Citation Nr: 21007582 Decision Date: 03/07/21 Archive Date: 02/10/21 DOCKET NO. 18-36 438 DATE: March 7, 2021 ORDER Service connection for a disability manifested by chest pain, including a heart disability, is denied. Service connection for a genitourinary disability, including benign prostatic hyperplasia (BPH) and Peyronie’s disease, is denied. Service connection for a right shoulder disability is denied. Service connection for a headache disability is denied. Service connection for a disability manifested by dizziness and/or blackouts is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against a finding that a current disability manifested by chest pain, including a heart disability, was incurred in or caused by service. 2. The preponderance of the evidence is against a finding that a current genitourinary disability, including BPH and Peyronie’s disease, was incurred in or caused by service. 3. The preponderance of the evidence is against a finding that a current right shoulder disability was incurred in or caused by service. 4. The preponderance of the evidence is against a finding that a current headache disability was incurred in or caused by service. 5. The preponderance of the evidence is against a finding that the Veteran has a current disability manifested by dizziness and/or blackouts that was incurred in or caused by service. CONCLUSIONS OF LAW 1. The criteria for establishing entitlement to service connection for a disability manifested by chest pain, including a heart disability, have not been met. 38 U.S.C. §§ 1101, 1137, 5107 (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2020). 2. The criteria for establishing entitlement to service connection for genitourinary disability, including BPH and Peyronie’s disease, have not been met. 38 U.S.C. §§ 1101, 1137, 5107 (2012); 38 C.F.R. § 3.303 (2020). 3. The criteria for establishing entitlement to service connection for a right shoulder disability have not been met. 38 U.S.C. §§ 1101, 1137, 5107 (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2020). 4. The criteria for establishing entitlement to service connection for a headache disability have not been met. 38 U.S.C. §§ 1101, 1137, 5107 (2012); 38 C.F.R. § 3.303 (2020). 5. The criteria for establishing entitlement to service connection a disability manifested by dizziness and/or blackouts have not been met. 38 U.S.C. §§ 1101, 1137, 5107 (2012); 38 C.F.R. § 3.303 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from February 1959 to February 1981. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an April 2015 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In January 2020, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A transcript of that hearing is of record. This matter was previously before the Board in April 2020, at which time it was remanded for further development. The requested development was completed, and the case has been returned to the Board for further appellate action. Service Connection Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110, 1131; 38 C.F.R. § 3.303. Generally, in order to prove service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999). Where a veteran served continuously for 90 days or more during a period of war, or during peacetime service after December 31, 1946, and certain chronic diseases, including cardiovascular disease and arthritis, become manifest to a degree of 10 percent within one year from the date of termination of such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. 1. Entitlement to service connection for a disability manifested by chest pain, including a heart disability The Veteran seeks service connection for chest pain, which he asserts began during service. During the January 2020 Board hearing, the Veteran testified that his chest pain began during service, and a stress test performed after service revealed a major blockage. Upon review of the record, the Board finds that the preponderance of the evidence is against a finding that a current disability manifested by chest pain, including a heart disability, was incurred in or caused by service. Service treatment records show that the Veteran complained of chest wall pain on numerous occasions beginning around 1969, which was noted to be in the in the region of the left pectoralis major muscle. An electrocardiogram performed in October 1970 noted sinus arrhythmia, but there was no evidence of heart or lung disease, and the diagnosis was chest wall syndrome. Subsequent cardiology treatment records do not show a diagnosis pertaining to the heart or lungs during service, and the assessments included chest pain of unknown etiology, a possible muscle strain, and costochondritis. An October 1980 report of medical history shows that the Veteran reported a history of pain or pressure in the chest upon his retirement. However, an October 1980 report of medical examination shows that the Veteran’s heart, lungs, and chest were normal at that time. Post service treatment records note chest wall pain as early as October 1983. Treatment records through 1997 show that chest x-rays were normal, and the Veteran had no history of heart disease. The assessments were history of pleuritic chest pain and atypical chest pain. In November 2002, the Veteran reported a history of pounding heart/palpitations. An electrocardiogram, echocardiogram, and heart sonogram performed between 2002 and 2003 were all normal. In February 2005, the Veteran reported left sided chest pain, which began a month ago. He underwent an exercise stress test to rule out ischemia, and the test was negative. In July 2015, the Veteran sought treatment for chest pain and dizziness, which started the night before. In August 2015, the Veteran was diagnosed with mild, nonobstructive coronary artery disease (CAD) after undergoing cardiac catheterization. The Veteran’s cardiologist indicated that the Veteran’s current symptoms were most likely due to ectopy and premature ventricular contractions (PVCs). An October 2019 disability benefits questionnaire (DBQ) completed by the Veteran’s private physician indicates that the Veteran has a current diagnosis of CAD with stable angina. The Veteran underwent a VA muscle injuries examination in May 2020, during which he reported having chest pain and being diagnosed with CAD. The examiner indicated that the Veteran did not have a current diagnosis of a muscle injury related to his reports of chest pain. In November 2020, another VA examiner reviewed the evidence of record and opined that it was less likely than not that any of the Veteran’s currently diagnosed heart conditions, including CAD, palpitations, or PVCs, were incurred in or caused by service. In support of this, the examiner explained that service treatment records show that the Veteran had chest wall pain during service, and although an October 1970 electrocardiogram showed sinus arrhythmia, the Veteran was further evaluated with an exercise stress test wherein no arrhythmia was found, and the test was normal. The examiner explained that the Veteran’s final in-service diagnosis was chest wall syndrome, more commonly known today as costochondritis, which is an acute condition that does not progress or cause palpitations, PVCs, or CAD. Therefore, the examiner concluded that the Veteran’s currently diagnosed heart conditions are less likely than not related to the Veteran’s in-service chest wall pain. The Board finds the opinion of the November 2020 VA examiner to be highly probative and persuasive, as it is based on a review of the evidence of record and supported a with reasoned medical explanation. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008). Although the Veteran believes that a current heart condition is related to service, as a lay person, he has not shown that he has specialized training sufficient to render such an opinion. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). While the Veteran is competent to report observable symptoms such as chest pain, the etiology of his currently diagnosed heart conditions are matters not capable of lay observation and require medical expertise to determine. Thus, the opinion of the Veteran regarding the etiology of a current heart disability is not competent medical evidence. In sum, the preponderance of the competent and probative evidence is against the claim, and service connection for a disability manifested by chest pain, including a heart disability, is denied. 2. Entitlement to service connection for a genitourinary disability, including BPH and Peyronie’s disease The Veteran seeks service connection for urinary retention/painful urination, which he asserts was incurred during service. During the January 2020 Board hearing, the Veteran testified that he was unable to urinate for 24 hours after undergoing hemorrhoid surgery during service. He further testified that he has continued to have abnormal urine flow and an inability to urinate at times. Upon review of the record, the Board finds that the preponderance of the evidence is against a finding that a current genitourinary disability was incurred in or caused by service. Service treatment records show that the Veteran reported problems with urinary voiding in May 1975, and the assessment was acute urinary retention secondary to medication for hemorrhoids. To the extent that the Veteran claims to have experienced continued urinary symptoms ever since his in-service treatment for acute urinary retention, the Board finds that such assertions are not consistent with the evidence of record. An October 1980 report of medical examination shows that the Veteran’s genitourinary system was normal upon his retirement, and he denied any frequent or painful urination on an accompanying report of medical history. Post-service treatment records show that the Veteran reported mild burning with urination in December 1985, and he was diagnosed with mild prostatitis. Thereafter, despite records showing treatment for other conditions, post-service treatment records show no additional treatment for urinary symptoms until November 1999. At that time, the Veteran reported a weak urine stream and the need to strain for urine, and he was diagnosed with BPH. The Board finds the contemporaneous medical evidence to be significantly more credible and probative than statements made to VA for purposes of seeking compensation. See Buchanan v. Nicholson, 451 F.3d 1331, 1336-1337 (2006) (the lack of contemporaneous medical records, the significant time delay between the affiants’ observations and the date on which the statements were written, and conflicting statements of the veteran are factors that the Board can consider and weigh against a veteran’s lay evidence). Subsequent post-service treatment records show that the Veteran reported “tightening” in the urine stream in April 2013 and dysuria in August 2013, which were attributed to a diagnosis of Peyronie’s disease in April 2014. An October 2019 DBQ completed by the Veteran’s private physician shows that the Veteran has current diagnoses of BPH and Peyronie’s disease. The Veteran underwent a VA examination in May 2020, and the examiner opined that it was less likely than not that the Veteran’s BPH was incurred in or caused by service. In support of this, the examiner explained that the Veteran’s service treatment records document acute and transitory urinary retention due to medication given for hemorrhoids, and the Veteran’s military separation examination was negative for urinary symptoms. The examiner further explained that BPH is a common condition in older men and not related to or caused by the acute, transitory urinary retention noted during service. In November 2020, another VA examination reviewed the evidence of record and opined that it was less likely than not that any of the Veteran’s currently diagnosed genitourinary conditions, including BPH and Peyronie’s disease, were incurred in or caused by service. In support of this, the examiner explained that the Veteran’s in-service urinary retention was due to medications he was taking for hemorrhoids at the time. She further explained that Peyronie’s disease is an abnormality in the shape of the penis caused by scar tissue, and urinary retention is not known to cause penile scar tissue. She further explained that BPH is enlargement of the prostate and a common occurrence in older men as they age, which is consistent with the Veteran being around age 60 when he was diagnosed with BPH in 1999. The Board finds the opinions of the VA examiners to be highly probative and persuasive, as they are based on a review of the evidence of record and supported with reasoned medical explanations. See Nieves-Rodriguez, 22 Vet. App. at 302-04. Although the Veteran believes that a current genitourinary disability is related to service, as a lay person, he has not shown that he has specialized training sufficient to render such an opinion. See Jandreau, 492 F.3d at 1377. In this regard, the diagnosis and etiology of genitourinary disabilities, which were diagnosed many years after the in-service treatment for acute urinary retention, are matters not capable of lay observation and require medical expertise to determine. Thus, the opinion of the Veteran regarding the etiology of a currently diagnosed genitourinary disability is not competent medical evidence. In sum, the preponderance of the competent and probative evidence is against the claim, and service connection for a genitourinary disability, including BPH and Peyronie’s disease, is denied. 3. Entitlement to service connection for a right shoulder disability The Veteran seeks service connection for a right shoulder injury, which he asserts was incurred during service. During the January 2020 Board hearing, the Veteran testified that he injured his right shoulder during service while trying to prevent a piece of lumber from falling. Upon review of the record, the Board finds that the preponderance of the evidence is against a finding that a current right shoulder disability was incurred in or caused by service. Service treatment records show that in April 1980, the Veteran reported right shoulder and elbow pain. The radiographic report also notes a history of blunt trauma to the right shoulder and elbow, but x-rays were within normal limits. To the extent that the Veteran claims to have experienced continued right shoulder pain ever since his in-service treatment for right shoulder pain in April 1980, the Board finds that such assertions are not consistent with the evidence of record. An October 1980 report of medical examination shows that the Veteran’s upper extremities were normal upon his retirement, and on an accompanying report of medical history, he denied having painful or “trick” shoulder or elbow; swollen or painful joints; and arthritis, rheumatism, or bursitis. Thereafter, despite records showing treatment for other conditions, post-service treatment records show no complaints of right shoulder pain until approximately 1994. A chest x-ray performed in July 1994 noted mild degenerative changes of the right acromioclavicular (AC) joint spaces. In November 1994, the Veteran reported tightness in the back of the right shoulder and neck for the past three weeks. The Board finds the contemporaneous medical evidence to be significantly more credible and probative than statements made to VA for purposes of seeking compensation. See Buchanan, 451 F.3d at 1336-1337. An October 2019 DBQ completed by the Veteran’s private physician indicates that the Veteran has a current diagnosis of degenerative joint disease of the AC joint. In January 2020, the Veteran submitted a letter that private physician who opined that it was very possible that the Veteran’s April 1980 injury to the right shoulder and elbow contributed to the development of his current right shoulder arthritis. However, the Board assigns little probative value to this opinion because it is not supported by a rationale and is speculative in nature, utilizing language that it is “possible” that the Veteran’s in-service injuries contributed to the development of right shoulder arthritis. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (holding that a medical opinion “must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions”); see also Polovick v. Shinseki, 23 Vet. App. 48, 54 (2009) (holding that a doctor’s statement that a veteran’s brain tumor “may well be” connected to Agent Orange exposure was speculative); Bloom v. West, 12 Vet. App. 185, 187 (1999) (noting that the use of the term “could,” without other rationale or supporting data, is speculative). The Veteran underwent a VA examination in May 2020, during which he reported hurting his right shoulder while carrying lumbar during service. The examiner opined that it was less likely than not that the Veteran’s current right shoulder disability was incurred in or caused by service. In support of this, the examiner reasoned, in part, that the Veteran’s records are silent for a right shoulder condition for 27 years after service. However, the Board assigns little probative value to this opinion, as the record shows right shoulder pain and degenerative changes of the AC joint space were noted significantly earlier than that, in 1994. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (holding that “[a]n opinion based on an inaccurate factual premise has no probative value”). In November 2020, another VA examiner reviewed the evidence of record and opined that it was less likely than not that a current right shoulder disability was incurred in or caused by service. In support of this, the examiner explained that osteoarthritis or degenerative arthritis is an age-related, gradually occurring disease of the joint due to the wearing out of joints. She further explained that the Veteran’s service treatment records show complaints of right shoulder pain that are consistent with a musculoskeletal strain, which is largely an acute condition and is not known to progress to or cause arthritis unless accompanied by severe trauma. The Board finds the opinion of the November 2020 VA examiner to be highly probative and persuasive, as it is based on a review of the evidence of record and supported a with reasoned medical explanation. See Nieves-Rodriguez, 22 Vet. App. at 302-04. Although the Veteran believes that a current right shoulder disability is related to service, as a lay person, he has not shown that he has specialized training sufficient to render such an opinion. See Jandreau, 492 F.3d at 1377. In this regard, the diagnosis and etiology of a shoulder disability, which was diagnosed many years after the in-service report of shoulder pain, are matters not capable of lay observation and require medical expertise to determine. Thus, the opinion of the Veteran regarding the etiology of a currently diagnosed shoulder disability is not competent medical evidence. In sum, the preponderance of the competent and probative evidence is against the claim, and service connection for a right shoulder disability is denied. 4. Entitlement to service connection for a headache disability The Veteran seeks service connection for headaches, which he asserts were incurred during service. During the January 2020 Board hearing, the Veteran testified that he began having headaches ever since he was hit in the back of the head with a piece of lumbar during service. Upon review of the record, the Board finds that the preponderance of the evidence is against a finding that a current headache disability was incurred in or caused by service. Service treatment records show that the Veteran reported frontal headaches in October 1961 and generally feeling bad all over with anorexia, weight loss, and difficulty sleeping. The treatment provider ordered sinus x-rays and prescribed phenylbutazone and neo-synephrine nasal drops. After undergoing additional testing, the Veteran was diagnosed with hookworm disease and treated with tetrachloroethylene. In November 1961, the Veteran reported that he felt much better, and his headaches and weakness had disappeared. Thereafter, an undated treatment record shows an assessment of status post motor vehicle accident and head injury. That record appears to be from sometime before August 10, 1978, as the second record on that page is dated August 10, 1978. In December 1978, the Veteran reported a vague history of intermittent headache and abdominal pain for about six months, and he was evaluated for gastrointestinal issues. In June 1979, he reported symptoms of abdominal cramps, mild diarrhea, and headache, and the assessment was gastritis. To the extent that the Veteran claims to have experienced continued headaches ever since the in-service reports of headaches, the Board finds that such assertions are not consistent with the evidence of record. A September 1979 report of medical history shows that the Veteran denied any frequent or severe headache or history of head injury. An October 1980 report of medical examination shows that the Veteran’s head and neurologic system were normal upon his retirement, and he denied any frequent or severe headache or history of head injury on an accompanying report of medical history. Thereafter, despite records showing treatment for other conditions, post-service treatment records show no treatment for headaches until approximately November 1994, when the Veteran reported tightness in the back of the right shoulder and neck and a headache for the past three weeks. The Board finds the contemporaneous medical evidence to be significantly more credible and probative than statements made to VA for purposes of seeking compensation. See Buchanan, 451 F.3d at 1336-1337. Subsequent treatment records show a couple complaints of headaches around 1997 and 1998. In May 2001, the Veteran reported a mild, dull headache with neck pain since March, and the assessment was tension headache with increased blood pressure. In August 2001, the Veteran reported a history of headaches about 10 to 15 years earlier, and then again about five years ago. He stated that his current headaches began about six months ago. In August 2009, he reported constant headaches from the left lower neck for the past five weeks, and the diagnosis was tension headaches. In November 2012, the Veteran reported a headache and dizziness after being hit in the head by a large swinging door, and the assessment was contusion of the head/mild concussion. A November 2013 treatment record notes symptoms of intermittent headaches and dizziness due to post-concussive syndrome after the closed-head injury in November 2012. Subsequent treatment records show intermittent complaints of headaches. An October 2019 DBQ completed by the Veteran’s private physician indicates that the Veteran complained of intermittent headaches since 2003 or before, and in November 2013, he was struck in the head by a heavy door and developed postconcussion syndrome with headaches and dizziness. In January 2020, the Veteran submitted a letter from that private physician who opined that it was very possible that the in-service motor vehicle accident and reported blow to the back of the head with a plank has contributed to the Veteran’s chronic headaches for which he is treated today and were further compounded by the 2013 concussion. However, the Board assigns little probative value to this opinion because it is not supported by a rationale and is speculative in nature, utilizing language that it is “possible” that the Veteran’s in-service injuries contributed to his current headaches. See Stefl, 21 Vet. App. at 124; see also Polovick, 23 Vet. App. at 54; Bloom, 12 Vet. App. at 187. The Veteran underwent a VA examination in May 2020, during which he reported that his headaches first started after being hit in the head with a two-by-four in the late 1970’s. He also reported subsequently sustaining a concussion after he was hit in the head by a swinging door and being told by a doctor that he had a stroke in the past. The examiner opined that it was less likely than not that the Veteran’s headaches were incurred in or caused by service. In support of this, the examiner indicated that the Veteran’s service treatment records were silent for a headache condition or diagnosis, and post-service treatment records showed no diagnosis of a headache condition for 20 years after service. However, the Board assigns little probative value to this opinion, as the Veteran’s service treatment records did reference symptoms of headaches, and the Veteran’s post-service treatment records first mention headaches about 14 years after service. See Reonal, 5 Vet. App. at 461. In November 2020, another VA examiner reviewed the evidence of record and opined that it was less likely than not that a current headache disability was incurred in or caused by service. In support of this, the examiner noted that the headaches and weakness noted in October 1961 reportedly disappeared by November 1961. She further explained that while the undated service treatment record referenced a vehicular accident during service, it was barely mentioned along with a head injury. Thus, a headache that could result from that vehicular accident was likely temporary, as headaches resulting from mild traumatic brain injuries resolve within a few months. The examiner further noted that the Veteran’s other in-service complaints of headaches were related to conditions accompanied by symptoms such as upper respiratory infection, gastritis, or viral syndrome. Therefore, the examiner concluded that it was less likely than not that a current headache disability was related to the Veteran’s in-service treatment for headaches. The Board finds the opinion of the November 2020 VA examiner to be highly probative and persuasive, as it is based on a review of the evidence of record and supported a with reasoned medical explanation. See Nieves-Rodriguez, 22 Vet. App. at 302-04. Although the Veteran believes that a current headache disability is related to service, as a lay person, he has not shown that he has specialized training sufficient to render such an opinion. See Jandreau, 492 F.3d at 1377. Although the Veteran is competent to report observable symptoms such as headaches, the Board has found that any assertion of continued headaches since service lack credibility, and the diagnosis and etiology of a current headache disability are matters not capable of lay observation and require medical expertise to determine. Thus, the opinion of the Veteran regarding the etiology of a current headache disability is not competent medical evidence. In sum, the preponderance of the competent and probative evidence is against the claim, and service connection for a headache disability is denied. 5. Entitlement to service connection for a disability manifested by dizziness and/or blackouts The Veteran seeks service connection for dizziness, which he asserts was incurred during service. During the January 2020 Board hearing, the Veteran testified that began having dizziness and headaches ever since he was hit in the back of the head with a piece of lumbar during service and that he blacked out once. Upon review of the record, the Board finds that the preponderance of the evidence is against a finding that the Veteran has a current disability manifested by dizziness and/or blackouts that was incurred in or caused by service. Service treatment records show that the Veteran complained of dizziness in February 1961, October 1961, March 1968, July 1969, and January 1970, and he reported blacking out for ten minutes in March 1968. To the extent that the Veteran claims to have experienced continued symptoms of dizziness and/or blackouts ever since the in-service treatment for those symptoms, the Board finds that such assertions are not consistent with the evidence of record. The record shows no further treatment for dizziness or blackouts between February 1970 and the Veteran’s retirement in October 1980. Although the Veteran reported a history of dizziness on an October 1980 report of medical history, the report of medical examination conducted upon his retirement shows that the Veteran’s inner ear was normal at that time, and there was no notation of a condition manifested by dizziness or blackouts. Thereafter, despite records showing treatment for other conditions, post-service treatment records show no complaints of dizziness or blackouts until approximately January 1995, when the Veteran reported occasional dizziness and sporadic unsteadiness. The Board finds the contemporaneous medical evidence to be significantly more credible and probative than statements made to VA for purposes of seeking compensation. See Buchanan, 451 F.3d at 1336-1337. Subsequent treatment records show a couple reports of dizziness around 1997 and 1998. In January 2008, the Veteran reported feeling dizzy with a drop in blood pressure. In August 2009, he reported having a headache for the past five weeks and some dizziness, and the diagnosis was tension headache. In September 2011, the Veteran reported feeling dizziness for the past two days, and the assessment was stress (primary encounter diagnosis), vertigo, and hypertension. The treatment provider indicated that the Veteran’s symptoms started with a stressful event, and he was advised to see a counselor. Later that month, a mental health treatment provider noted that the Veteran’s dizziness may have been anxiety related. The Veteran subsequently denied any dizziness in September 2011 and January 2012. In November 2012, the Veteran reported a headache and dizziness after being hit in the head by a large swinging door, and the assessment was contusion of the head / mild concussion. A November 2013 treatment record notes symptoms of intermittent headaches and dizziness due to post-concussive syndrome after the closed-head injury in November 2012. During a January 2015 psychotherapy session, the Veteran reported feeling tired, depressed, and dizzy at times. In July 2015, the Veteran reported symptoms of chest pain and dizziness, and the assessment was chest pain, which may be due to reflux. In August 2015, the Veteran’s cardiologist attributed those symptoms to ectopy and premature ventricular contractions (PVCs). Thereafter, the Veteran denied any symptoms of dizziness or vertigo in November 2016 and February 2017. In April 2019, the Veteran reported increased dizziness and shaking. The treatment provider indicated that he was not sure which medications may be causing this and noted that the Veteran was submitting an application for VA benefits, which may be associated with increased symptoms note. An October 2019 DBQ completed by the Veteran’s private physician indicates that in November 2013, the Veteran was struck in the head by a heavy door, and he developed postconcussion syndrome with headaches and dizziness. The Veteran underwent a VA examination in May 2020, during which he reported being hit in the back of the head with a two-by-four during service and that he believed his dizziness was related to his headaches. The examiner indicated that the Veteran did not have a current diagnosis of a vestibular condition and opined that it was less likely than not that the Veteran’s claimed dizziness and blackouts were incurred in or caused by service. In support of this, the examiner explained that the Veteran’s documented symptoms of dizziness during service were acute and transitory, as the Veteran’s military separation examination did not note a condition manifested by dizziness, and there was no evidence of a condition manifested by dizziness shortly after service. She further explained that the Veteran was treated for dizziness after a head injury in 2012, but current medical records do not show a diagnosis of a condition manifested by dizziness. The Board finds the opinion of the VA examiner to be highly probative and persuasive, as it is based on a review of the evidence of record and supported a with reasoned medical explanation. See Nieves-Rodriguez, 22 Vet. App. at 302-04. Although the Veteran believes that he has a current disability manifested by dizziness and/or blackouts that is related to service, as a lay person, he has not shown that he has specialized training sufficient to render such an opinion. See Jandreau, 492 F.3d at 1377. Although the Veteran is competent to report observable symptoms such as dizziness, the Board has found that any assertion of continued dizziness since service lack credibility, and the diagnosis and etiology of a current disability manifested by dizziness and/or blackouts are matters not capable of lay observation and require medical expertise to determine. Thus, the opinion of the Veteran regarding the etiology of a current disability manifested by dizziness and/or blackouts is not competent medical evidence. In sum, the preponderance of the competent and probative evidence is against the claim, and service connection for a disability manifested by dizziness and/or blackouts is denied. K. A. BANFIELD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Banister, 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.