Citation Nr: 21022471 Decision Date: 04/15/21 Archive Date: 04/15/21 DOCKET NO. 15-35 359 DATE: April 15, 2021 ORDER Entitlement to service connection for a lumbar spine disability is denied. Entitlement to service connection for a cervical spine disability is denied. Entitlement to service connection for headaches is denied. FINDINGS OF FACT 1. A lumbar spine disability was not manifest during active service, or until many years after service, and is not shown to be causally or etiologically related to an in-service event, injury, or disease. 2. A cervical spine disability was not manifest during active service, or until many years after service, and is not shown to be causally or etiologically related to an in-service event, injury, or disease. 3. A headaches disability was not manifest during active service, or until many years after service, and is not shown to be causally or etiologically related to an in-service event, injury, or disease. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a lumbar spine disability have not been met or approximated. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. §§ 3.303, 3.304 (2020). 2. The criteria for entitlement to service connection for a cervical spine disability have not been met or approximated. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. §§ 3.303, 3.304 (2020). 3. The criteria for entitlement to service connection for a headaches disability have not been met or approximated. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. §§ 3.303, 3.304 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1972 to April 1974. This matter comes before the Board of Veterans’ Appeals (Board) from a February 2012 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida. The Veteran testified at a travel board hearing before the undersigned Veterans Law Judge (VLJ) in April 2017. A transcript of the hearing is of record. The Board remanded the issues on appeal for additional development in February 2017 and August 2018. The directives having been substantially complied with, the matter again is before the Board. D’Aries v. Peake, 22 Vet. App. 97, 105 (2008); Stegall v. West, 11 Vet. App. 268 (1998). This appeal was originally certified to the Board with two additional issues: entitlement to service connection for the right knee and the left knee. However, in a June 2020 rating decision, the RO granted entitlement to service connection for the right knee and the left knee. As such, those service connection issues are no longer in appellate status before the Board. Grantham v. Brown, 114 F.3d 1156, 1159 (Fed. Cir. 1997). Veterans Claims Assistance Act of 2000 (VCAA) The Veterans Claims Assistance Act of 2000 (VCAA) and implementing regulations impose obligations on VA to provide claimants with notice and assistance. 38 U.S.C. §§ 5100, 5102, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2020). The Veteran in this case has not referred to any deficiencies in either the duties to notify or assist; therefore, the Board may proceed to the merits of the claim. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015, cert. denied, U.S.C. Oct. 3, 2016) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board….to search the record and address procedural arguments when the [appellant] fails to raise them before the Board”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to an appellant’s failure to raise a duty to assist argument before the Board). The Board has reviewed all of the evidence in the Veteran’s claims file. Although the Board has an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that the evidence submitted by the Veteran or obtained on his behalf be discussed in detail. Rather, the Board’s analysis below will focus specifically on what evidence is needed to substantiate the claim and what the evidence in the claims file shows, or fails to show, with respect to the claim. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) and Timberlake v. Gober, 14 Vet. App. 122, 128-130 (2000). Service Connection for Cervical Spine, Lumbar Spine, and Headaches Disabilities Legal Criteria for Service Connection - General Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). To establish entitlement to service-connected compensation benefits, a Veteran must show: “(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service-the so-called “nexus” requirement.” Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Service connection may also be granted for disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303(d). Service connection may also be established for a current disability on the basis of a presumption that certain chronic diseases, to include arthritis, manifesting themselves to a certain degree within a certain time after service must have had their onset in service. 38 U.S.C. §§ 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309(a). For arthritis, the disease must have manifested to a degree of 10 percent or more within one year of service. 38 C.F.R. § 3.307(a)(3). Service connection can also be established through continuity of symptomatology. Walker v. Shinseki, 708 F.3d 1331 (2013); 38 C.F.R. §§ 3.303(b), 3.309. For chronic diseases shown as such in service or within the applicable presumptive period, subsequent manifestations of the same chronic disease at any later date are service-connected unless attributable to an intercurrent cause. 38 C.F.R. § 3.303(b). For a chronic disease to be considered to have been “shown in service,” there must be a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings. Id. When the condition noted in service or within the presumptive period is not a chronic disease, a showing of continuity of symptomatology after discharge is required. Id. VA is required to give due consideration to all pertinent medical and lay evidence in evaluating a claim for disability benefits. 38 U.S.C. § 1154(a). 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. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Lay evidence cannot be determined to be not credible merely because it is unaccompanied by contemporaneous medical evidence. Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006). However, the lack of contemporaneous medical evidence can be considered and weighed against a Veteran’s lay statements. Id. Further, a negative inference may be drawn from the absence of complaints or treatment for an extended period. Maxson v. West, 12 Vet. App. 453, 459 (1999), aff’d sub nom. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). Proof of a current disability is a threshold to establishing service-connection for any claimed disability. In the absence of proof of a present disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). To be a present as a current disability, there must be evidence of the condition at some time during the appeals period. Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998). After the evidence is assembled, it is the Board’s responsibility to evaluate the entire record. See 38 U.S.C. § 7104(a) (2012). When there is an approximate balance of evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each issue shall be given to the claimant. See 38 U.S.C. § 5107 (2012); 38 C.F.R. §§ 3.102, 4.3. In Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990), the United States Court of Appeals for Veterans Claims (Court) stated that “a veteran need only demonstrate that there is an ‘approximate balance of positive and negative evidence’’ in order to prevail.” To deny a claim on its merits, the preponderance of the evidence must be against the claim. See Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert, 1 Vet. App. at 54. Evidence and Analysis The Veteran’s claim for his cervical and lumbar spine disabilities share the same factual background and were examined at the same time. The Board will therefore discuss these two claims together for the sake of clarity. 1. Entitlement to service connection for a lumbar spine disability The Veteran is claiming service connection for a lumbar spine disability, asserting that he hurt his spine in a motorcycle accident during active service in October 1973. The Veteran’s service treatment records are silent for any lumbar spine or cervical spine disability during active service, to include as a result of an active service motorcycle accident in October 1973. The Veteran’s exit examination of April 1974 was silent for lumbar spine, cervical spine, or headaches complaints. Social Security records from November 1985 show the Veteran has been awarded Social Security disability commencing in July 1985 following a back injury at work where the Veteran, working as a warehouseman in a furniture store, had originally hurt his back while lifting heavy furniture in November 1983. After laminectomy surgery on his lumbar back in November 1984, the Veteran continued to have pain in the lumbosacral region with radiating pain into his legs. The Veteran’s lumbar back injury persisted, and he has been determined by Social Security to be unable to work due to his lumbar back injury from November 1983. This record also indicates the Veteran receives workman’s compensation for that injury. The Veteran received a VA examination for his claimed lumbar spine disability in January 2012. This examiner diagnosed degenerative disc disease of the lumbar spine with left-sided S1 radiculopathy and lumbar laminectomy with residuals. The examiner found range of motion to be flexion to 25 degrees, extension to 20 degrees, right lateral flexion to 10 degrees, left lateral flexion to 15 degrees, right lateral rotation to 20 degrees, and left lateral rotation to 20 degrees. There was no additional limitation of range of motion after three repetitions. Functional loss was noted as less movement than normal, pain on movement, and disturbance of locomotion. Localized tenderness and pain on palpation were noted. This January 2012 VA examiner provided a negative opinion for service connection, saying it was less likely than not, less than 50 percent probability, that the Veteran’s lumbar spine disability was incurred in service or related to an injury in service. The examiner’s rationale was that the Veteran’s service treatment records were silent for any lumbar spine injury or complaints, even after the acknowledged inservice motorcycle accident. The exit examination from service was silent for any lumbar spine or similar condition. The examiner continued, noting the observation and diagnosis of degenerative disc disease was more likely than not related to the Veteran’s natural aging process and not any traumatic injury. The Veteran received an examination from a private chiropractor in April 2013. This chiropractor noted the arthritis of both the cervical spine and the lumbar spine, along with degenerative disc disease in both the cervical and lumbar areas of the spine. This chiropractor stated that the Veteran’s lumbar and cervical conditions were likely due to service, without any further explanation. The same chiropractor examined the Veteran again in January 2015 with the same diagnoses for the cervical and lumbar spine and provided the same conclusory opinion for service connection. The Veteran received another VA examination in October 2019. This examiner diagnosed both degenerative disc disease and degenerative joint disease of the lumbar spine. Range of motion measurements were flexion to 60 degrees, extension to 30 degrees, and right and left lateral flexion, and right and left lateral rotation, each to 30 degrees. Pain was noted on the examination and causes functional loss, primarily in flexion. There was no objective evidence of localized tenderness or pain on palpation of the joints or associated tissue of the lumbar spine. There were no changes in range of motion measurements after three repetitions, and the Veteran reported no flareups. Muscle strength was five on a scale of five and reflexes were normal. Intermittent moderate pain was noted in the lower extremities due to radiculopathy. Intervertebral disc syndrome (IVDS) was noted but the Veteran did not have any incapacitating episodes requiring bedrest prescribed by a physician in the last 12 months. The Veteran used no assistive devices. This October 2019 VA examiner provided a negative opinion for service connection, saying it was less likely than not, less than 50 percent probability, that the Veteran’s lumbar spine or cervical spine disability was incurred in or caused by the claimed in-service injury, event, or illness. The examiner’s rationale was that the Veteran’s lumbar spine and cervical spine degenerative disc and joint disease was due to osteoarthritis likely due to the aging process, and not from any traumatic injury as claimed by the Veteran. The examiner noted the October 1973 motorcycle accident claimed by the Veteran as the source of his cervical and lumbar spine disabilities, but also noted that the Veteran’s 1984 workplace injury and subsequent treatment, leading to his Social Security disability rating and subsequent workman’s compensation award. The examiner opined that the Veteran’s current lumbar back and cervical spine conditions were due to this 1984 workplace injuries, rather than a 1973 motorcycle accident that resulted in no lumbar or cervical spine injury, per the service treatment records. 2. Entitlement to service connection for a cervical spine disability The Veteran received his first VA examination for his cervical spine claim in January 2012. The examiner diagnosed degenerative disc disease of the cervical spine based on x-ray evidence. Range of motion was 45 degrees in flexion, 40 degrees in extension, left and right lateral flexion each at 40 degrees, right lateral rotation at 70 degrees and left lateral rotation at 50 degrees. There were no changes in range of motion after three repetitions, and localized tenderness and pain were noted. Pain on movement was noted. This January 2012 VA examiner provided a negative opinion for service connection, saying it was less likely than not, less than 50 percent probability, that the Veteran’s cervical spine disability was incurred in service or related to an injury in service. The examiner’s rationale was that the Veteran’s service treatment records were silent for any cervical spine injury or complaints, even after the acknowledged inservice motorcycle accident. The exit examination from service was silent for any cervical spine or similar condition. The examiner continued, noting the observation and diagnosis of degenerative disc disease was more likely than not related to the Veteran’s natural aging process and not any traumatic injury. The Veteran received another VA examination for his cervical spine claim in October 2019, uploaded to the claims file in November 2019. The examiner noted diagnoses of degenerative disc disease and degenerative joint disease of the cervical spine. Occasional flareups were mentioned by the Veteran, and functional loss was described as pain in motion of the upper back and cervical spine. Range of motion was considered abnormal, with flexion and extension each to a normal 45 degrees, right and left lateral flexion each to a normal 45 degrees, but right and left lateral rotation each to 60 degrees. Repetitive use testing did not result in any reduced ranges of motion. Muscle strength was five on a scale of five, reflexes were normal, and mild numbness in the upper extremities due to radiculopathy was noted. This October 2019 VA examiner provided a negative opinion for service connection, saying it was less likely than not, less than 50 percent probability, that the Veteran’s lumbar spine or cervical spine disability was incurred in or caused by the claimed in-service injury, event, or illness. The examiner’s rationale was that the Veteran’s lumbar spine and cervical spine degenerative disc and joint disease was due to osteoarthritis likely due to the aging process, and not from any traumatic injury as claimed by the Veteran. The examiner noted the October 1973 motorcycle accident claimed by the Veteran as the source of his cervical and lumbar spine disabilities, but also noted that the Veteran’s 1984 workplace injury and subsequent treatment, leading to his Social Security disability rating and subsequent workman’s compensation award. The examiner opined that the Veteran’s current lumbar back and cervical spine conditions were due to this 1984 workplace injuries, rather than a 1973 motorcycle accident that resulted in no lumbar or cervical spine injury, per the service treatment records. The Board finds the January 2012 and October 2019 VA examination reports and opinions to be of great probative value, along with both the VA treatment notes and private treatment regarding the Veteran’s claimed lumbar and cervical spine disabilities with associated lower extremity radiculopathy. Indeed, the VA examiners considered the Veteran’s contention, the claims file, and clinical medical evidence before providing a negative opinion for direct service connection. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (the probative value of a medical opinion is derived from a factually accurate, fully articulated, and soundly reasoned opinion). A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). The examiners’ negative opinions were supported by a sufficiently clear and well-reasoned medical rationale and was consistent with the verifiable facts regarding the Veteran’s contentions. See Bloom v. West, 12 Vet. App. 185, 187 (1999); Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998); see also Claiborne v. Nicholson, 19 Vet. App. 181, 186 (2005). The Board notes the 2014 and 2015 examinations and opinions by the Veteran’s chiropractor, but finds them to be of low probative value when it comes to the etiology of the two cervical and lumbar spine disabilities. The chiropractor in question returned diagnoses of the cervical and lumbar disabilities similar to that of VA, but did not have the opportunity to review the entire claims file when he made a conclusory opinion regarding service connection of the cervical and spine disabilities without any basis in the evidence. Generally, the degree of probative value which may be attributed to a medical opinion issued by a VA or private treatment provider takes into account such factors as its thoroughness and degree of detail, and whether there was review of the claims file. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000). Also significant is whether the examining medical provider had a sufficiently clear and well-reasoned rationale, as well as a basis in objective supporting clinical data. See Bloom v. West, 12 Vet. App. 185, 187 (1999); Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998); see also Claiborne v. Nicholson, 19 Vet. App. 181, 186 (2005) (rejecting medical opinions that did not indicate whether the physicians actually examined the veteran, did not provide the extent of any examination, and did not provide any supporting clinical data). The Court has held that a bare conclusion, even one reached by a health care professional, is not probative without a factual predicate in the record. Miller v. West, 11 Vet. App. 345, 348 (1998). The Board acknowledges that the Veteran is competent to testify as to his beliefs that his disabilities are related to service. Barr v. Nicholson, 21 Vet. App. 303, 307-08 (2007). In order for lay evidence to be competent, the individual must have personal knowledge, derived from his/her own senses, of what is being attested; “[c]ompetent testimony is thus limited to that which the witness has actually observed, and is within the realm of his personal knowledge.” Layno v. Brown, 6 Vet. App. 465, 471 (1994). Here, the Veteran, via the supplied statements, is competent to testify about his symptoms relating to his claimed lumbar and cervical symptoms. However, there is nothing in the record to suggest that the Veteran has the appropriate training, experience, or expertise to render a medical opinion regarding etiology of his lumbar back or cervical spine disability. See 38 C.F.R. § 3.159(a)(1) (setting forth that competent medical evidence means evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions). While the Veteran is competent to report what he has experienced, he is not competent to ascertain the etiology of any current condition, as the causative factors for such are not readily subject to lay observation. See Layno v. Brown, 6 Vet. App. 465 (1994); Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (concerning rheumatic fever); see also Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Accordingly, his assertions to that effect are of no probative value. The Board acknowledges the Veteran’s statements that his lumbar and cervical spine symptoms could be related to service. However, the Board notes that the Veteran’s service treatment records, to include reports of medical history, are silent for any treatment or complaint of any lumbar condition or cervical condition during active service ending in April 1974 or until 1983, the initial workplace accident, nine years after active service ended. The Board notes especially that even though the Veteran asserts an October 1973 motorcycle accident was the cause of his lumbar and cervical conditions, that the service treatment records were silent for any chronic effects of that accident, to include any lumbar or cervical problems at the end of active service in April 1974. A negative inference may be drawn from the absence of complaints or treatment for an extended period. Maxson v. West, 12 Vet. App. 453, 459 (1999), aff’d sub nom. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). The Board also notes with emphasis the 1983 intervening workplace accident of the Veteran that led to Social Security disability and workman’s compensation benefits, but is omitted from the Veteran’s testimony or other lay statements. See Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991); Pond v. West, 12 Vet. App. 341 (1999) (although the Board must take into consideration the Veteran’s statements, it may consider whether self-interest may be a factor in making such statements); Caluza v. Brown, 7 Vet. App. 498 (1995), aff’d, 78 F.3d 604 (Fed. Cir. 1996) (per curiam). The Board notes there are no other statements besides the previously mentioned chiropractor by any medical provider, VA or private, that are in favor of a possible nexus to service for the Veteran’s claimed lumbar and/or cervical spine disability. Upon review of the record, the Board concludes that entitlement to service connection for a lumbar spine or cervical spine disability is not warranted. The Board notes a current diagnosis of a lumbar spine disability and cervical spine disability in January 2012 and again in October 2019, and thus the requirement for a current disability is shown for each the lumbar back claim and the cervical spine claim. The Board acknowledges the Veteran’s contentions, and the Veteran’s post-service statements are noted. However, the Veteran’s service medical records, to include all examinations, are silent for any existing lumbar spine or cervical spine condition at the time of separation, and there is no competent evidence to tie the current assertion to any in-service disease or injury. Two VA examiners have discussed all of the Veteran’s lumbar and cervical spine disabilities and all possible risk factors raised by the record, and opined that the current lumbar spine and/or cervical spine disability is not related back to active service. The Board thus finds the Veteran fails the third prong of the test for entitlement to direct service connection. See Davidson v. Shinseki, 581 F.3d 1313, 1315-16 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); 38 C.F.R. § 3.303. With regard to possible presumptive service connection for degenerative arthritis, the weight of evidence shows no formal diagnosis of any lumbar or cervical spine arthritis on any examination, private or VA, until January 2012, 38 years after active service. As such, presumptive service connection is not warranted. 38 C.F.R. §§ 3.303, 3.309. Based on the above, the Board finds that the weight of the competent and credible evidence demonstrates that the Veteran’s claimed lumbar and/or cervical spine disability was not incurred in service. For these reasons, the Board finds that a preponderance of the evidence is against the claim of service connection for a lumbar and/or cervical spine disability, and the claim must be denied. Because the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not for application. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 3. Entitlement to service connection for headaches The veteran claimed service connection for headaches in his original claim, to include as due to the medications he took for his cervical and lumbar spine difficulties. VA provided an examination for the Veteran’s claimed headaches in October 2019, uploaded to the claims file in November 2019. This examiner noted the Veteran’s stated history, that his headache pain resulted from basic training in 1972. During the Veteran’s testimony before the undersigned VLJ in April 2017, he attributed the headaches to his October 1973 motorcycle accident. The examiner noted claimed symptoms of prostrating pain, lasting less than a day and occurring about once a month, and localized to the left side of his head. This examiner declined to make a diagnosis of a current condition of chronic headaches. This examiner provided a negative opinion for service connection, saying it was less likely than not, less than 50 percent probability, that the Veteran’s claimed headaches were incurred in or caused by the claimed inservice injury, event, or illness. The examiner’s rationale was that the Veteran’s service treatment records for his entire time of service from August 1972 to April 1974 contained no record of any complaints of headaches. The examiner also noted there was no medications taken by the Veteran for his diagnosed cervical or lumbar spine conditions that had any side effects of headaches. The Board finds October 2019 examination to be highly probative as it was sound and thorough, and had sufficiently clear and well-reasoned rationale, as well as a basis in objective supporting medical literature and clinical data. See Bloom v. West, 12 Vet. App. 185, 187 (1999); Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998); see also Claiborne v. Nicholson, 19 Vet. App. 181, 186 (2005). In the absence of proof of a present disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Here, there is no diagnosis of a current disability of a chronic headaches disability by any VA medical examiner. Thus, the Veteran’s claim does not meet the first prong of service connection, the requirement of a current disability. See Davidson v. Shinseki, 581 F.3d 1313, 1315-16 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); 38 C.F.R. § 3.303. Upon review of the evidence of record, the Board finds that the weight of the competent and probative evidence does not demonstrate that entitlement to service connection is warranted for the Veteran’s claimed chronic headaches disability. Here, no examiner or medical professional has made a diagnosis of a current disability related to the Veteran’s claimed headaches. The service treatment records note no headaches during active service, to include any mention on the service exit examination in April 1994. The Board notes the statements from the Veteran regarding his headaches disability. Generally, lay evidence is probative with regard to a disease with “unique and readily identifiable features” that is “capable of lay observation.” See Barr v. Nicholson, 21 Vet. App. 303, 308-09 (2007). Lay evidence on its own can be sufficient evidence of a diagnosis if (1) the 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 Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Additionally, a lay person may speak to etiology in some limited circumstances in which nexus is obvious merely through observation, such as sustaining a fall leading to a broken leg. Id. A layperson cannot provide evidence as to more complex medical questions and, specifically, cannot provide an opinion as to etiology in such cases. See Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (concerning rheumatic fever). See 38 C.F.R. § 3.159(a)(2). To the extent that the Veteran can observe symptoms such as pain in his head, he is competent to comment on and endorse these symptoms. However, the determination of the etiology of a chronic headaches disability is a complex medical determination beyond his competence. See Layno v. Brown, 6 Vet. App. 465 (1994); see also Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Accordingly, his assertions to that effect are of no probative value. In the absence of proof of a present disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Here, there is no diagnosis of a current disability of a headaches disability by any VA medical examiner. Thus, the Veteran’s claim fails the first prong of service connection, the requirement of a current disability. See Davidson v. Shinseki, 581 F.3d 1313, 1315-16 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); 38 C.F.R. § 3.303. Because the Veteran has no in-service or related disease or injury that occurred in service or within one year after leaving active service that is not already accounted for in his other service-connected disabilities, the Veteran fails the second prong of the test for entitlement to direct service connection. See id. The Board has considered the recent holding in Saunders v. Wilkie in which service connection was deemed possible in the absence of a diagnosis when such factors as pain are shown to limit functional ability. Saunders v. Wilkie, 886 F.3d 1356, 1364 (Fed. Cir. 2018) (“pain alone can serve as a functional impairment and therefore qualify as a disability”). That Federal Circuit decision qualified that holding, however: “[w]e do not hold that a veteran could demonstrate service connection simply by asserting subjective pain…. To establish the presence of a disability, the veteran will need to show that [his] pain reaches the level of functional impairment of earning capacity.” Id. at 1365. In this case, however, the VA examination conducted during the pendency of this appeal in October 2019 did not show any symptoms of a chronic headaches disability or any other related condition. The Veteran has received multiple examinations for his lumbar spine and cervical spine, which extensively document those disabilities, but there has been no observation of symptoms for headaches as a chronic condition or as an effect of the Veteran’s medications for his lumbar and cervical spine disabilities. (CONTINUED ON NEXT PAGE) Based on the above, the Board finds that the weight of the competent and credible evidence demonstrates that the Veteran’s claimed headaches disability was not incurred in service. For these reasons, the Board finds that a preponderance of the evidence is against the claim of service connection for a headaches disability, and the claim must be denied. Because the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not for application. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. MICHAEL A. PAPPAS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Setter, 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.