Citation Nr: 21010558 Decision Date: 02/25/21 Archive Date: 02/25/21 DOCKET NO. 16-47 989 DATE: February 25, 2021 ORDER Entitlement to service connection for a back disability to include nerve damage (previously claimed as a back strain and lumbago) is denied. Entitlement to service connection for a left knee disability is denied. Entitlement to service connection for a right knee disability is denied. FINDINGS OF FACT 1. The preponderance of the evidence weighs against finding that the Veteran’s back disability with possible nerve damage is causally related to active service, to include as due to in-service treatment for a back strain and lumbago. 2. The evidence of record demonstrates that the Veteran’s bilateral knee disability did not manifest in service or for many years thereafter and is not otherwise related to any in service injury, event, or disease. CONCLUSIONS OF LAW 1. The criteria for establishing entitlement to service connection for a back disability to include nerve damage (previously claimed as a back strain and lumbago) have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2014); 38 C.F.R. §§ 3.102, 3.303 (2018). 2. The criteria for establishing entitlement to service connection for a bilateral knee disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2014); 38 C.F.R. §§ 3.102, 3.303 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had honorable active duty service with the United States Army from September 1975 to March 1976, and from February 1981 to July 1986. In December 2015 and August 2018, the Veteran and witnesses testified at a hearing before a Veterans Law Judge. Transcripts of both hearings have been associated with the claims file. Pursuant to a January 2019 Board decision, this matter was remanded for additional development to include scheduling the Veteran for new VA examinations and affording the agency of original jurisdiction (AOJ) the opportunity to consider newly submitted evidence. As the requested development is now complete, this matter has been returned to the Board for appellate consideration. Duty to Assist and to Notify VA is required to notify a claimant of what information or evidence is necessary to substantiate the claim; what subset of the necessary information or evidence, if any, the claimant is to provide; and what subset of the necessary information or evidence, if any, the VA will attempt to obtain. 38 C.F.R. § 3.159(b) (2018). Copies of compliant VCAA notices were located in the claim’s file. VA’s duty to assist includes providing a thorough and contemporaneous medical examination, especially where it is necessary to determine the current level of a disability. Peters v. Brown, 6 Vet. App. 540, 542 (1994). In this case, neither the Veteran nor his representative has raised any issues with the duty to notify or duty to assist. 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 duty to assist argument). Thus, upon careful review of the file, the Board finds that all necessary development has been accomplished, and therefore appellate review may proceed without prejudice to the Veteran. See Bernard v. Brown, 4 Vet. App. 384 (1993). Service connection, generally Service connection may be granted for any current disability that is the result of a disease contracted or an injury sustained while on active duty service. 38 U.S.C. § 1110, 1131 (2014); 38 C.F.R. §§ 3.303 (a), 3.304 (2018). Entitlement to service connection benefits is established when the following elements are satisfied: (1) the existence of 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 disease or injury incurred or aggravated during service (the medical ‘nexus’ requirement). See Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); 38 C.F.R. § 3.303 (a) (2018). Service connection also is permissible on a secondary basis for disability that is proximately due to, the result of, or aggravated by a service-connected disability. 38 C.F.R. § 3.310 (a) and (b) (2018). See also Allen v. Brown, 7 Vet. App. 439, 448 (1995). In order to prevail on the issue of entitlement to secondary service connection, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and, (3) nexus evidence establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). Furthermore, in determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107 (2014); 38 C.F.R. § 3.102 (2018); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of the matter, the benefit of the doubt will be given to the Veteran. Id. The Board notes that it has thoroughly reviewed the record in conjunction with this case. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, the extensive evidence submitted by the Veteran or on his behalf. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (the Board must review the entire record but does not have to discuss each piece of evidence). Rather, the Board’s analysis below will focus specifically on what the evidence shows, or fails to show, on the claim. See Timberlake v. Gober, 14 Vet. App. 122, 129 (2000) (noting that the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive and provide the reasons for its rejection of any material evidence favorable to the claimant). Lay evidence, if competent and credible, may serve to establish a nexus in certain circumstances. See Davidson v. Shinseki, 581 F.3d 1313 (2009) (noting that lay evidence is not incompetent merely for lack of contemporaneous medical evidence). When considering whether lay evidence may be competent, the Board must determine, on a case by case basis, whether the Veteran’s particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007) (holding that “[w]hether lay evidence is competent and sufficient in a particular case is a factual issue. 1. Entitlement to service connection for a back disability to include nerve damage (previously claimed as back strain and lumbago) The Veteran contends that his low back condition is causally related to active service. As discussed in more detail below, the preponderance of the evidence is against his claim. In analyzing the Veteran’s claim, the threshold inquiry before the Board is whether the Veteran’s current diagnosis was incurred in or otherwise casually related to active service, to include as due to an in-service injury or disease. While the Board acknowledges that the Veteran has a current diagnosis of degeneration of the lumbar spine, and the record shows in-service treatment for a lumbar strain, the preponderance of the evidence weighs against finding that his current lumbar spine condition is casually related to active service, to include as due to an in-service injury, event or disease. As a preliminary matter, the Board observes that service treatment records were found for the Veteran’s second period of service only. At enlistment, no abnormalities impacting the back or bilateral knees were identified. A report of medical history included a statement that the Veteran was in good health. No complaints of recurrent back, knee or joint pain were reported. Thereafter, only a single reference to a low back condition was indicated. In May 1985, a primary care clinic record listed back pain with heavy lifting. Other symptoms included swelling in the right side of the face, right knee and heel pain. On physical examination, the Veteran denied any experience with back spasms or centralized tenderness. His range of motion was described as good. A possible low back strain was identified. No other diagnosis was indicated. At separation, normal physical findings were reported in June 1986. The comments section referenced a mild low back strain following strenuous physical training exercises. According to the Veteran, he received treatment following the initial injury with no additional symptoms over the prior 8-month period. A report of medical history, also dated June 1986, referenced recurrent back pain. Negative responses were reported for the inquiry regarding a trick or lock knee, bone joint or other deformity. In August 1986, a nursing clinical record noted complaints of a popping sensation in the lower back after lifting a 55-gallon drum. Pain impacted the middle of lower back and around both sides. The Veteran endorsed a previous in-service injury to the low back on or about 1984. Post-service treatment records show treatment for low back pain. In November 2002, radiological imaging revealed minimal osteoarthritis at L3, L4 and L5. The spinous processes, pedicles and transverse processes were normal. The sacroiliac joints were also normal, bilaterally. Loss of the normal lordosis was indicated. The Veteran endorsed an experience with muscle spasms. A primary care treatment record, dated May 2003, referenced episodic low back pain. During the clinical interview, the Veteran reported an in-service low back injury following a parachute jump in 1986. Current symptoms included severe low back pain with exacerbation 1 or 2 times per year. Prescribed treatments include oral medication - Percocet. After onset, pain required him to miss work for several days. According to the Veteran, magnetic resonance imaging (MRI) of the lumbar spine was conducted at a hospital in Florida in 1997. Two herniated discs were reportedly observed. In November 2002, X-ray films of the lumbar spine revealed minimal osteoarthritis, L3, L4 and L5. The spinous processes, pedicles and transverse processes were normal. The sacroiliac joints were also normal, bilaterally. Loss of the normal lordosis and muscle spasms were indicated. Complaints of low back pain and lumbago were listed as current conditions in March and May 2003. Prescribed medications include, Cyclobenzaprine. In April 2009, an orthopedic surgery consultation considered the Veteran’s report of chronic lower back pain. During clinical interview, he endorsed a period of active service as an infantryman. Post-service, the Veteran worked as a blacksmith. Performance of his official duties required prolonged walking, standing, persistent bending and leaning, as needed to place horseshoes. Complaints of low back pain with spinal tenderness and decreased range of motion were listed in a primary care treatment record, dated February 2010. During the clinical evaluation, the Veteran reported worsening pain over the previous few weeks. He denied any recent history of fall or injury. Mild pain relief was endorsed with use of oral medication, Etodolac. On examination in February 2012, a current diagnosis of a lumbar strain was indicated. The dates of diagnosis were listed as 1985 and 2003. During the clinical interview, the Veteran reported an initial instance of low back pain due to heavy lifting while loading an airplane in-service. He denied seeking medical attention. Current symptoms include flare-ups of pain twice per year. To treat pain the Veteran used heat therapy, rest and oral medication, Percocet. Range of motion testing revealed forward flexion limited to 60 degrees, extension limited to 20 degrees, left and right lateral flexion and left and right lateral rotation limited to 20 degrees. Pain was observed with all ranges of motion. No additional loss of range of motion was reported with repetitive use testing. Functional loss was described as less movement than normal, weakened movement, pain with movement, and interference with sitting, standing and weight-bearing. Localized tenderness or pain to palpation was described as tenderness to midline of the lumbar spine at L3-L5. Guarding and muscle spasms were suggested, with no evidence of an abnormal gait or spinal contour. Muscle strength testing yielded normal findings. There was no evidence of muscle atrophy. Sensation and deep tendon reflexes were normal. Straight leg raise testing was positive on the right side only. There was no evidence of radiculopathy, neurological abnormalities or intervertebral disc syndrome. The Veteran denied use of assistive devices. Diagnostic testing confirmed degenerative arthritis. Functional impact was described as difficulty lifting over 10 pounds with increased pain after walking more than 2 blocks. Following the clinical evaluation, the examiner opined that it was less likely than not that the Veteran’s lumbar strain and lumbar degeneration is causally related to active service, to include as due to in-service treatment for a lumbar strain. In support of the stated conclusion, the examiner noted that the Veteran received in-service treatment for an upper back strain in September 1985 and returned to full duty. Post-service treatment records show complaints of low back pain beginning in 2003. Some document the Veteran’s lay assertions regarding an in-service injury following a parachute jump in 1985 or 1986. Military personnel records make no reference to any such injury or related treatment. According to the Veteran, he was treated for low back pain in 1997, which included a referral for magnetic resonance imaging (MRI). He suggested that two herniated discs were discovered. Available medical evidence does not confirm the reported treatment or diagnostic findings. Moreover, even if the alleged findings had been shown, the conclusions were noted more than 10 years after separation. Accordingly, no etiological linkage to active service was established. In October 2016, degeneration of the lumbar intervertebral disc (IVDS) was listed as a current condition. In a private medical opinion, dated October 2017, a current diagnosis of degenerative disc disease (DDD) of the lumbar spine was rendered. The physician suggested that the condition was causally related to the Veteran’s period of active service. In support of the stated conclusion, the opinion merely acknowledged a report of in-service treatment for a lumbar strain in 1985 and suggested that the Veteran’s current symptoms were consistent with that injury. A similar opinion was offered by the same physician one year later. In September 2018, a primary care physician’s note referenced complaints of an in-service injury to the low back and bilateral knees. During the clinical interview, the Veteran reported involvement in an accident while loading a mobilizer into a galaxy. He states that the strut broke causing him to fall to his knees, where he was subsequently dragged. Thereafter, frequent bouts of knee and back pain were reported. In multiple Board hearings with related lay statements, the Veteran testified regarding in-service back and bilateral knee injuries. Specifically, he reported an in-service accident involving loading vehicles to be placed on mobilizers. The Veteran also reported a fall due to a parachute jump. He suggested an in-patient hospitalization related to his injuries. Pursuant to a January 2019 Board remand decision, this matter was remanded for further development to include obtaining an addendum opinion which addressed favorable medical evidence, to include treatment records suggesting complaints of low back pain in August 1986. In October 2019, the Veteran was afforded an additional VA examination. Current diagnoses were listed as a back strain (resolved) and degenerative arthritis of the spine. During the clinical interview, the Veteran reported an in-service injury to the low back while on serving with the Joint Services Special Operations Command at MacDill Air Force Base in 1983 or 1984. Reportedly, he was moving heavy communications equipment on a mobilizer when the strap broke causing something in his back to snap. According to the Veteran, he fell to his knees because the vehicle was pulling him. Following the incident, he was treated at sick call and provided oral medication, Percocet was prescribed to treat back pain. The Veteran reported several profiles were granted due to pain, with no further history of treatment. In 1986, he separated from active service and continued to experience low back pain. The Veteran endorsed treatment at multiple VA medical facilities, which included physical therapy. In the 1990s, he received treatment at a hospital in Florida for multiple herniated discs in his back and neck. The Veteran acknowledged use of a transcutaneous electrical nerve stimulation (TENS) unit to treat pain. Pain was described as constant and impacted the muscles in his side. Difficulty with prolonged walking and standing was reported. Episodic bouts with severe pain occurred 4 or 5 times per year, with nausea and a popping sensation while bending. At times, pain impaired the Veteran’s ability to ambulate for up to two weeks. Range of motion testing revealed forward flexion limited to 70 degrees, extension limited to 20 degrees, left and right lateral flexion limited to 25 degrees, and left and right lateral rotation limited to 30 degrees. Range of motion did not contribute to functional loss. No pain was observed on examination, to include with weight-bearing. There was no evidence of localized tenderness or pain on palpation of the lumbar spine. No additional functional loss was observed with repetitive use testing. Pain impaired the Veteran’s functional ability over time however, it could not be quantified in terms of loss of range of motion. The Veteran denied any experience with muscle spasms or guarding. No additional factors were identified as contributing to the Veteran’s functional ability. Muscle strength, deep tendon reflexes and sensation was normal. There was no evidence of muscle atrophy. Straight leg raise testing was normal, bilaterally. There was no evidence of radiculopathy, intervertebral disc syndrome or ankylosis. No neurological abnormalities were identified. The Veteran denied use of assistive devices. On the date of examination, the Veteran was observed ambulating independently with a normal gait. Diagnostic testing confirmed arthritis, with no evidence of fracture. A functional impact was described as constant back pain, with flare-ups due to physical activity. The examiner suggested that pain would impair the Veteran’s ability to perform physical labor requiring heavy lifting, repetitive bending or twisting. Following the clinical evaluation, the examiner opined that it was less likely as not (less than 50 percent probability) that the Veteran’s low back condition is causally related to active service, to include as due to in-service treatment for a lumbar strain. In support of the stated conclusion, the examiner noted that service treatment records document a back strain in 1985, with no reports of continuing back problems or complaints. In his report of medical history at separation, the Veteran denied any problems with back pain over the prior 8-month period. Moreover, back strain and muscle strain injuries are the most common causes of low back pain. Generally, the back is prone to related injuries due to its weight-bearing function and overuse with repetitive motion such as twisting and bending. Although pain and inflammation can appear debilitating at the time of initial injury, more than 90 percent of patients completely recover from an episode of lumbar muscle strain or sprain within one month. Post-service, VA medical records document treatment for new complaints of back pain beginning in 2002 or 2003. At that time, X-ray films document muscle spasm (back strain) as well as minimal osteoarthritis consistent with age. Subsequent radiological imaging documented degenerative changes with associated disc bulging without any evidence of previous bony injury. Similarly, degenerative disc disease commonly results from water loss and age-related wear and tear. In August 2020, an addendum opinion was prepared. Therein, the examiner acknowledged review of newly submitted treatment records. They included evidence of treatment for an acute back injury (new and separate back strain with muscle spasm) that occurred when the Veteran attempted to lift a 55-gallon drum in August 1986. A reference to a previous in-service back injury, in 1984, was also noted. Per his DD-214, the Veteran was discharged from military service in July 1986 and was therefore no longer on active duty at the time of the injury in August 1986. Considering the above, to include the newly submitted treatment evidence, the evidence is silent for any sequelae between the Veteran’s in-service lumbar strain and his current complaints of symptoms. As previously noted, muscle injuries resolve spontaneously and do not cause vertebral/disc degeneration. In making all determinations, the Board has fully considered all medical evidence and lay assertions of record. Although the Veteran’s competence to report on his current symptoms and their onset, there is no evidence that he possesses the specialized skills and expertise necessary to render complex medical opinions or opine as to the nature and etiology of his current symptoms. Layno v. Brown, 6 Vet. App. 465, 470 (1994); see also Jandreau v. Nicholson, 492 F.3d 1372, 1377. Further, mere conclusory or generalized lay assertions that an in-service event or illness caused a current disability are insufficient to establish nexus in the absence of competent medical evidence. Waters v. Shinseki, 601 F.3d 1274, 1278 (2010). In this case, service treatment records document treatment for an acute episode of a back strain with no evidence of a chronic condition or long-term disability. Post- service treatment records show new and separate instances of treatment for a lumbar strain several months after separation and again, years later in 2003. There is no evidence of persistent symptoms or a chronic condition dating back to active service. X-ray films confirm osteoarthritis in November 2002 and degeneration of the lumbar discs in October 2016. In multiple lay statements, the Veteran has reported several in-service injuries. They include being dragged while loading a military vehicle, parachute jumping, and low back pain as incident to strenuous physical exercise. He also reported a period of in-service hospitalization. According to the Veteran, he has current diagnoses including a lumbar strain, degenerative disc disease, and scoliosis. However, review of service treatment records found no evidence of hospitalization related to a lumbar spine or bilateral knee condition. In fact, the first indication of an in-patient hospitalization occurred in January 2000; when the Veteran was treated for drainage and removal of a left axilla abscess with cellulitis. Moreover, the Veteran’s military personnel records listed his official occupation as automatic data communications center operator and infantryman. There is no evidence that his official duties included parachute jumping. Considering the above, the Board finds the Veteran’s lay assertions internally inconsistent. In addition, the Veteran has been afforded multiple VA examinations. At no time has his previous diagnoses, to include a lumbar strain and degeneration of the lumbar spine, been etiologically linked to active service, to include as due chronic symptomology related to an injury sustained therein. Moreover, the VA examiners indicated that lumbar strains and muscle sprains are a common occurrence with active motion and typically resolve within one month after onset. Similarly, lumbar spine degeneration is a progressive condition that develops over time, to include as a natural outgrowth of the aging process. While the Board acknowledges the Veteran’s in-service treatment for a lumbar strain, there is no evidence of a permanent disability or chronic symptomology related thereto. In fact, the record show multiple instances of re-injury in post-service treatment records. A diagnosis of lumbar spine degeneration was first noted more than 2 decades after separation. Although the Board is sympathetic to the Veteran’s subjective belief that his low back condition is causally related to active service, to include in-service treatment for a lumbar strain, the evidence of record does not support his contention. Accordingly, as the preponderance of the evidence is against the claim, the provisions of 38 U.S.C. § 5107 (b) regarding reasonable doubt are not applicable. The claim of entitlement to service connection for a low back disability to include nerve damage must be denied. 2. Entitlement to service connection for a bilateral knee disability (previously claimed as a left and right knee condition) The Veteran contends that his bilateral knee condition is causally related to active service. In considering the Veteran’s claim, the threshold inquiry before the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has a current diagnosis of degenerative arthritis of the bilateral knees, the preponderance of the evidence weighs against finding that the Veteran’s current condition is etiologically related to active service. Service treatment records are silent for pain, treatment or a diagnosis of a bilateral knee condition. Post-service treatment records show periodic complaints of knee pain. In September 1986, a primary care clinic record listed back pain with heavy lifting, right side of the face swelling, and right heel/knee pain. Years later, X-ray films, revealed osteoarthritis at the patellofemoral joint in February 2006. In April 2009, an orthopedic surgery consultation referenced a history of prolonged bilateral knee pain with intermittent swelling. Worsening symptoms impacted the left knee. Prolonged sitting and standing caused increased pain. A physical examination revealed tenderness over the joint line of the knee. Oral medications, Tylenol and Etodolac, were prescribed to treat pain. In October 2008, the Veteran’s clinical history referenced a history of left knee pain with swelling and a “giving out” sensation. An MRI of the right knee indicated that the medial and lateral menisci, anterior and posterior cruciate were intact. No medial or lateral collateral ligament abnormalities were observed. Moderate chondromalacia was observed at the patella, with thinning of the articular cartilage and posterior patellar bone. An orthopedic outpatient record, dated November 2009, noted radiological finding of the bilateral knee, with degenerative joint disease and medial loading. The Veteran was advised regarding use of bilateral knee braces. Tylenol was used to treat pain. Subsequent X-rays, dated October 2010, revealed new small supra patellar osteophytes in the bilateral knees. Joint spacing of the medial and lateral compartments were symmetric and well-maintained. Current diagnoses of arthralgia of the knee were rendered in August 2011 and osteoarthritis of the bilateral knee in September 2018. A nursing note, dated September 2013, listed pain in the bilateral shoulders and knees. Suspicion of bilateral knee arthralgia was indicated. In September 2018, a primary care treatment record referenced an in-service injury to the low back and bilateral knee. Specifically, the Veteran suggested he was injured while loading a mobilizer onto a galaxy during active service. He contends that a strut broke, causing him to fall to his knew where he was dragged by a vehicle. No specific treatment for his alleged injuries was identified. A private physician’s opinion, dated October 2018, indicated that the Veteran’s bilateral knee osteoarthritis was casually related to active service. In support of the noted conclusion, the physician merely suggested that his current complaints of symptoms were consistent with duties performed during active service. Pursuant to a January 2019 Board remand decision, the Veteran was afforded a VA examination of the bilateral knees. On examination in October 2019, a current diagnosis of degenerative arthritis of the bilateral knees was indicated. The dates of diagnosis were listed as 2008 for the right knee and 2006 for the left. During the clinical interview, the Veteran reported an in-service injury to the bilateral knees when a strap securing heavy communications equipment broke. At the time, he was attempting to load the equipment onto a mobilizer. Reportedly, he felt a snap in his back and fell to his knees, where he was dragged by a vehicle. Thereafter, the Veteran was reportedly evaluated and treated with ice packs and cortisone injections in both his knees. No other treatment was reported. Since separation, the Veteran experienced frequent bouts with bilateral knee pain. He sought treatment at numerous VA medical facilities between 2006 and 2010. Current symptoms include constant bilateral knee pain, with worsening symptoms on the right side. Prolonged walking, standing, and climbing caused increasing pain. The Veteran also acknowledged bouts with swelling and popping. Oral medication and ice packs were used to treat pain. The Veteran denied any experience with flare-ups or functional loss. Range of motion of the bilateral knees were normal with no evidence of pain on examination. There was no evidence of pain with weight-bearing, localized tenderness, pain on palpation of the joint, or crepitus. Neither pain, weakness, fatigability or incoordination significantly limited the Veteran’s functional ability over time. Muscle strength testing was normal with no evidence of muscle atrophy or ankylosis. Joint stability testing was normal, with no evidence of recurrent subluxation, lateral instability, or recurrent effusion. No additional conditions were observed, to include a recurrent patellar dislocation or meniscus condition. On the date of examination, the Veteran ambulated well with a normal gait. He denied use of assistive devices. Diagnostic testing confirmed osteoarthritis in the bilateral knees. No functional impact was indicated. The Veteran remained able to perform duties related to the Veteran’s post-service employment as a blacksmith. X-ray films revealed minimal left knee degenerative joint disease. Other imaging revealed mild degenerative changes, primarily involving both patellofemoral spaces, small area of periosteal reaction along the proximal posterior right tibia, bilateral joint space narrowing. In making all determinations, the Board has fully considered all medical evidence and lay assertions of record. Generally, the Veteran is presumed competent to report on the onset of current symptoms, their impact on daily living and employment, and such reporting is deemed credible. However, in the absence of proof of medical expertise, he is not qualified to offer a complex etiological opinion. While the Board recognizes the Veteran’s report of bilateral knee pain dating back to active service and suggests in-service treatment, there is no evidence of any such treatment or chronic symptomology. Moreover, the Veteran’s post-service employment history included work as blacksmith where his core duties included repetitive bending, twisting, and prolonged sitting and standing. Although the Veteran’s treatment history includes a favorable diagnosis of bilateral knee osteoarthritis; the diagnosis was rendered almost two decades after separation. While the Board is sympathetic to the Veteran’s subjective belief that his bilateral knee condition is causally related to active service, the evidence of record does not support his contentions. In this case, the Board affords greater probative weight to the VA examiner’s negative opinion regarding etiology, absence of in-service treatment, or evidence of a chronic bilateral knee condition. Moreover, the Veteran’s post-service employment history included years of work as a blacksmith. Performance of his official duties required routine bending, twisting, kneeling, prolonged walking and standing. Under the circumstances, the Veteran’s current condition cannot be logically related to his period of active service. Since the preponderance of the evidence is against the claim, the provisions of 38 U.S.C. § 5107 (b) regarding reasonable doubt are not applicable. The Veteran’s claim of entitlement to service connection for bilateral knee disability must be denied. B. MULLINS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board N. Whitaker, 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.