Citation Nr: 21014334 Decision Date: 03/11/21 Archive Date: 03/11/21 DOCKET NO. 15-38 630 DATE: March 11, 2021 ORDER Entitlement to an initial 10 percent rating, but no higher, for a storage mite syndrome for the period prior to November 24, 2020 is granted. Entitlement to a rating in excess of 10 percent for storage mite syndrome is denied. Entitlement to service connection for diverticulitis is denied. Entitlement to service connection for rheumatic arthritis of various joints is denied. Entitlement to service connection for bilateral shoulder strain is denied. FINDINGS OF FACT 1. During the entire period on appeal, the Veteran’s storage mite syndrome was characterized by treatment with oral antihistamine therapy for less than 6 weeks per year. 2. The preponderance of the evidence is against finding that the Veteran’s diverticulitis began during active service or is otherwise related to an in-service injury or disease. 3. The preponderance of the evidence of record is against finding that the Veteran has had a current disability of rheumatoid arthritis at any time during or approximate to the pendency of the claim. 4. The preponderance of the evidence is against finding that the Veteran’s current bilateral shoulder strain disability began during active service or is otherwise related to an in-service injury or disease. CONCLUSIONS OF LAW 1. The criteria for a 10 percent rating for storage mite syndrome for the period prior to November 24, 2020 have been met. 38 U.S.C. § §§ 1155, 5107 (2012); 38 C.F.R. § §§ 4.1, 4.3, 4.7, 4.118, Diagnostic Code (DC) 7806 (2020). 2. The criteria for a rating in excess of 10 percent for storage mite syndrome have not been met. 38 U.S.C. § §§ 1155, 5107 (2012); 38 C.F.R. § §§ 4.1, 4.3, 4.7, 4.118, DC 7806 (2020). 3. The criteria for service connection for diverticulitis have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2020). 4. The criteria for service connection for rheumatic arthritis of various joints have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2020). 5. The criteria for service connection for bilateral shoulder strain have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from November 1984 to November 1988 and from November 1990 to May 1991. This matter came before the Board of Veterans Appeals (Board) on appeal from an August 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). An October 2018 Board decision remanded the issues on appeal for further development. An October 2020 Board decision then denied service connection for diabetes mellitus, granted service connection for the sacroiliac joint and remanded the remaining issues on appeal for further development. A December 2020 rating decision granted service connection for hypertension. As this constituted a complete grant of the benefit sought on appeal, it is not before the Board. The decision also increased the rating for storage mite syndrome from 0 to 10 percent effective November 24, 2020. Because higher ratings for this disability are assignable during the period and the Veteran is presumed to seek the maximum available benefit, the issue remains on appeal. See AB v. Brown, 6 Vet. App. 35, 38 (1993). The October 2020 Board decision asked the agency of original jurisdiction (AOJ) to take steps to obtain private treatment records from Damas Hospital regarding diverticulitis, including colonoscopy records, and from the Veteran’s private rheumatologist Dr. Leon. The record shows that an October 2020 letter was sent asking the Veteran to complete an authorization for those records and provide information about dates of treatment, however the record is silent for any indication that the Veteran responded to the request. The Board notes that the duty to assist is not a one-way street. See Wood v. Derwinski, 1 Vet. App. 190. 192 (1991). While VA does have a duty to assist the Veteran in the development of the claim, that duty is not limitless, and the Veteran must be prepared to cooperate with VA’s efforts to obtain all relevant evidence. Olson v. Principi, 3 Vet. App. 480, 483 (1992). The Board therefore finds that there has been substantial compliance with the October 2020 remand directives regarding obtaining private records and will proceed to adjudicate the issues on appeal based on the evidence of record. 1. Entitlement to an initial compensable rating for storage mite syndrome the period prior to November 24, 2020, and in excess of 10 percent thereafter The Veteran contends that he is entitled to an increased rating for storage mite syndrome, which is current rated as noncompensable prior to November 24, 2020, and at 10 percent disabling thereafter. For the reasons that follow, the Board finds that a uniform rating of 10 percent, but no higher, is warranted for the entire period on appeal. Disability ratings are determined by applying the criteria set forth in VA’s Schedule for Rating Disabilities. Individual disabilities are assigned separate diagnostic codes. See U.S.C. §1155; 38 C.F.R. § 4.1. When there is a question as to which of two evaluations applies, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for the rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. In evaluating the severity of a particular disability, it is essential to consider its history. 38 C.F.R. § 4.1; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary importance. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). That said, higher evaluations may be assigned for separate periods based on the facts found during the appeal period. See Fenderson v. West, 12 Vet. App. 119, 126 (1999). This practice is known as staged ratings. Id. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall resolve reasonable doubt in favor of the claimant. 38 U.S.C. § 5107; 39 C.F.R. §§ 3.102, 4.3; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Changes to the rating criteria for the skin became effective August 13, 2018. Claims pending prior to the effective date will be considered under both the old and new rating criteria, and whatever criteria is more favorable to the veteran will be applied. 83 Fed. Reg. 32, 592 (July 13, 2018). As the current appeal is an initial increased rating claim arising from the Veteran’s September 2013 application for compensation, it must be considered under both the old and new criteria. For the entire period on appeal, the Veteran’s storage mite syndrome has been rated under Diagnostic Code 7806, which rates dermatitis or eczema. Under the older criteria, a 10 percent rating was warranted for at least 5 percent, but less than 20 percent, of the entire body, or at least 5 percent, but less than 20 percent, of exposed areas affected, or; intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs required for a total duration of less than six weeks during the past 12-month period. A 30 percent rating was warranted for 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected, or; systemic therapy such as corticosteroids or other immunosuppressive drugs required for a total duration of six weeks or more, but not constantly, during the past 12-month period. A 60 percent rating was warranted for more than 40 percent of the entire body or more than 40 percent of exposed areas affected, or; constant or near-constant systemic therapy such as corticosteroids or other immunosuppressive drugs required during the past 12-month period. Under the older criteria for rating skin disabilities, a topical corticosteroid may constitute systemic therapy under DC 7806 based on the factual circumstances of the case. Johnson v. Shulkin, 862 F.3d 1351, 1354-56 (Fed. Cir. 2017); 38 C.F.R. § § 4.118. Under the new criteria, DC 7806 directs that dermatitis/eczema be rated under the General Rating Formula for the Skin. Under the General Rating Formula, a 10 percent rating is warranted for at least one of the following: characteristic lesions involving at least 5 percent, but less than 20 percent, of the entire body affected; or at least 5 percent, but less than 20 percent, of exposed areas affected; or intermittent systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required for a total duration of less than 6 weeks over the past 12-month period. A 30 percent rating is warranted for at least one of the following: characteristic lesions involving 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected; or Systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required for a total duration of 6 weeks or more, but not constantly, over the past 12-month period. A 60 percent rating is warranted for at least one of the following: characteristic lesions involving more than 40 percent of the entire body or more than 40 percent of exposed areas affected; or constant or near-constant systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, psoralen with long-wave ultraviolet-A light (PUVA), or other immunosuppressive drugs required over the past 12-month period. This is the highest rating available under the DC. Under the new criteria, systemic therapy is defined as treatment that is administered through any route (orally, injection, suppository, intranasally) other than the skin, and topical therapy is treatment that is administered through the skin. Period prior to November 24, 2020 May 2011 VA treatment records noted angioedema manifested by swollen eyelids. The provider noted that an allergy consult would be provided, and prescribed Benadryl as needed. June 2011 VA treatment records show that the Veteran reported eyelid swelling six times in the prior two years and throat itching associated with eating certain foods. The provider continued to recommend treatment with Benadryl as needed. An August 2014 VA examination found that the Veteran did not have visible conditions and there was no evidence of active skin rash or lesions. The examiner found that no oral or topical medication had been used in the prior 12 months. The Veteran reported that he last had hives in December 2011, but that he also had mild throat itching associated with dietary exposures that occurred several times per year and was controlled with sporadic use of antihistamines. In the accompanying VA opinion, the examiner clarified that it was the allergic reactions that were diagnosed as storage mite syndrome. A November 2020 VA examination diagnosed storage mites syndrome. The Veteran reported an intermittent allergic reaction with itching/swelling of the eyelids, itching on the throat, hives and lip swelling. He reported that he had at least 3 episodes per year and used Benadryl with good response, most recently 2 months prior to the examination. The examiner found use of oral antihistamines for less than 6 weeks in the prior 12 months. On physical examination, the examiner found that zero percent of the total body area and exposed body areas were affected. At the outset, the Board finds that the VA examinations are adequate for appellate review. There is no evidence that the examiners were not competent or credible, and as the reports are based on the Veteran’s statements, in-person examinations and the examiners’ observations, the Board finds they are entitled to significant probative weight. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302–05 (2008). Again, the Veteran’s storage mite syndrome is rated as noncompensable for the period prior to November 24, 2020. A 10 percent rating is warranted under the new criteria for the skin when there is intermittent systemic therapy required for a total duration of less than 6 weeks over the past 12-month period, defined as any treatment administered through a route other than through the skin. Upon review of the above, the Board finds that the preponderance of the competent evidence supports the conclusion that the Veteran’s storage mite syndrome required treatment with oral antihistamines for less than 6 weeks per year throughout the period on appeal. The record clearly shows a history of oral antihistamine use prior to November 24, 2020. Evidence shows that the Veteran was advised to treat his allergic symptoms, including throat itch, with Benadryl in 2011, he reported at the August 2014 examination that he had allergic reactions involving throat itching several times per year that were controlled with antihistamines, and the November 2020 examiner found the same symptoms and course of treatment. There is simply no evidence in the record that the Veteran stopped treating his storage mite syndrome with oral antihistamines during the intervening period. To the contrary, the evidence indicates that the Veteran had been treating his disability in the same manner for years prior to the November 2020 VA examination. While the August 2014 skin examination found no treatment, that finding appears to correspond to the noted lack of rash or lesions, as the examiner separately noted ongoing use of antihistamines associated with storage mite syndrome. Moreover, the November 2020 examiner specifically noted that the Veteran had at least 3 outbreaks “per year” and treated his outbreaks with Benadryl. There is no indication in the report that the Veteran was only referring to the 12 months prior to the November 2020 VA examination, particularly as he described it as happening “at least” 3 times per year, suggesting a multi-year pattern. The Board also notes that the pattern reported to the November 2020 examiner is the same as that reported to the August 2014 examiner, suggesting that the pattern of symptoms and treatment persisted throughout the period. The Board notes that the Veteran is competent to report symptoms such as lip swelling, throat itching and the treatment he uses. The Board therefore finds that the Veteran’s storage mite syndrome required treatment with oral antihistamines throughout the period on appeal. As the treatment was administered by a route other than through the skin, a 10 percent rating is warranted under the new criteria for the skin for the period prior to November 24, 2020. 38 C.F.R. § § 4.118, DC 7806. Rating in excess of 10 percent Having found that a 10 percent rating is warranted prior to November 24, 2020, there is now a uniform rating for the entire period on appeal. The Board will now consider whether a rating in excess of 10 percent is warranted at any point during the appeal period. Again, to warrant a 30 percent rating under the new or the old criteria, the evidence would need to show symptoms affecting 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas or systemic therapy required for a total duration of 6 weeks or more, but not constantly, over the past 12-month period. Upon review, the Board finds that the competent evidence does not support the conclusion that the Veteran’s symptoms more closely approximately the severity associated with a 30 percent rating under either the old or the new criteria for the skin at any point during the period on appeal. As discussed above, the Veteran’s overall disability picture during the period was characterized itching/swelling of the eyelids, itching on the throat, hives and lip swelling and a need for systemic therapy for less than 6 weeks per year. The record is silent for any indication, and the Veteran does not contend, that his symptoms affected either 20 to 40 percent of the total body area or 20 to 40 percent of exposed body areas. Both VA examinations found that 0 percent of the skin was affected. There is also no indication in the record that the Veteran has required the use of antihistamines for more than 6 weeks per year at any point during the period on appeal. It is also not shown that the Veteran has any functional loss beyond that currently compensated, as symptoms that affect up to 20 percent of the total body area/exposed areas and use of systemic therapy for less than 6 weeks per year are encompassed by the 10 percent rating currently assigned. The Board has also considered a rating under DC 6522, which rates allergic rhinitis, but as there is no indication that the Veteran’s storage mite syndrome causes nasal polyps or nasal obstruction, it would provide no benefit to the Veteran. All potentially applicable Diagnostic Codes have been considered. See Schafrath v. Derwinski, 1 Vet. App. 589, 593 (1991). The preponderance of the evidence is against a rating above 10 percent for storage mite syndrome. As such, the benefit-of-the-doubt doctrine is inapplicable. 38 C.F.R. § 4.3. A rating in excess of 10 percent is therefore not warranted. Service Connection 2. Entitlement to service connection for diverticulitis The Veteran contends that he is entitled to service connection for diverticulitis. After a review of the competent evidence of record, the Board concludes that the Veteran’s diverticulitis is not related to service and service connection is therefore not warranted. Service treatment records are silent for complaints, treatment or diagnosis of diverticulitis. October 2010 VA treatment records noted a diagnosis of diverticulosis by history. April 2011 and June 2011 VA treatment records showed a diagnosis of diverticulosis and noted that a colonoscopy had been done 5 years earlier. February 2014 VA treatment records show a diagnosis of mild diverticulosis of the sigmoid and descending colon. January 2019 records show a diagnosis of diverticular disease of the colon. The Veteran submitted a September 2013 application claiming compensation benefits for “diverticulos” but did not make any specific assertions regarding the onset of his disability or the relationship between his disability and his active service. His October 2015 VA9 Formal Appeal stated that all of his disabilities came up due to service but did not make any specific statements regarding diverticulitis, its onset or its relationship to service. The Board finds that the competent evidence of record does not support the conclusion that the Veteran’s diverticulitis began in service or was otherwise due to service. Service treatment records are silent for diverticulitis or any reports of symptoms associated with the disability. The Veteran was discharged from service in 1991. While the record shows VA treatment beginning in March 2002, the first report of diverticulitis in the record is the October 2010 report of a history of diverticulosis, followed by reports in April 2011 and June 2011 that he had been diagnosed after a colonoscopy around 2006. Unfortunately, as discussed above, records from Damas Hospital are not in the claim file as the Veteran did not cooperate with VA’s attempts to obtain those records. There is simply no competent evidence of record that establishes either an earlier onset of diverticulitis or a relationship between the Veteran’s disability and his active service. The record is negative for any evidence, other than the Veteran’s own generalized assertion that he is entitled to service connection and that his disability came up due to service, of a relationship between his service and the later diagnosis of diverticulitis. The Veteran did not present any lay or medical evidence of symptoms or diagnosis of diverticulitis, diverticulosis or any other colon disability prior to 2006 or any evidence of a relationship between his disability and his service. While the Veteran contends that his diverticulitis is related to service, as a layperson, he does not possess the medical expertise required to provide a nexus opinion. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). The Board acknowledges that a VA examination was not obtained for this issue but finds that an examination is not required to make a final adjudication. Although the Veteran contends service connection is warranted for diverticulitis, there is no indication (or specific assertion) that it was manifested in, or is otherwise directly related to, the Veteran’s active service. The Veteran did not report a diagnosis or onset of any symptoms in service. Moreover, STRs are silent for diverticulitis or any colon complaints and VA treatment records are silent for a history of diverticulosis until around 2006. The Board therefore finds that the preponderance of the evidence indicates that the Veteran’s diverticulitis was not caused by or incurred in service. Service connection is therefore not warranted. 38 C.F.R. § 3.303. 3. Entitlement to service connection for rheumatoid arthritis of various joints The Veteran contends that he is entitled to service connection for a rheumatoid arthritis. The Board concludes that the Veteran does not have a current diagnosis of rheumatoid arthritis and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Service connection is therefore not warranted. 38 C.F.R. § 3.303(a), (d); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The Board notes that the Veteran has reported symptoms of multiple joint discomfort in the back, neck sacroiliac joints and shoulders, however service connection has already been granted for cervical degenerative arthritis, lumbosacral strain with degenerative arthritis, and osteoarthritis of the sacroiliac joint as well as for fibromyalgia. Therefore, the Board finds that Veteran’s specific joint complaints have been addressed separately and the Board will limit its analysis regarding rheumatoid arthritis to the question of whether the Veteran is entitled to service connection for the systemic disease. The issue of service connection for the bilateral shoulders will also be separately addressed below. February 1986 service treatment records noted complaints of back pain and a family history of rheumatoid arthritis. The provider recorded and impression of muscle pain and noted that arthritis, including rheumatoid arthritis, should be ruled out. December 1986 service treatment records also recommended evaluation regarding rheumatoid arthritis. March 1987 service treatment records show an orthopedic consultation for pain. The provider diagnosed trigger point muscle spasm. VA treatment records show that the Veteran was evaluated for rheumatoid arthritis. December 2011 VA treatment records show that rheumatoid factor test showed result under 7. A December 2013 record noted a diagnosis of rheumatoid arthritis but did not state the basis for this diagnosis. A June 2014 record noted that the Veteran was seeing an outside rheumatologist who told him he did not have rheumatoid arthritis and studies suggested degenerative changes instead. January 2015 VA treatment records also noted that the Veteran’s private rheumatologist believed the Veteran did not have rheumatoid arthritis. July 2018 VA treatment records noted that the Veteran was concerned about fibromyalgia due to his persistent muscle pain and the lack of evidence in the prior rheumatology workup. An August 2014 VA examination found that there was no evidence for a diagnosis of rheumatoid arthritis. The examiner noted the Veteran’s reports of general pain at different joints but found that the examination was compatible with osteoarthritis of the joints rather than rheumatoid arthritis. A June 2019 VA examination found that the Veteran did not have a current diagnosis of rheumatoid arthritis. The examiner explained that rheumatoid factor testing was non-reactive and thus there was no objective evidence to support a diagnosis. Regarding the Veteran’s complaints of multiple joint discomfort in the Veteran’s back, neck, sacroiliac joints and shoulders, the examiner found degenerative arthritis in the cervical and lumbar spine and trochanteric pain syndrome and femoral acetabular impingement syndrome in the left hip. At the outset, the Board finds that the VA examinations are adequate for appellate review. There is no evidence that the examiners were not competent or credible, and as the reports are based on the Veteran’s statements, in-person examinations and the examiners’ observations, the Board finds them entitled to significant probative weight. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302–05 (2008). Upon review of the above, the Board finds that the preponderance of the competent evidence of record is against a finding that the Veteran has had a current diagnosis of rheumatoid arthritis at any point during the period on appeal. While service treatment records indicated that an evaluation for rheumatoid arthritis was recommended, the records are silent for a diagnosis. During the period on appeal, the record shows that evaluations for rheumatoid arthritis were consistently negative. The VA examinations both found that the Veteran did not have a current diagnosis of rheumatoid arthritis, noting that rheumatoid factor tests were negative. Unfortunately, as discussed above, records from the Veteran’s private rheumatologist are not in the claim file as the Veteran did not cooperate with VA’s attempts to obtain those records. However, VA treatment records contain reports of the private provider’s findings that the Veteran did not have rheumatoid arthritis. The VA records specifically noted the private provider’s assessment that the Veteran had degenerative arthritis, not rheumatoid arthritis, consistent with the VA examination findings. Subsequent records again noted that workups for rheumatoid arthritis had been negative and fibromyalgia was suspected. Significantly, the Veteran has since been service connected for both fibromyalgia and degenerative arthritis of multiple joints. There is simply no basis upon which the Board can conclude that the Veteran has had a diagnosis of rheumatoid arthritis during the period on appeal. The Board therefore finds that the Veteran does not have a current disability of rheumatoid arthritis and has not had one at any point during the period on appeal. As with all claims for service-connection, in the absence of proof of a present disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Service connection for rheumatoid arthritis is therefore not warranted. 38 C.F.R. § 3.303. 4. Entitlement to service connection for bilateral shoulder strain The Veteran contends that he is entitled to service connection for a bilateral shoulder disability. After a review of the competent evidence of record, the Board concludes that the Veteran’s bilateral shoulder strain is not related to service and service connection is therefore not warranted. December 1986 service treatment records noted a Sprengel’s deformity, with the left shoulder elevated, and reports of back pain. March 1987 records noted left arm pain radiating to the elbow and the provider diagnosed trigger point muscle spasm. June 1987 service treatment records noted pain in the left vertebral scapular muscles and shoulder pain. The provider noted an elevated left shoulder when the Veteran was asked to relax. The provider found that there was a self-induced postural deformity, etiology unknown. The examiner also found a protective muscle spasm in the left upper back. The Veteran’s October 1988 and March 1991 separation examinations were both negative for a symptoms, complaints or diagnosis of a shoulder disability. A June 1992 report of medical history is also silent for shoulder or other joint complaints. October 2013 VA treatment records show that the Veteran complained of right shoulder pain for 4 days, triggered by waxing his car. The provider diagnosed shoulder strain. May 2014 VA treatment records show a chest x-ray finding of degenerative changes of the spine and shoulders and a diagnosis of thoracolumbar levoscoliosis. A June 2019 VA shoulder examination diagnosed bilateral shoulder strain. The Veteran reported occasional shoulder discomfort beginning in 2010 and persisting since that time. The provider found that x-rays did not show degenerative changes in the shoulders and therefore found that the Veteran did not have degenerative arthritis. The examiner did not offer an opinion regarding the etiology of the Veteran’s bilateral shoulder strain. A December 2020 VA opinion found that the Veteran’s bilateral shoulder strain was not due to service. The examiner noted the Veteran’s 1986 complaints of shoulder pain during service and orthopedic evaluation but found that the symptoms in service were not related to the current diagnosed shoulder strain. As a rationale, the provider noted that the March 1989 examination was silent for shoulder complaints and there were no shoulder complaints or treatment in the Veteran’s active duty service period from 1990 to 1991, with the March 1991 separation examination again silent for shoulder complaints. The provider also noted a lack of evidence of complaints or treatment within 5 years of service. At the outset, the Board finds that the VA examinations are adequate for appellate review. There is no evidence that the examiners were not competent or credible, and as the reports are based on the Veteran’s statements, in-person examinations and the examiners’ observations, the Board finds they are entitled to significant probative weight. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302–05 (2008). The Veteran submitted a September 2013 application claiming compensation benefits for joint pain but did not make any specific assertions regarding the onset of his bilateral shoulder strain or the relationship between his disability and his active service. His October 2015 VA9 Formal Appeal stated that all of his disabilities came up due to service but did not make any specific statements regarding his bilateral shoulder disability, its onset or its relationship to service. The Board finds that the competent evidence of record does not support the conclusion that the Veteran’s bilateral shoulder strain began in service or was otherwise due to service. While service treatment records show shoulder pain and muscle spasm, the December 2020 VA opinion found that the current bilateral shoulder condition was not related to that pain in service. In so finding, the examiner specifically considered the Veteran’s shoulder pain during service but stated that the absence of shoulder complaints not only at the March 1989 separation examination, but in the Veteran’s secondary period of active duty from 1990 to 1991 and at the March 1991 separation examination, showed that the disability had not begun in service and persisted since service. The Board finds that this conclusion is consistent with the other competent evidence of record, including the Veteran’s competent lay evidence. The first post-service complaint of shoulder pain was the October 2013 VA treatment records showing that the Veteran reported right shoulder pain due to waxing his car. Significantly, at the June 2019 VA examination the Veteran reported onset of his shoulder pain disability not in service but in 2010, nearly 20 years after separation from service. While the Veteran reported that his disability “came up due to service,” the record is silent for a contention that the disability began in service and had been continuous since that time. There is simply no competent evidence of record that establishes either an earlier onset of the Veteran’s current bilateral shoulder strain or a relationship between the disability and his active service. The Board acknowledges the Veteran’s contention that his shoulder disability is due to service. However, the Veteran did not present any lay or medical evidence of symptoms or diagnosis between separation from service and 2010, when he reported onset of his bilateral shoulder strain. The Board notes that the Veteran is competent to report the onset of lay observable symptoms such as pain and accords his statement regarding onset of his current shoulder pain significant probative weight. However, while the Veteran contends that his bilateral shoulder strain is related to service, as a layperson, he does not possess the medical expertise required to provide a nexus opinion. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). The Board therefore finds that the preponderance of the evidence indicates that the Veteran’s bilateral shoulder strain was not caused by or incurred in service. Service connection is therefore not warranted. 38 C.F.R. § 3.303. E. I. VELEZ Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Arnold 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.