Citation Nr: 21010484 Decision Date: 02/25/21 Archive Date: 02/25/21 DOCKET NO. 14-13 789 DATE: February 25, 2021 ORDER Entitlement to service connection for degenerative joint disease (DJD) of the lumbosacral spine is denied. Entitlement to service connection for DJD of the cervical spine is denied. FINDINGS OF FACT 1. DJD of the lumbosacral spine was not present during active duty, did not manifest to a compensable degree within one year of separation from active duty, continuity of symptomatology is not established, and the Veteran’s current DJD of the lumbosacral spine is not otherwise causally related to active service. 2. DJD of the cervical spine was not present during active duty, manifest to a compensable degree within one year of separation from active duty, continuity of symptomatology is not established, and the Veteran’s current DJD of the cervical spine is not otherwise causally related to active service. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for DJD of the lumbosacral spine have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 2. The criteria for entitlement to service connection for DJD of the cervical spine have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the U.S. Navy from May 1971 to May 1975, from December 1978 to December 1980, and from February 1981 to April 1983. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from rating decisions of a Department of Veterans Affairs (VA) Regional Office (RO). In an August 2012 rating decision, the RO, in pertinent part, confirmed a prior denial of service connection for a low back disability and denied service connection for a cervical spine disability. The Veteran filed a timely notice of disagreement received by VA in August 2012. In March 2014, the RO issued a statement of the case. The Veteran’s substantive appeal was received by VA in April 2014. In October 2017, the Veteran testified at a Board hearing before the undersigned in Washington, D.C. A transcript is of record. In a January 2018 decision, the Board noted that in a September 1978 rating decision, the RO denied entitlement to service connection for a lumbosacral strain, finding that acute back injuries in service resulted in no permanent disability. The RO notified the Veteran of the decision the same month and he did not initiate an appeal. However, prior to mailing the notification, the RO received correspondence from the Veteran enclosing two lay statements, including one from his wife reporting he had “complained of back pain since 1973 almost constantly. It seems to bother him quite often. [He] has complained of this back pain throughout our relationship.” As this new evidence is dated within a year of the issuance of the September 1978 decision and was not addressed in the September 1978 notice letter, the Board found that new and material evidence was received within a year of the 1978 decision and the decision therefore did not become final. See Beraud v. McDonald, 766 F.3d 1402, 1406–07 (Fed. Cir. 2014) (holding that a claim remains pending where VA failed to fulfill a statutory duty to determine the character of newly submitted evidence and declining to presume that VA considered records of which it had notice, but never obtained); Bond v. Shinseki, 659 F.3d 1362 (Fed. Cir. 2011) (noting that 3.156(b) requires VA to determine whether subsequently submitted evidence constituted new and material evidence relating to an earlier claim); 38 C.F.R. § 3.156(a), (b). Therefore, the Board recharacterized the claim as one for service connection rather than an application to reopen the previously denied claim. The Board remanded the matter for additional evidentiary development. In April 2019 and May 2020, the Board again remanded the matter for additional evidentiary development. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166–67 (Fed. Cir. 2004). Certain specifically enumerated chronic diseases, including arthritis, will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service (a year following separation for arthritis); or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309; Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). Service connection may also be granted for disability that is proximately due to or the result of a 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) caused by or (b) aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 446–48 (1995). VA will not concede that a nonservice-connected disease or injury was aggravated by a service-connected disease or injury unless the baseline level of severity of the nonservice-connected disease or injury is established by medical evidence created before the onset of aggravation or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity of the nonservice-connected disease or injury. 38 C.F.R. § 3.310(b). Whether the disability was permanently worsened is not a part of the necessary analysis of these claims and should not be included. Ward v. Wilkie, 31 Vet. App. 233, 234–35 (2019). In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence that it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36, 39–40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). “When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter,” the benefit of the doubt shall be given to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. The question is whether the evidence supports the claim or is in relative equipoise, with the claimant prevailing in either event, or whether a fair preponderance of the evidence is against the claim, in which event the claim must be denied. Gilbert, 1 Vet. App. at 54. Service treatment records corresponding to the Veteran’s first period of active duty show that at his April 1971 enlistment examination, his spine was examined and determined to be normal. On a report of medical history, the Veteran denied a history of arthritis and recurrent back pain. In-service treatment records show that in April 1972, the Veteran sought treatment for pain of the right ischial crest. He reported that he had been working when a plane turned and hit him in the back and threw him to the port catwalk. X-rays were negative. The Veteran was diagnosed as having muscle trauma. The following day, the Veteran was noted to have a large bruise over the left iliac crest. One week later, he sought treatment for back pain. He was noted to have residual muscle spasm. In May 1972, the Veteran reported aching in the low back since being blown into the port catwalk 25 days prior. Physical examination of the back was normal and an x-ray was negative. The Veteran was advised that time was required for healing. In July 1972, the Veteran reported morning back soreness which generally cleared during the day. In February 1973, the Veteran sought treatment for low back pain which he indicated had been present for the past year since having been hit by a turning airplane. Specifically, the Veteran reported that when he woke up in the mornings or when he stood for a long time, his back would begin to ache. Examination showed that straight leg raising was normal, reflexes were normal, and there was no weakness. There was paralumbar muscle tenderness. The Veteran was assessed as having back strain. In April 1973 the Veteran sought treatment for low back pain which he indicated had been present for the past day. His muscles were tight, but his range of motion was good. He was assessed as having muscle strain. In February 1974, the Veteran sought treatment for a headache and low back pain. He reported that he had been in a car accident in which he was hit from the side. Examination showed that he was neurologically intact. His major complaint was low back pain slightly to the right. He indicated that the pain felt like it was in the muscle. Examination showed negative straight leg raising. There was tenderness over the right lower back with tight muscles. The impression was back muscle strain. Six days later, the Veteran was evaluated in the orthopedic clinic where he reported that he still had minor back pain without radiculopathy, as well as stiffness in his neck, and occasional headaches. On examination, he exhibited mild lumbosacral sprain with minimal restricted motion. The examiner indicated that the Veteran exhibited normal motion of the cervical spine. Reflexes and sensation were normal in the upper and lower extremities. X-ray studies were negative. The assessment was lumbosacral and cervical muscular strain. At the Veteran’s May 1975 separation examination, his neck and spine were examined and determined to be normal. In August 1978, following the Veteran’s first period of service, he submitted an original application for VA compensation benefits, seeking service connection for an April 1972 back injury. In response to the RO’s request that he submit or identify evidence of back treatment since service separation, in a September 1978 letter, the Veteran indicated that he had received no treatment for his low back since service because he was told that his back pain would eventually go away. He indicated that because he still had back pain, however, he decided to file the present claim of entitlement to service connection for a low back disability. As set forth above, the Veteran also submitted a September 1978 statement from his spouse who indicated that the Veteran had complained of back pain since 1973. In addition, the Veteran submitted a September 1978 statement from a fellow sailor who explained that he had served with the Veteran. He indicated that he had firsthand knowledge of one of the Veteran’s accidents and that the Veteran often complained of recurring pain in his back. Service treatment records corresponding to the Veteran’s second period of active duty show that at his December 1978 entrance examination, his spine was examined and determined to be normal. In addition, on a report of medical history, the Veteran denied having or having had recurrent back pain. He reported a history of having bruised his lower mid back in the past, but the examiner determined that there were no sequalae from that past injury. In-service treatment records show that in November 1979, the Veteran sought treatment and reported that he had pulled a muscle in his back carrying a pump. Range of motion and gait were good, sensation was normal, and no spasms were noticed. The assessment was muscle strain. In April 1980, the Veteran again complained of lower back pain. Strength, reflexes, and sensation were normal. There were no spasms. The assessment was muscle strain. In August 1980, the Veteran was involved in another motor vehicle accident, in which he reportedly hit his head on the steering wheel. He was noted to have an acute contusion/lip laceration. He was diagnosed as having a mild concussion. Two days after the accident, the Veteran sought treatment for pain in the lumbar spine and light headedness. Examination showed multiple bruises and pain in the lumbar spine. The assessment was pain and multiple bruises following auto accident. He was treated with hot soaks and aspirin. At the Veteran’s December 1980 separation examination, his spine and neck were examined and determined to be normal. Records pertaining to the Veteran’s third period of active duty show that at his February 1981 reenlistment examination, his neck and spine were examined and determined to be normal. On a report of medical history completed at the time of the examination, the Veteran denied having or having had recurrent back pain. In-service treatment records corresponding to the Veteran’s third period of active duty show that in May 1981, the Veteran lost his balance and fell into the fin of a missile, sustaining a small laceration to his scalp near the left temple. The cut was cleaned with antiseptic. The remaining service treatment records are negative for complaints or findings of a low back or cervical spine disability. At the Veteran’s February 1983 separation examination, on a report of medical history, the Veteran endorsed having or previously having had recurrent back pain. On clinical evaluation, however, his neck and spine were examined and determined to be normal. The post-service record on appeal contains VA and private clinical records dated from 2002 to 2020. In pertinent part, these records include private clinical records showing that in January 2005, the Veteran was evaluated for multiple complaints. It was noted that he had AIDS as well as recent acute renal failure. His complaints included aches, pain the extremities and a pins and needles sensation. He denied radicular pain. Later that month, he reported that he still had some “bone aches.” In February 2005, his clinician noted that the Veteran’s “bony pain” was questionably related to HIV. In May 2005, the Veteran reported a history of bony pain which comes and goes, particularly in his hips. He also reported some sharp shooting pain down his right leg to his foot. The initial assessments were sciatica and questionable osteoarthritis or early necrosis. The examiner ordered X-ray studies of the hips and spine. In June 2005, multiple views of the lumbar spine showed no evidence of subluxation, dislocation, bone, joint, or soft tissue abnormality. The assessment was normal lumbar spine. Subsequent clinical records show continued complaints of diffuse bony pain, particularly in the hips. In August 2005, an MRI of the pelvis was normal. In January 2006, the Veteran reported chronic diffuse bone pain. It was noted that a bone scan had been within normal limits and that rheumatology lab work had been scheduled. VA clinical records show that in March 2006, the Veteran underwent X-ray studies of the lumbar spine in connection with his complaints of back pain. The study showed that the spine exhibited no evidence of fracture, bone destruction, spondylolysis or spondylolisthesis, and the intervertebral disc spaces were normal. The impression was normal lumbar spine. April 2006 VA treatment records show that the Veteran denied any pain of the back, neck, or any other part of the body. VA treatment records from a few days later show the Veteran complained of pain in the bones of his legs and back assessed as three on a ten-point scale of severity. In June 2006, the Veteran was referred to the neurology with complaints of chronic pain in his hips, legs, low back, and neck for more than a year, increasing with time. In October 2006, the Veteran complained of a diffuse “bony” pain that was most severe in his back and lower leg. The Veteran stated that he had had extensive imaging with fairly normal x-rays and normal bone scan by a non-VA provider. In August 2007, a VA magnetic resonance imaging (MRI) scan of the Veteran’s lumbar spine revealed mild facet arthrosis, right eccentric peripheral annular fissure at L4–L5 with mild encroachment on the neural foramen without significant central canal compromise. VA treatment records from August 2008 and January 2012 indicate that the Veteran’s pain may have been related to Grave’s disease. In September 2008, VA treatment records show the Veteran continued to complain of body pains, especially in the low back. VA treatment records from December 2010 reveal the Veteran reported a history of low back pain. The Veteran also had neck pain, which was most likely due to musculoskeletal pain versus radiculopathy. MRIs of the cervical and lumbar spine were recommended for further evaluation. A January 2011 VA MRI of the Veteran’s cervical spine revealed multilevel degenerative disc disease (DDD) and facet arthrosis, most pronounced at C5–C6 with moderate central canal compromise and moderate to severe bilateral neural foraminal narrowing. January 2011 VA treatment records also show that the Veteran complained of shooting pains mainly in his neck and back. His neck and back pain were assessed as secondary to degenerative disc changes and bony changes. VA treatment records show that in May 2011, the Veteran had neck discomfort, which was related to DDD. In June 2011, the Veteran reported back pain at four on a ten-point scale. VA treatment records from a psychiatry inpatient consult in June 2011 show the Veteran reported a sudden increase in the severity of his joint and back pains a month prior associated with increasingly severe nausea, vomiting, and diarrhea. February 2012 treatment records from the VA neurology clinic show that the Veteran had an updated consult because his back pain had been increasing. The Veteran stated that his neck pains were much worse and he had cracking in his neck anytime he moved it. He also indicated that most of his pain was in his low back. An MRI of the cervical spine was recommended. The treating physician assessed that the Veteran had vague descriptions of pains and the examination was nonfocal except for lower back musculoskeletal pain. The neck pain was likely due to DJD. VA treatment records from May 2012 capture the Veteran’s complaints of, in pertinent part, back pain. The Veteran was afforded a VA examination in June 2012, at which he reported that during active service, he had been hit by a plane and knocked onto the deck. He indicated that following the injury, he experienced pain in his cervical and lumbar spine and was treated. He recalled that an x-ray of his back was performed, which was negative. He did not remember additional details other than he was given pain medications. He indicated that his back and neck pain thereafter improved. With respect to post-service symptoms, he recalled that his neck did not start to bother him until six or seven years before the June 2012 examination. After examining the Veteran and reviewing the record, the examiner diagnosed the Veteran as having cervical and lumbar degenerative joint disease. The examiner concluded that it was less likely than not that the Veteran’s current disabilities were incurred in or caused by service. The examiner noted the in-service episodes of treatment but explained that all were acute and recoverable episodes during which no chronic condition was identified. The examiner further noted that repeated x-ray studies in service were negative and most the of the diagnoses were for muscle strain or spasm. The examiner further noted that in reviewing the post-service record on appeal, imaging studies as late as 2006 had been negative. It was not until 2007 that degenerative joint disease of the lumbar spine was found on imaging. With respect to the neck, the examiner concluded that it was less likely than not that the current cervical spine DJD was caused by the lumbar spine disability. In a June 2012 statement, the Veteran’s VA primary care physician indicated that “[r]epeated injuries during his military service contributed to the severity of his degenerative disc disease and osteoarthritis and thus his longstanding chronic pain syndrome related to clinically evident left cervical radiculopathy and right lumbar radiculopathy.” August 2014 VA treatment records include an assessment by the Veteran’s primary care physician that the Veteran experienced: Significant chronic pain associated with musculoskeletal injury during his military service (struck by an airplane in 1972 with prolonged clinical f/up, auto accident in 1974 with head trauma, concussion, neck and back injury, MVA in 1980 with concussion, 1982 trauma with maxillary/zygoma fracture). His multiple traumas have contributed to his chronic pain and to his significant degenerative arthritis. His current symptoms are worsened by residuals of his military service. He has described pain since he has been under our care in 2005. This assessment is repeated in subsequent VA treatment records, including in August 2014, November 2014, February 2015, July 2015, January 2016, and March 2016. In an August 2014 letter, the Veteran’s VA primary care physician indicated that that the Veteran had “[s]ignificant chronic pain associated with musculoskeletal injury during his military service.” She noted that the Veteran sustained multiple traumas during service which “have contributed to his chronic pain and to his significant degenerative arthritis. His current symptoms are worsened by residuals of his military service.” In May 2016, the Veteran reported he was feeling better than ever because of significant improvements in his physical pain levels and that he was able to reduce his pain medication. July 2016 VA treatment records show the Veteran reported his pain was zero on a ten-point scale. VA social work records from August 2016 show the Veteran reported he was doing well and feeling better due to decreased pain. In August 2017, the Veteran was afforded a VA cervical spine examination. He reported that he had been in several car accidents and training accidents during active duty. He said he remembered injuring his neck many times and having neck problems for many years. After examining the Veteran and reviewing the record, the examiner concluded that it was less likely than not that the Veteran’s current cervical spine degenerative joint disease was proximately due to his lumbar spine disability. The examiner explained that the Veteran had normal posture of his back, and did not have kyphosis. There was no excess strain on his neck due to his back condition. The examiner explained that the Veteran’s current neck DJD was most likely due to normal aging. The August 2017 VA examiner also concluded that the Veteran’s DJD of the cervical spine was less likely than not incurred in or casually related to service. The examiner noted that the Veteran had sustained multiple injuries but was not diagnosed as having cervical spine degenerative arthritis until 2011, making it less likely as not that the arthritis was due to his time in service. Moreover, the examiner explained that the Veteran’s current neck arthritis is most likely age related. The Veteran was also afforded a VA lumbar spine examination in August 2017. On examination, the Veteran reported back pain since service. He asserted that his back pain was due to many car accidents and training accidents. After examining the Veteran and reviewing the record, the examiner concluded that the Veteran’s current back disability, DJD with history of strain, was less likely than not incurred in or caused by active duty. The examiner considered the service treatment records showing episodes of treatment for back problems but noted that no chronic treatment had been needed. He concluded that the Veteran’s current back problems were more likely than not due to normal aging and wear and tear of the back than his time in service. At the October 2017 Board hearing before the undersigned, the Veteran discussed his several injuries during active duty. He explained that when he was denied VA disability benefits after his first period of active duty service, he reenlisted for financial reasons. In addition, the Veteran testified that he had back pain since the first in-service injury when an aircraft struck him in April 1972. The Veteran also testified that he could not remember if his neck hurt after the first incident, but recalled being provided with a neck brace. The Veteran was afforded another VA examination in October 2019. After examining the Veteran and reviewing the record, the examiner opined that the Veteran’s current low back disability was not at least as likely as not related to his injuries during active duty. The examiner reasoned that although there was documented strain in service, in-service x-rays were negative and the Veteran’s 1978 separation examination did not list any residuals. The examiner further noted that the Veteran went on to successfully perform various jobs in government and construction and had had no diagnosis of post-service lumbar spine disabilities until 2006, once the aging process was in place. Regarding the Veteran’s claimed cervical spine disability, the October 2019 VA examiner opined that the Veteran’s current cervical spine disability was not at least as likely as not incurred in or caused by an in-service injury, event, or illness. The examiner reasoned that although cervical strain was noted in service, in-service x-rays were negative and the 1978 separation examination did not list any residuals. The examiner again noted that the Veteran went on to successfully perform various jobs in government and construction and had had no diagnosis of cervical pain until 2006 when the aging process was in place. The Veteran was afforded another VA examination in June 2020. Regarding the Veteran’s low back disability, the examiner opined that the disability was not at least as likely as not related to the Veteran’s service. The examiner reasoned that although back issues were noted during the first period of service, the Veteran was admitted for reenlistment with normal clinical examinations in December 1978 and again in February 1981. As a result, the Veteran’s back issues in service were acute and resolved. Further, the examiner explained, although the Veteran endorsed having or having had recurrent back pain on his February 1983 separation examination, there was no discussion or notes of this from the examining physician and examination was negative. After considering the record and examining the Veteran, the examiner indicated that it was highly unlikely that a back condition having its origins as early as 1983 would not manifest sooner than 2006 and thus the Veteran’s current lumbar spine disabilities were less likely than not due to or incurred in service. The examiner explained that age is the lead indicator of risk for degenerative changes of the spine; approximately 50 percent of males will have degenerative spine disease by the age of 50. Regarding the Veteran’s cervical DJD, the June 2020 VA examiner opined that the disability was not at least as likely as not related to the Veteran’s service. The examiner indicated that no neck issue was noted on the Veteran’s separation examination in 1983 and there was no care proximate to service. Because there was no evidence of neck issues until 2006, the VA examiner concluded that it was less likely than not that the Veteran’s current neck disability was incurred in or related to service. Further, the examiner explained that there is no anatomical connection by which the Veteran’s low back conditions could have impacted the Veteran’s neck conditions, especially the degenerative changes. For that reason, the examiner opined, it was not at least as likely as not that the Veteran’s cervical DJD and DDD was due to the Veteran’s lumbosacral strain and DJD. 1. Entitlement to service connection for DJD of the lumbosacral spine The Veteran contends that his DJD of the lumbosacral spine is the result of multiple back injuries during active service, was shown as chronic in service, or was noted in service with continuity of symptomatology since that time. See, e.g., April 2020 Appellate Brief. As a preliminary matter, the Board finds that DJD of the lumbosacral spine was not present during active service nor was it manifest to a compensable degree within one year of separation. As detailed above, in-service x-rays of the lumbar spine were negative, affirmatively establishing that arthritis was not present at that time. Moreover, upon examinations at the Veteran’s separation in May 1975, December 1980, and February 1983, his spine was examined and affirmatively found to be normal on each occasion. Based on this evidence, the Board finds that a chronic low back disability, to include arthritis, was not present during active duty or manifest to a compensable degree within one year of separation. This conclusion is strengthened by the June 2012, August 2017, and June 2020 VA opinions to the effect that the Veteran’s back problems during active service were acute, rather than chronic, and resolved during the Veteran’s service. Moreover, the post-service clinical evidence shows that imaging studies as late as October 2006 revealed a normal spine. It was not until an August 2007 MRI, more than 20 years after the Veteran’s final period of active service, that mild facet arthrosis was identified. The Board has considered the in-service treatment records documenting multiple back complaints of back pain as well as the lay statements of record noting back pain since service but finds that such statements are not competent to establish the presence of arthritis in service or within one year of separation from active duty, nor are they competent to attribute the Veteran’s symptoms to arthritis. See Jandreau v. Nicholson, 492 F.3d 1372, 1376–77 (Fed. Cir. 2007). Questions of competency notwithstanding, the Board assigns more probative weight to the findings of the VA clinicians given the clinical expertise and the rationale supporting those opinions. The Board also finds that the preponderance of the evidence shows that the Veteran’s current DJD of the lumbosacral spine is not otherwise causally related to his active service. As detailed above, all VA examiners in this matter have opined that there is less than a 50 percent probability that the Veteran’s current DJD of the lumbosacral spine is causally related to his in-service injuries. All of the examiners opined that in-service injuries were resolved during the Veteran’s active service and were unrelated to the Veteran’s current DJD of the lumbosacral spine—which did not manifest until more than 20 years after the Veteran’s last period of active service. In particular, the June 2020 VA examiner explained that the nature of the current pathology indicated that the Veteran’s DJD of the lumbosacral spine was due to the natural aging process. The Board assigns the June 2020 VA opinion significant probative weight as it was based on a review of the claims folder, consideration of the Veteran’s reported medical history, a physical examination, and included a rationale with reference to relevant evidence of record. The Board has also considered the opinions of the Veteran’s primary care physician, restated in the record several times, that the Veteran’s chronic pain is associated with musculoskeletal injury during the Veteran’s active service and that those injuries contributed to the Veteran’s chronic pain and significant degenerative arthritis. The Board finds that this opinion is entitled to less probative weight because the physician did not provide any rationale to support the conclusion. See Nieves-Rodriguez v. Peak, 22 Vet. App. 295, 304 (2008) (“[M]edical opinion is [not] entitled to any weight . . . if it contains only data and conclusions.”). Similarly, the Board has considered the Veteran’s contentions to the effect that his multiple back injuries in service caused his current DJD of the lumbosacral spine. As a layperson, however, the Veteran is not competent to provide an opinion on the etiology of the current DJD because it would involve medical inquiry into biological processes, anatomical relationships, and physiological functioning. Such internal physical processes are not readily observable and are not within the competence of the Veteran in this case, who has not been shown by the evidence of record to have had medical training or skills. See Jandreau, 492 F.3d at 1376–77. In light of all of the evidence of record, the Board finds that the preponderance is against finding a medical nexus and therefore service connection is not warranted. For the foregoing reasons and bases, the Board concludes that the preponderance of the evidence is against the claim of service connection for DJD of the lumbosacral spine. Under these circumstances, the benefit-of-the-doubt rule does not apply. 2. Entitlement to service connection for DJD of the cervical spine. The Veteran contends that his current DJD of the cervical spine was proximately caused by or aggravated by his DJD of the lumbosacral spine. As a preliminary matter, the Board finds that DJD of the cervical spine was not present during active service nor was it manifest to a compensable degree within one year of separation. As detailed above, the Veteran’s in-service x-rays were negative, and upon examination at the Veteran’s separation in May 1975, December 1980, and February 1983, his spine and neck were examined and affirmatively found to be normal. In this regard, the Board has considered the in-service treatment records documenting multiple neck and spine injuries and complaints of neck pain. However, the assessment of those injuries and episodes of pain were generally spasm or strain, and x-ray imaging to assess those injuries was negative. Further, the Veteran’s spine and neck were examined and found to be normal at each of his separation examinations. Thus, the probative evidence of record shows that any conditions of the cervical spine due to in-service injuries were short-term and resolved during the Veteran’s periods of active service. The Board has considered the Veteran’s contentions that his current DJD of the cervical spine manifested during service, but the Board notes that as a layperson, the Veteran is not competent to diagnose such disability. See Jandreau, 492 F.3d at 1376–77. The post-service clinical evidence is also silent for any findings, treatment, or diagnosis of DJD of the cervical spine in the first year following separation from active duty. In this regard, the Veteran told VA providers that extensive imaging studies in October 2006 were normal. It was not until a January 2011 MRI, more than 20 years after the Veteran’s final period of active service, that DDD and facet arthrosis were diagnosed. In addition, the evidence does not contain notations of DJD during service with continuity of symptomatology since that time. As explained, the service treatment records include negative findings of x-rays and there were no notations of DJD in service or within the year following service. For these reasons, the preponderance of the evidence is against finding that the Veteran’s current DJD of the cervical spine had its inception during active duty, was manifest to a compensable degree within one year of separation, or was present on a continuous basis since service. The Board also finds that the preponderance of the evidence shows that the Veteran’s current DJD of the cervical spine is not otherwise causally related to active service. As detailed above, all VA examiners in this matter have opined that there is less than a 50 percent probability that the Veteran’s current DJD of the cervical spine is causally related to his in-service injuries. The examiners opined that in-service injuries were resolved during the Veteran’s active service and were unrelated to the Veteran’s current DJD of the cervical spine—which did not manifest until more than 20 years after the Veteran’s last period of active service. In particular, the October 2019 VA examiner indicated that the Veteran’s DJD of the cervical spine was due to the natural aging process. The VA examiners based their opinions on reasoned rationale and a thorough review of and reference to relevant evidence of record. In this regard, the Board has also considered the opinion of the Veteran’s primary care physician, restated in the record several times, that the Veteran’s chronic pain is associated with musculoskeletal injury during the Veteran’s active service and that those injuries contributed to the Veteran’s chronic pain and significant degenerative arthritis. The Board finds that this opinion is entitled to less probative weight because the physician did not provide any rationale to support the conclusion. See Nieves-Rodriguez, 22 Vet. App. at 304 (“[M]edical opinion is [not] entitled to any weight . . . if it contains only data and conclusions.”). Similarly, the Board has considered the Veteran’s contentions to the effect that his multiple injuries in service caused his current DJD of the cervical spine. As a layperson, however, the Veteran is not competent to provide an opinion on the etiology of the current DJD because it would involve medical inquiry into biological processes, anatomical relationships, and physiological functioning. Such internal physical processes are not readily observable and are not within the competence of the Veteran in this case, who has not been shown by the evidence of record to have had medical training or skills. See Jandreau, 492 F.3d at 1376–77. Questions of competency notwithstanding, the Board assigns more probative weight to the findings of the VA clinicians given the clinical expertise and the rationale supporting those opinions. The Board also finds that the preponderance of the evidence is against awarding service connection on a secondary basis. Although the Veteran has contended that his DJD of the cervical spine was caused by or aggravated by DJD of the lumbosacral spine, as discussed above the claim of entitlement to service connection for DJD of the lumbosacral spine is denied. It therefore cannot form the basis of an award of service connection for DJD of the cervical spine on a secondary basis. In light of all of the evidence of record, the Board finds that the preponderance is against finding a medical nexus and therefore service connection is not warranted. For the foregoing reasons and bases, the Board concludes that the preponderance of the evidence is against the claim of service connection for DJD of the cervical spine. Under these circumstances, the benefit-of-the-doubt rule does not apply. K. Conner Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Hillan Sosa, Associate 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.