increase) in service. As such, the Veteran has not demonstrated that thoracic scoliosis worsened during service. So, while thoracic scoliosis was noted at enlistment, without a showing of an in-service increase in the disability, the presumption of aggravation is not established. This conclusion is further supported by the post-service evidence. To the extent that the Veteran claims that her back has been symptomatic since service, she has neither submitted nor identified evidence showing treatment for back problems immediately after active service. Following her period of ADT in 1974, the Veteran continued as a member of the Air National Guard until her discharge in 1985 without any back complaints which strengthens the conclusion that her pre-service thoracic scoliosis was essentially unaffected by service. Multiple reports of medical history show she continued to deny recurrent back pain and clinical evaluations of the spine were normal. Other reports show she consistently reported that she had not experienced any significant illnesses or injuries and was not currently taking any medications. See Reports of Medical History dated in January 1975, January 1977, October 1979, November 1982, and October 1983. The earliest relevant medical evidence is found in a 2009 MRI report of the thoracic spine which shows mild multilevel spondylosis, disc herniations/protrusions, disc bulge and a bone lesion representing a lipoma or hemangioma. See MRI report from Spectrum MRI Full Body Imaging Center, dated January 21, 2009. The next relevant evidence is found in VA clinical records from 2016 when the Veteran complained of mid back pain of 2 years duration which she attributed to accidents in the military. Recent X-rays from October 2016 showed minimal degenerative disease mid dorsal spine. A February 2017 entry notes the Veteran was diagnosed with a T8 hemangioma (osseous lesion) as far back as 2006 and at that time the Veteran reported a history of multiple auto accidents in 2006 which had aggravated her back pain. Imaging of the thoracic spine at that time showed exaggerated thoracic kyphosis, disc space narrowing normal diffuse degenerative changes, and minimal scoliosis of the lumbar spine. VA clinical records dated from November 2016 to February 2017. The Veteran underwent VA examination in April 2016. The examiner reviewed the claims file, including the Veteran’s back history, specifically referencing the thoracic scoliosis noted at enlistment in 1973 and her reported back injury from a fall in 1974. After conducting an examination, the examiner determined that the Veteran’s back pain was less likely than not incurred in or caused by the thoracic scoliosis deviation that was noted at service entrance as there was no medical evidence that she was evaluated for back pain during service. Furthermore, there was no back condition noted during periodic examinations in October 1979 and October 1983. The Veteran was provided additional VA medical examination in March 2017. After reviewing the claims file, the Veteran’s reported inservice back injury, and conducting an examination, the examiner confirmed diagnoses of thoracic scoliosis and degenerative arthritis of the spine that was less likely as not related to service. It was explained that because the Veteran was noted to have thoracic scoliosis upon entering service, it was not due to service. Back (Thoracolumbar Spine) Conditions DBQ dated April 28, 2016 and March 15, 2017. In an April 2017 addendum opinion, the examiner found no medical evidence to support aggravation of the Veteran’s pre-existing thoracic scoliosis by military service. It was explained that the natural history of scoliosis of the spine is often the development of back pain caused by repetitive strain injury and eventually degenerative arthritis and degenerative disc disease due to altered biomechanics of the spine. The findings on the Veteran’s X-rays at age 65 and MRI at age 57 are not unexpected in an individual with longstanding thoracic scoliosis regardless of military service. Additionally, the Veteran denied back pain on multiple evaluations after her reported injury, therefore the thoracic scoliosis which clearly and unmistakably existed prior to service, was clearly and unmistakably not aggravated beyond its natural progression by an in-service event, injury or illness. VA Medical Opinion DBQ, dated April 12, 2017. As the most competent and credible evidence of record does not show an increase in the severity of thoracic scoliosis during service, the presumption of aggravation does not attach. As such, a discussion of clear and unmistakable evidence to rebut the presumption of aggravation is not required. Wagner, 370 F.3d at 1096. Because the Veteran’s pre-existing thoracic scoliosis was not aggravated by military service entitlement to service connection must be denied. The Board is also unable to attribute the post-service multilevel disc disease, degenerative arthritis of the spine and spinal hemangioma to the Veteran’s military service. In this case, service treatment records are silent for any complaints, treatment or diagnosis of a chronic back problems and the currently diagnosed back disorders other than thoracic scoliosis were first manifested years after the Veteran’s period of ADT. There is also no evidence relating them to service, therefore the claim cannot be granted on a direct basis. See VA DBQs in April 2016 and March 2017. To the extent the Veteran argues that a relationship exists between these current spine disorders and service, such an assertion treads into the realm of medical expertise. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). In any event, the probative value of her belief is outweighed by that of the medical examiners, who clearly do have the education, training and experience to address the etiology of musculoskeletal disorders. More importantly, the Veteran’s account of back injury during service and problems since then are clearly refuted by service treatment records which are negative for any record of back complaints or chronic symptoms. See Macarubbo v. Gober, 10 Vet. App. 388 (1997) (holding that the credibility of lay evidence can be affected and even impeached by inconsistent statements, internal inconsistency of statements, inconsistency with other evidence of record, facial implausibility, bad character, interest, bias, self-interest, malingering, desire for monetary gain, and witness demeanor). Even accepting that an in-service back injury occurred as alleged, the Board finds it much more reasonable to conclude that such injury was acute and transitory, given that the service records note no description of the type of injury that the Veteran now describes, and post-service medical records are negative for complaints, findings, or treatment of back pain, until many years after active duty. See Curry v. Brown, 7 Vet. App. 59 (1994) (a Veteran’s version of events from the past may be of limited credibility and probative value in the absence of medical records showing treatment for the claimed disorder). Accordingly, the preponderance of the evidence is against the claims and there is no reasonable doubt to be resolved. 38 U.S.C. § 5107(b). sinusitis At her November 2020 hearing, the Veteran testified that she did not have any kind of allergies or sinus problems prior to service and that she developed a sinus condition during basic training. (T. at pgs. 5-6). In this case, the record raises a question of whether her current sinusitis preexisted her military service. See Enlistment Report of Medical Examination, dated October 13, 1973 (showing sinusitis). Since service treatment records show sinusitis was noted at enlistment in 1974, the presumption of soundness at entrance does not attach and the Board needs next to determine whether the pre-existing disorder was aggravated during service. Wagner, 370 F.3d at 1096; (citing 38 U.S.C. § 1153 and 38 C.F.R. § 3.306). Here, the remaining service treatment records are negative for evidence of any measured worsening of sinusitis or any sinus problems in general during her period of ADT. A June 1974 report of medical history just prior to discharge shows the Veteran continued to note her history of mild seasonal sinusitis treated with antihistamines with no complications or sequelae. However, the fact that she may have been treated for sinusitis during service, in and of itself, does not establish aggravation, but rather is reflective of no more than temporary or intermittent flare-ups given the lack of specific findings/problems. See Jensen, 4 Vet. App. at 306-307. As such, the Veteran has not demonstrated that sinusitis worsened during service. So, while it was noted at enlistment, without a showing of an in-service increase in the disability, the presumption of aggravation is not established. This conclusion is further supported by the post-service evidence. Although multiple reports of medical history note the Veteran’s history of sinusitis, they also show she consistently reported that she had not experienced any significant illnesses or injuries and was not currently taking any medications. The lack of findings/problems weighs further strengthens the conclusion that her pre-service sinusitis did not worsen (increase) during ADT in 1974. See Reports of Medical History dated in January 1975, January 1977, October 1979, November 1982, and October 1983. The Veteran underwent VA examination in March 2017. The examiners reviewed the claims file, including the Veteran’s medical history, specifically referencing the sinusitis noted at enlistment in 1973. After conducting an examination, the examiner determined that the sinusitis was less likely than not related to service since the Veteran was noted to have had sinusitis since 1972 before entering service. The Veteran was provided additional VA medical examination in November 2017. After reviewing the claims file and conducting an examination, the examiner concluded that the Veteran’s sinusitis was not aggravated beyond its natural progression by service. She explained that chronic sinusitis results when repeated exposure to environmental allergens and pollutants causes a chronic inflammatory response with each subsequent exposure. This inflammatory response is not elicited by rigorous physical activity or geographic location but only to environmental allergens. As a result, the Veteran’s current sinusitis was not aggravated beyond its natural progression by military service. See March 2016 Sinusitis, Rhinitis and Other Conditions of the Nose, Throat, Larynx, and Pharynx DBQ and November 2017 VA Medical Opinion DBQ. As the most competent and credible evidence of record does not show an increase in the severity of sinusitis during service the presumption of aggravation does not attach. As such, a discussion of clear and unmistakable evidence to rebut the presumption of aggravation is not required. Wagner, 370 F.3d at 1096. Because the Veteran’s pre-existing sinusitis was not aggravated by military service entitlement to service connection must be denied. thyroid disorder At her November 2020 hearing, the Veteran testified that during basic training she experienced symptoms of shaking, and cramps which she believes were the early manifestations of a thyroid condition. (T. at pgs. 9). Service treatment records fail to reveal any significant signs or symptoms that can be construed as related to a thyroid disorder during her period of ADT. Although the Veteran also claims to have experienced thyroid problems since service, post-service treatment records do not show a diagnosis of hypothyroidism until 2007. See clinical records from Kaiser Permanente, dated April 17, 2007. These records do not suggest that any pertinent symptomatology originated during military service and there is no other evidence of record to suggest the presence of hypothyroidism prior to the indicated dates of diagnosis. A VA examination has not been provided to address the Veteran’s claimed disability. However, since service and post-service treatment records provide no basis to grant this claim, and in fact provide evidence against it, the Board finds no basis to obtain a VA examination or medical opinion. Duenas v. Principi, 18 Vet. App. 512, 519 (2004) (indicating that, generally, VA is not obligated to provide an examination for a medical nexus opinion based on unsubstantiated lay statements alone). To the extent the Veteran asserts that her current hypothyroidism represents a continuation of symptoms she experienced during service such an assertion treads into the realm of medical expertise. This is especially true where a particular condition is not readily amenable to mere lay diagnosis or probative comment regarding etiology. See Jandreau, 492 F.3d at 1377; Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007). In Waters v. Shinseki, 601 F.3d 1274 (Fed. Cir. 2010), the Federal Circuit Court held that, when determining whether a VA examination and opinion are required under 38 U.S.C. § 5103A (d)(2), the law requires competent evidence of a disability or persistent or recurrent symptoms of a disability, but does not require competent evidence of a nexus, only that the evidence indicates an association between the disability and service or a service-connected disability. But the Federal Circuit Court went on to clarify in Waters that a Veteran’s conclusory generalized statement that a service illness caused their present medical problems was not enough to entitle them to a VA medical examination, since all Veterans could make such a statement, and such a theory would eliminate the carefully drafted statutory standards governing the provision of medical examinations and require VA to provide such examinations as a matter of course in virtually every disability case. To the extent the Veteran reports experiencing thyroid problems during service and continuously since then, the Board finds her account lacks credibility as the statements are not supported by the record. See Macarubbo, 10 Vet. App. 388. The objective contemporaneous medical records stand in sharp contrast to the Veteran’s lay reports and are more probative as to the circumstances surrounding the onset of her hypothyroidism rather than her inconsistent history reported many years thereafter. See Curry, 7 Vet. App. 59. Accordingly, the preponderance of the evidence is against the claim, and there is no reasonable doubt to be resolved. 38 U.S.C. § 5107(b). Thomas H. O'Shay Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J.R. Bryant 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.