Citation Nr: 21010583 Decision Date: 02/25/21 Archive Date: 02/25/21 DOCKET NO. 17-63 574 DATE: February 25, 2021 ORDER Entitlement to an effective date prior to October 20, 2014 for service connection of degenerative changes, cervical spine C4-5 and C5-6 is denied Entitlement to a rating higher than 20 percent for degenerative changes, cervical spine C4-5 and C5-6 is denied. Entitlement to service connection for a traumatic brain injury (TBI) is denied. FINDINGS OF FACT 1. On October 20, 2014, the Veteran filed a formal claim for service connection for degenerative changes of the cervical spine; there were no prior formal or informal claims for the cervical spine pending. 2. Degenerative changes of the cervical spine is not manifested by forward flexion limited to 15 degrees or less, or the functional equivalent thereto, nor is there evidence of favorable ankylosis of the entire cervical spine or bedrest prescribed by a physician. 3. A TBI was not sustained during service and TBI residuals were not manifested during service and are not otherwise attributable to service. CONCLUSIONS OF LAW 1. The criteria for an effective date prior to October 20, 2014 for service connection of degenerative changes, cervical spine C4-5 and C5-6 have not been met. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. 2. The criteria for a rating higher than 20 percent for degenerative changes of the cervical spine have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a Diagnostic Code 5242. 3. The criteria for service connection for a traumatic brain injury (TBI) have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served honorably in the United States Army from June 1974 to October 1995. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from June 2012, April 2015, and October 2017 rating decisions of the Department of Veterans’ Affairs (VA) Regional Office (RO). This matter is being adjudicated under the legacy appellate framework. In the substantive appeals perfecting these issues to the Board, the Veteran declined a personal hearing before the Board. The Veteran’s claim for service connection for a TBI was previously before the Board, and, in July 2019, the Board remanded the matter for further development. Further development in substantial compliance with the Board’s previous remand instructions has been completed. 1. Entitlement to an effective date prior to October 20, 2014 for service connection of degenerative changes, cervical spine C4-5 and C5-6 is denied. The Veteran is seeking an effective date earlier than October 20, 2014 for the grant of service connection for his cervical spine disability. The effective date of an evaluation and grant of compensation will be the date of receipt of the claim or the date entitlement arose, whichever is the later. See 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400. The effective date for a grant of service connection is the day following the date of separation from active service or the date entitlement arose, if the claim is received within one year after separation from active service; otherwise date of receipt of claim, or date entitlement arose, whichever is later. See 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400(b)(2)(i). A “claim” is a formal or informal communication in writing requesting a determination of entitlement or evidencing a belief in entitlement to a benefit. See 38 C.F.R. § 3.1 (p). “Date of receipt” of a claim, information, or evidence means the date on which a claim, information, or evidence was received by VA. See 38 C.F.R. § 3.1 (r). The Board notes that, effective March 24, 2015, VA amended its adjudication regulations to require that all claims governed by VA’s adjudication regulations be filed on standard forms prescribed by the Secretary (i.e., VA Form 21-526). 38 U.S.C. § 5101(a); 38 C.F.R. § 3.151(a). This rulemaking also eliminated the constructive receipt of VA reports of hospitalization or examination and other medical records as informal claims for increase and revised 38 C.F.R. § 3.400(o)(2). These amendments, however, are only applicable with respect to claims and appeals filed on or after March 24, 2015 and are not applicable in the present case. See 79 Fed. Reg. 57,660, 57,686 (Sept. 25, 2014). As such, any documented communication from, or action by, a veteran indicating intent to apply for a benefit under laws administered by VA may be considered an informal claim. See 38 C.F.R. § 3.155(b). To determine when a claim was received, the Board must review all communications in the claims file that may be construed as an application or claim. See Quarles v. Derwinski, 3 Vet. App. 129, 134 (1992). Upon review of the record, the Board finds that an effective date earlier than October 20, 2014 is not warranted for the grant of service connection for the cervical spine disability. Notably, VA has a duty to determine the breadth of a claim from intent and the evidence of record. The claimant’s intent in filing a claim is paramount to construing its breadth especially because the claimant knows what symptoms are causing the disability. Here, based upon the evidence, the claim and the pleadings, the Board finds that there was no intent to file a claim for residuals of a cervical spine disability prior to October 20, 2014. Prior to October 20, 2014, there are medical records, correspondence, and claims dating back to the Veteran’s discharge from service. These do not contain any complaints of a cervical spine disability related to service. Notably, the Veteran first reported having neck pain in 2003, after a bookshelf fell on his head. There was no evidence at that time or until October 20, 2014 that the Veteran believed he was entitled to a benefit based on a cervical spine disability. The Board also finds that the medical evidence of record is insufficient to establish an earlier effective date. The mere existence of such records generally cannot be construed as an informal claim; rather, there must be some intent by the claimant to apply for a benefit. See Criswell v. Nicholson, 20 Vet. App. 501, 504 (2006). Furthermore, in the absence of a sufficient manifestation of intent to apply for benefits for a particular disease or injury, a document providing medical information which refers to a disability in and of itself is not an informal claim for VA benefit. Ellington v. Nicholson, 22 Vet. App. 141, 145-46 (2007). In addition, a veteran’s attempt to obtain treatment does not comprise a claim. Dunson v. Brown, 4 Vet. App. 327, 330 (1993). Here, although VA was in possession of both VA and private treatment records related to the Veteran’s cervical spine disability prior to October 2014, there was no evidence at any point of the Veteran’s intent to apply for a benefit. Thus, the medical records received prior to October 20, 2014 do not establish either a claim or a basis for an earlier effective date. The Board has given the most favorable reading possible to the facts of this case but finds that there is no interpretation of the facts of this case which will support a legal basis for favorable action with regard to the Veteran’s claim. There was no communication or submission of evidence from the Veteran evidencing intent to apply for benefits regarding his cervical spine disability prior to October 20, 2014. Accordingly, the Board finds no basis in law or facts in this case for an earlier effective date for service connection for degenerative changes of the cervical spine. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. In reaching this conclusion, the benefit of the doubt doctrine was considered. However, as a preponderance of the evidence is against this claim this doctrine is not for application. See 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 2. Entitlement to a rating higher than 20 percent for degenerative changes, cervical spine C4-5 and C5-6 is denied. Disability evaluations are determined by evaluating the extent to which a veteran’s service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing his symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10. If two evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that evaluation; otherwise, the lower evaluation will be assigned. 38 C.F.R. § 4.7. Staged ratings are appropriate for any rating claim when the factual findings show distinct time periods during the appeal period where the service-connected disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007). The Veteran’s cervical spine disability is currently rated 20 percent disabling pursuant to 38 C.F.R. § 4.71a, Diagnostic Code 5242. Disabilities of the spine are evaluated under the General Formula for Diseases and Injuries of the Spine (General Rating Formula). 38 C.F.R. § 4.71(a), Diagnostic Codes 5235-5242. The General Rating Formula provides a 20 percent rating is for forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; or, the combined range of motion of the cervical spine not greater than 170 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 30 percent disability rating is provided for forward flexion of the cervical spine 15 degrees or less; or, favorable ankylosis of the entire cervical spine. A 40 percent disability rating is provided for unfavorable ankylosis of the entire cervical spine. A 100 percent disability rating is assigned for unfavorable ankylosis of the entire spine. Note (1) to the rating formula specifies that any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, should be separately evaluated under an appropriate diagnostic code. Note (2) (See also Plate V) provides that, for VA compensation purposes, normal forward flexion of the cervical spine is zero to 45 degrees, extension is zero to 45 degrees, left and right lateral flexion are zero to 45 degrees, and left and right lateral rotation are zero to 80 degrees. The combined range-of-motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range-of-motion of the cervical spine is 340 degrees. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range-of-motion. Note (3) provides that, in exceptional cases, an examiner may state that because of age, body habitus, neurologic disease, or other factors not the result of disease or injury of the spine, the range-of-motion of the spine in a particular individual should be considered normal for that individual, even though it does not conform to the normal range-of-motion stated in Note (2). Provided that the examiner supplies an explanation, the examiner's assessment that the range-of-motion is normal for that individual will be accepted. Note (4) instructs to round each range-of-motion measurement to the nearest five degrees. Note (5) provides that, for VA compensation purposes, unfavorable ankylosis is a condition in which the entire lumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. Under the IVDS Rating Formula (Diagnostic Code 5243), a 10 percent disability rating is assigned with incapacitating episodes having a total duration of at least 1 week but less than 2 weeks during the past 12 months; a 20 percent disability rating is assigned with incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months; a 40 percent disability rating is assigned with incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months; and a maximum 60 percent disability rating is assigned with incapacitating episodes having a total duration of at least 6 weeks during the past 12 months. Note (1) provides that an incapacitating episode is a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician. Note (2) provides that if intervertebral disc syndrome is present in more than one spinal segment, provided that the effects in each spinal segment are clearly distinct, each segment should be evaluated on the basis of incapacitating episodes or under the General Rating Formula for Diseases and Injuries of the Spine, whichever method results in a higher evaluation for that segment. As a preliminary matter, although the examinations of record failed to note passive range of motion and range of motion in non-weight-bearing conditions, the Board finds that these examinations nevertheless are adequate for VA rating purposes. Passive range of motion is the amount of motion possible when an examiner moves a body part with no assistance from the individual being evaluated. It is usually greater than active range of motion because the integrity of the soft tissue structures does not dictate the limits of movement. Comparisons between passive range of motion and active range of motion provide information about the amount of motion permitted by the associated joint structures (passive range of motion) relative to the individual’s ability to produce motion at a joint (active range of motion). Cynthia Norkin & D. Joyce White, Measurement of Joint Motion: A Guide to Goniometry 8-9 (2016). Testing the joint under weight-bearing conditions involves movement of the body against gravity. J. Randy Jinkins, et. al., Upright, Weight-bearing, Dynamic-kinetic Magnetic Resonance Imaging of the Spine: Initial Results, 15 J. Eur. Radiol. 1815-25 (2005). When evaluating range of motion, it is preferable to test in weight-bearing conditions because testing in non-weight-bearing conditions underestimates the degree of pathology present. Id. at 1823. Because there is no indication that the structural integrity of the Veteran’s spine is compromised, such that passive range of motion in this case would be more limited than active, and because testing in weight-bearing conditions is more demonstrative of the degree of pathology, the Board finds that the failure to test for limitation of motion on passive range of motion and in non-weight-bearing is not prejudicial. Therefore, there is no prejudice in evaluating the Veteran's range of motion using the available findings of active range of motion. Turning to the facts of the case, the Veteran filed a claim for service connection for his cervical spine disability in October 2014. At the December 2017 VA examination, the Veteran reported having intermittent neck pain radiating down his left arm when he rotated his head to the left. He denied having flare ups but stated that due to his intermittent pain, he had to maintain his neck in a forward flexed position in order to sleep. Range of motion testing revealed forward flexion of the cervical spine to 30 degrees and extension limited to 20 degrees. The examiner noted pain on the examination, but such pain did not result in or cause functional loss. There was no evidence of pain with weight bearing but there was evidence of pain on palpation of mid to distal cervical spinous processes. The Veteran was able to perform repetitive use testing with at least three repetitions with no additional loss of function or range of motion. The examination further revealed there was no evidence of guarding, muscle spasms or muscle atrophy. The Veteran did demonstrate some intermittent pain in the left upper extremity; however, his reflexes and sensatory touch remained intact bilaterally. At the November 2019 VA examination, the Veteran reported pain in the posterior neck without radiation of pain to the upper extremities. He described the pain as constant, jabbing, and pinching in nature. He used over-the-counter medication and topical cream to alleviate his symptoms. He denied having flare-ups but noted that he had difficulty sleeping and driving due to his neck pain. Range of motion testing revealed forward flexion and extension to 20 degrees. The examiner noted pain in all directions which did not result in or cause functional loss. While there was no evidence of pain with weightbearing, there was tenderness on palpation over the posterior neck over the mid to distal cervical spine and bilateral upper trapezius muscles. The Veteran was able to perform repetitive use testing with at least three repetitions with no additional loss of function or range of motion. There was no evidence of guarding, muscle spasms, or muscle atrophy and the Veteran demonstrated normal muscle strength bilaterally. Upon review of the evidence, the Board finds that a rating higher than 20 percent is not warranted for the Veteran’s cervical spine disability. Initially, the Board notes that a higher rating is not warranted based on incapacitating episodes for any time period during the appeal. In this regard, the Veteran has a 20 percent rating for his cervical spine disability. In order to warrant a higher rating, there must be a diagnosis of IVDS that results in incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months. Here, there is no evidence of incapacitating episodes as defined by VA regulation at any point during the appeal period. Thus, a higher rating based on incapacitating episodes is not warranted. The Board also finds against a disability rating higher than 20 percent under the General Rating Formula for Disease and Injuries of the Spine. To that end, the evidence of record is devoid of a showing of lay or medical evidence of either forward flexion of the cervical spine limited to 15 degrees or the functional equivalent thereto, or favorable ankylosis of the entire cervical spine. For definitional purposes, favorable ankylosis is defined as fixation of a spinal segment in neutral position (zero degrees). See 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, Note (5). Here, the Veteran was able to flex his cervical spine to at least 20 degrees. He denied having flare ups and was able to perform repetitive use testing with at least three repetitions with no additional loss in function or range of motion. Even considering his description of his pain on motion, any additional limitation in motion was not functionally equivalent to forward flexion limited to 15 degrees. Thus, the criteria for a rating higher than 20 percent have not been met. See Correia and Sharp, supra. While he demonstrated some loss of motion in all directions, there was no evidence of muscle guarding, atrophy, or spams. Ultimately, the Board finds that the Veteran’s symptoms, to include his limitation in motion, are adequately contemplated by the currently assigned 20 percent rating. In reaching these conclusions, the Board has considered the requirements of 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca v. Brown, 8 Vet. App. 202, 204-07 (1995). To the extent that the Veteran reports cervical spine pain, the Board finds that the current rating contemplates periarticular pathology productive of painful motion. 38 C.F.R. § 4.59. The Board has considered all potentially applicable provisions of 38 C.F.R. Parts 3 and 4, whether or not they have been raised by the appellant or his representative, as required by Schafrath v. Derwinski, 1 Vet. App. 589 (1991). The Board, however, has found no section that provides a basis upon which to assign a higher disability rating for his cervical spine disability. The Board acknowledges the Veteran’s assertions that his disability is more severe than evaluated. The Veteran is competent to report his symptoms and has presented credible descriptions of his disability. Layno v. Brown, 6 Vet. App. 465, 469 (1994). The Board finds, however, that neither the lay nor medical evidence demonstrates that the criteria for the next higher evaluations have been met, i.e. forward flexion limited to 15 degrees or the functional equivalent thereto, or favorable ankylosis of the entire cervical spine. The Veteran’s descriptions of reduced range of motion are credible as reflected by his schedular rating for motion loss. However, the Veteran does not describe fixed motion. The more probative evidence is that prepared by neutral skilled professionals, and such evidence demonstrates that the Veteran’s cervical spine is not manifested, or more nearly approximate, forward flexion to 15 degrees or favorable ankylosis of the entire cervical spine. Finally, under Johnson v. McDonald, 762 F.3d 1362 (Fed.Cir. 2014), a veteran may be awarded an extraschedular rating based upon the combined effect of multiple conditions in an exceptional circumstance where the evaluation of the individual conditions fails to capture all the service-connected disabilities experienced. In this case, however, even after applying the doctrine of reasonable doubt, there are no additional service-connected disabilities that have not been attributed to a specific service-connected condition. Accordingly, this is not an exceptional circumstance in which extraschedular consideration may be required to compensate the Veteran for a disability that can be attributed only to the combined effect of multiple conditions. In sum, the evidence deemed most probative by the Board establishes that the Veteran’s cervical spine disability more nearly approximates the criteria for the currently assigned 20 percent rating and a higher rating is not warranted. Since the preponderance of the evidence is against the claim, the benefit of the doubt rule is not applicable. See 38 U.S.C. § 5107(b); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990); 38 C.F.R. § 3.102. For these reasons, the claim is denied. 3. Entitlement to service connection for TBI is denied. The Veteran is seeking service connection for residuals of a TBI. Specifically, the Veteran contends that during service, he sustained head injuries while boxing and playing football. He also describes in incident where he was struck by a steel bar in the head. 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 chronic diseases 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; 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). Lay persons are competent to provide opinions on some medical issues falling within the realm of common knowledge. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Upon review of the record, the Board finds that the Veteran’s TBI residuals were not manifested during service and are not otherwise etiologically related to his period of service. Turning to the facts of the case, the Veteran’s service treatment records are silent for any complaints, treatments, or manifestations of a traumatic brain injury. There is documentation that the Veteran sustained a fractured nose while boxing; he was also struck by a steel bar at one point during service. However, while he did sustain injuries such as lacerations, he did not lose consciousness and there was no evidence of a concussion or brain injury. The Veteran’s service treatment records also document the Veteran’s complaints of periodic headaches; however, these headaches were secondary to his sinus infections and upper respiratory infections. Upon discharge, the Veteran reported having head injuries and headaches; he clarified that his head symptoms were related to his sinusitis. See Report of Medical History dated July 1995. Post-service treatment records are silent for any complaints, manifestations, or residuals of a head injury until 2003. In March 2003, the Veteran sustained a concussion at work when a bookshelf fell on his head. Subsequently, he continued to have headaches and neck pain, along with difficulty concentrating. Since 2003, the Veteran has sought continuous treatment for his TBI residuals, to include evaluations by neurologists, ophthalmologists, osteopaths, chiropractors, and acupuncturists. At one point, the Veteran did report having a previous head injury “in the distant past,” but both he and his treatment providers noted that he was functioning very well prior to the March 2003 bookshelf incident. See Private Treatment Records dated March 27, 2003, December 5, 2003, February 25, 2004, and July 29, 2005. As to the issue of etiology, there are two opposing nexus opinions of record. Most recently, at the February 2020 VA examination, the examiner opined that the Veteran’s claimed TBI residuals were less likely than not incurred in or caused by service. In so finding, the examiner acknowledged the Veteran’s reports of sustaining “a couple” head injuries during service. However, the examiner found that it was unlikely the Veteran sustained an in-service TBI as there was no documentation of any significant head injury nor was there any evidence of loss of consciousness during service. Rather, the examiner opined that the Veteran’s reported residuals were related to his post-service head injuries, dated 2003, 2014, and 2017, as his symptoms, to include cognitive impairment, occurred after the 2003 injury. The Board finds that this opinion is highly probative as to the issue of etiology. The examiner considered the Veteran’s medical history, to include his subjective lay statements and the objective medical records and found that the Veteran’s claimed symptoms were more likely related to his post-service injury. The examiner’s opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The examiner’s opinion is also consistent with the remaining objective medical evidence of record, which establishes that the Veteran did not manifest any TBI residuals during service or after discharge and he was functioning well prior to the 2003 accident. Contrarily, in a March 2010 private medical opinion, Dr. S.T. found that the Veteran’s brain damage reached its critical level after the March 2003 civilian injury; however, she stated that the severity of the Veteran’s residuals was disproportionate to level of injury he sustained. She also implied that the Veteran was susceptible to injury based on previous head trauma sustained in the military. She opined that she thought that his military career provided a significant amount of damage. The Board finds that while Dr. S.T. is competent to opine as to the etiology of the Veteran’s TBI residuals, the Board assigns this opinion little probative value, as it contradicts the objective evidence of record. Although Dr. S.T. claims that the March 2003 head injury aggravated a previous in-service injury, there is no evidence that the Veteran sustained a head injury during service or manifested any TBI residuals prior to discharge or any time before 2003. The Board finds that it is speculative, at best, to suggest that the 2003 head injury aggravated an already existing head injury, as the Veteran was functioning with no issues prior to the 2003 accident. He was able to earn his PhD and was teaching at a university with no cognitive dysfunction. His military personnel record contains outstanding reviews and recommendations with no evidence of any impairment to functioning or inability to do his job, even after his alleged head injuries. Without more, the March 2010 opinion is conclusory at best and does not assist the Board in reaching a conclusion. The only remaining evidence in favor of the Veteran’s claim consists of lay statements. The Veteran and his witnesses contend that the Veteran sustained several concussions during service during boxing classes and while playing football. They stated that in addition to losing consciousness, the Veteran began to demonstrate some mild cognitive impairment during service, to include difficulty making rational decisions. See Written Statements received March 2010. As lay witnesses, the Veteran and his witnesses are certainly able to describe what they experienced and/or witnessed within their direct purview. However, given the objective evidence of record, the Board assigns these statements little probative value as to the issue of etiology. Notably, the lay statements directly contradict the objective evidence of record which indicate that the Veteran did not incur a head injury or any residuals during service. Although he was treated for boxing injuries, he specifically denied experiencing loss of consciousness and there was no evidence of any limitation in cognition. Further, the earliest available post-service treatment records indicate that the Veteran was functioning “very well” prior to the 2003 head injury. In addition, the lay witnesses are not competent to establish that the Veteran’s in-service injuries are etiologically related to his current symptoms. See Layno v. Brown, 6 Vet. App. 456 (1994); Washington v. Nicholson, 19 Vet. App. 362, 368 (2005). As it specifically pertains to the Veteran’s statements, when reviewing the inconsistent and/or contradictory accounts as to symptom onset, the Board places greater probative weight to the Veteran’s report of symptomatology on his reports of medical histories and various questionnaires during service as they were made contemporaneous in time to the time periods in question and made in the context of seeking appropriate evaluation for any existing disabilities. See Rucker v. Brown, 10 Vet. App. 67, 73 (1997) (statements made to physicians for purposes of diagnosis and treatment are exceptionally trustworthy because the declarant has a strong motive to tell the truth in order to receive proper care); see also Curry v. Brown, 7 Vet. App. 59, 68 (1994) (contemporaneous evidence may have greater probative value than history provided by the Veteran). Thus, while the Veteran is competent to report experiencing loss of consciousness and other TBI residuals during service, the Board finds that such allegations are not consistent with the overall evidentiary record and that, while actual corroboration of these events is not required, his assertations are not credible given review of the entire evidentiary record – including the Veteran’s own statements during service and while receiving treatment for his post-service TBI. Thus, based on the entirety of the record, the Board finds that the Veteran’s allegations of TBI residuals during service and since discharge is not credible. In sum, there is no competent or credible link between the Veteran’s period of service and his current TBI residuals. Given that the evidence is against the claim, the benefit of the doubt doctrine is inapplicable. Service connection for an TBI residuals is denied. 38 U.S.C. § 5107(b). DAVID R. SEATON Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Orie, 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.