Citation Nr: 21023453 Decision Date: 04/20/21 Archive Date: 04/20/21 DOCKET NO. 17-23 618 DATE: April 20, 2021 ORDER Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), is denied. Entitlement to service connection for a headache condition is denied. REMANDED Entitlement to service connection for lumbar spine disability is remanded. Entitlement to service connection for bilateral shoulder disability is remanded. Entitlement to service connection for bilateral knee disability is remanded. Entitlement to service connection for left hand disability is remanded. Entitlement to service connection for umbilical hernia residuals is remanded. Entitlement to a compensable rating for residuals of puncture wound and muscle injury, left groin, is remanded. FINDINGS OF FACT 1. The Veteran’s acquired psychiatric disorder did not originate in service, within a year of service, and is not otherwise etiologically related to his active service. 2. The Veteran’s headache condition did not originate in service, within a year of service, and is not otherwise etiologically related to his active service. CONCLUSIONS OF LAW 1. The criteria for service connection for an acquired psychiatric disorder have not been met. 38 U.S.C. §§ 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303. 2. The criteria for service connection for headache condition have not been met. 38 U.S.C. §§ 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1980 to June 1981. The Veteran had additional service in the Army Reserve between November 1979 and June 1985. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a November 2015 rating decision by a Department of Veterans Affairs Regional Office (RO). In September 2020, the Veteran testified at a Board videoconference hearing before the undersigned. A copy of the transcript of that hearing has been associated with the claims file. The Board held the record open for 90 days for the Veteran to submit additional relevant evidence. The Board notes finds that all available STRs have been obtained. In this regard, STRs were associated with the claims file in August 2013 which mainly documents treatment for a puncture wound that occurred in May 1982 during a period of Army Reserve service. Those records also include the Veteran’s May 1979 Army Reserve enlistment examination. Thereafter, the Board notes that an August 2014 Request for Information shows that all available STRs were sent to VA. A VA letter was sent the Veteran notifying him that several attempts had been made to obtain his STRs from June 1980 to June 1981, but that those records could not be located and were deemed unavailable for review. The letter detailed the attempts to obtain outstanding STRs as well as a September 2015 correspondences noting that STRs covering an umbilical hernia and umbilical hernia repair from 1981 were received. The Veteran was requested to submit any STRs covering the period from June 1980 to June 1981 in his possession. In consideration of VA attempts to obtain all outstanding STRs, including findings that all available STRs had been sent to VA, the Board finds that VA has fulfilled its duty to assist in obtain from the Veteran’s STRs from his period of active duty service. Lastly, the Board notes that the Veteran has been represented by the California Department of Veterans Affairs during the whole course of this appeal. The appeal was certified to the Board in March 2016. In March 2021, more than 90 days after the case was certified to the Board, the Veteran submitted VA Form 21-22 appointing Disabled American Veterans (DAV) as his new representative. The Board notes that 38 C.F.R. § 20.1305 (designated 20.1304 prior to January 18, 2019) requires a showing of good cause for a change in representation in excess of 90 days after the certification of the appeal to the Board. As the matter on appeal was certified to the Board in August 2017, the Veteran’s request for a new representative is beyond 90 days after certification. Neither the Veteran nor the designated representative have provided any reason for the requested change of representation. As such, the Board finds that no good cause has been shown to change representation, and, therefore, the proper representation is the California Department of Veterans Affairs. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated during service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. In order to establish entitlement to service connection, there must be (1) evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) a causal connection between the claimed in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Service connection may be presumed for certain chronic diseases which develop to a compensable degree within one year after discharge from service, even though there is no evidence of the disease during the period of service. That presumption is rebuttable by probative evidence to the contrary. 38 U.S.C. §§ 1101, 1137; 38 C.F.R. §§ 3.307, 3.309(a). Lay evidence presented by a Veteran concerning continuity of symptoms after service may not be deemed to lack credibility solely because of a lack of contemporaneous medical evidence. Buchanan v. Nicholson, 451 F.3d 1331 (2006). The Board has the authority to discount the weight and probity of evidence in light of its own inherent characteristics and its relationship to other evidence. Madden v. Gober, 125 F.3d 1477 (Fed. Cir. 1997). The Board must assess the credibility and weight of all the evidence, including the medical evidence, to determine its probative value, accounting for evidence which it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. Masors v. Derwinski, 2 Vet. App. 181 (1992); Wilson v. Derwinski, 2 Vet. App. 614 (1992); Hatlestad v. Derwinski, 1 Vet. App. 164 (1991); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Equal weight is not accorded to each piece of evidence contained in the record; every item of evidence does not have the same probative value. The Board must determine whether the evidence supports the claim or is in relative equipoise, with the appellant prevailing in either case, or whether the preponderance of the evidence is against the claim, in which case, service connection must be denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 1. Acquired Psychiatric Disorder The Veteran seeks entitlement to service connection for an acquired psychiatric disorder. Specifically, the Veteran asserts that he developed an acquired psychiatric disorder as a result of an assault against himself and a fellow service member while he was stationed in Panama. See July 2014 Statements in Support of Claim. As noted above, the Veteran’s active duty service STRs appear incomplete. When service records are incomplete the Board has a heightened obligation to explain its findings and conclusions and carefully consider the benefit-of-the-doubt rule. See Cuevas v. Principi, 3 Vet. App. 542, 548 (1992); O’Hare v. Derwinski, 1 Vet. App. 365, 367 (1991). However, the case law does not lower the legal standard for proving a claim of service connection, but rather increases the Board’s obligation to evaluate and discuss in its decision all of the evidence that may be favorable to the Veteran. See Russo v. Brown, 9 Vet. App. 46 (1996). Moreover, there is no presumption, either in favor of the claimant or against VA, arising from missing records. See Cromer v. Nicholson, 19 Vet. App. 215, 217-18 (2005) (wherein the Court declined to apply an “adverse presumption” where records have been lost or destroyed while in government control which would have required VA to disprove a claimant’s allegation of injury or disease). The Board also notes that the record does not show that attempts were made to obtain STRs from the period of the Veteran’s Army Reserve service from June 1981 to June 1985. However, the Veteran has consistently asserted that his acquired psychiatric disorder is directly related to witnessing and being the victim of physical assaults that occurred during his period of active duty service between 1980 and 1981. Accordingly, remanding this matter for the sole purpose of obtaining any outstanding STRs not relevant to his claim would serve no useful purpose. A review of the available service treatment records does not reveal any complaints or treatment related to the Veteran’s reported stressors (detailed below). They do show that in February 1981, the Veteran reported having an umbilical bulge his whole life, and that the bulge had increased in size over the past year. He underwent an umbilical hernia repair procedure that same month. The claims file also contains service personnel records. Those records include a May/June 1981 Proposed Separation Action Up Expeditious Discharge Program (EPD) memorandum that was sent to the headquarters of the 4th Battalion, 20th Infantry, at Fort Clayton, Panama. The memorandum proposed the Veteran to be released from active duty service and transferred to the Individual Ready Reserve due to an inability to adjust to military regimentation and follow rules and regulations. Post-service records include a November 1985 VA medical record showing the Veteran was admitted for in-patient substance abuse treatment. He denied ever having had any head injury with loss of consciousness. He did report often having bad headaches. See VA Medical Records Received July 2014. An April 2013 VA medical record shows the Veteran reported a traumatic event that occurred during service in Panama in 1980. He also reported being court martialed because he refused to testify. See VA Medical Records Received December 2013. The Veteran also requested mental health service in April 2013 to assist with coping with a traumatic event that occurred during service in Panama in 1980. The Veteran stated that he witnessed fellow soldiers use an iron pipe to hit a commanding officer in the head in an attempt to kill him. The Veteran also reported that he was too afraid to testify against the enlisted men and was court martialed as a result. See VA Medical Records Received July 2014. In June 2013 the Veteran reported that while he was stationed in Panama, some fellow soldiers beat up their NCO, and then beat him into submission to prevent him from reporting the incident. He also stated that he later did report the incident, but received an Article 15 for doing so. In addition, the Veteran reported that he was in a truck driven by a fellow soldier who was drunk, that the truck flipped over, and he was cited for the incident. A November 2013 VA mental health record shows the Veteran reported that during service, he began drinking and using cocaine. He also reported that he “walked in on troops trying to assassinate platoon Sergeant” with an iron rod to the back of his head, and that he never was the same since that incident. He also reported receiving an Article 15 because he witnessed the attack and failed to intervene. In this regard, the Veteran stated he did not know what was going on at that time. The Veteran also reported that he eventually received and Chapter 5 medical discharge and was sent to reserve duty. See VA Medical Records Received December 2013. In a January 2014 VA Form 21-0781, Statement in Support of Claim for Service Connection for PTSD, the Veteran asserted that while he was stationed in Panama, he was assaulted several times in a “blanket party” with repeated beatings to his back, arms and legs, and that he received death threats in an attempt to pressure him to participate in a conspiracy to kill a fellow service member. In addition, the Veteran stated that an identified service member “carried out their plan by catching Sergeant [redacted] off guard and hitting on the back of the head with the iron pipe and [stomping] on him after he fell.” In an accompanying January 2014 VA Form 21-4138, Statement in Support of Claim, the Veteran asserted that he witnessed the attack on the Sergeant who survived the attack, and that he feared for his life afterwards. The Veteran further asserted that he was prosecuted for not coming forward to give an eye-witness account. The Veteran also asserted that from 1985 to 1989, he struggled with alcohol and drug abuse and was sent to prison where he witnessed multiple stabbings and killings. In a June 2014 VA medical record, the doctor noted that the Veteran came in to complete forms for his service connection claims. The Veteran reported multiple problems since service, many of which stemmed from an assault that reportedly occurred in Panama in 1981. In this regard, the Veteran reported witnessing another service member being attacked, and that the men responsible for the attack thereafter began to harass and beat him. The Veteran further reported having had PTSD since that time. See VA Medical Records Received April 2017. A September 2014 VA mental health record shows the Veteran reported witnessing an attack on a Sergeant by two other service members. The Veteran also reported that he ran away after the attack, but was caught, beaten him up, and told not to tell anyone. In addition, the Veteran reported being court martialed for denying that the incident happened. See VA Medical Records Received April 2017. In a September 2014 letter, the Veteran’s VA psychiatrist noted diagnoses for PTSD, mood disorder and anxiety disorder. See VA Medical Records Received September 2014. The Veteran submitted a Statement in Support of Claim in September 2014, in which he stated that he was physically assaulted several times due to being a witness to an event. In a December 2014, Statement in Support of Claim for Service Connection for PTSD Secondary to Personal Assault, the Veteran reported being the victim of several “blanket parties” during which he was beaten and kicked repeatedly in his stomach and back. The Veteran underwent a VA PTSD examination in September 2015. The examiner noted a diagnosis for PTSD that conformed to the DSM-5 criteria. The Veteran reported that he began to experience symptoms of anxiety during active duty service. During service, the Veteran reported witnessing fellow soldiers use an iron pipe to hit a commanding officer in the head in an attempt to kill him. In addition, the Veteran reported that he was also beaten by the same fellow soldiers and rendered unconscious so that he would not testify against them, and that he was warned that if he said anything, they would kill him. As a result of his beating, he reported being hospitalized two weeks later requiring emergency surgery. The examiner opined that it was “as likely as not, that the Veteran’s current disability (PTSD) is consistent with the circumstances, conditions, or hardships of his... military service.” In support of this opinion, the examiner noted that the Veteran reported symptoms supporting a diagnosis for PTSD. In addition, the examiner noted that the Veteran’s reported stressor event was recorded because the beaten officer was medevacked, and the Veteran required emergency surgery two weeks later. In an October 2015 VA addendum opinion, the examiner stated that the September 2015 positive nexus opinion was based on the Veteran’s reported history of in-service stressors. In this regard, the examiner noted that a review of the Veteran’s service records did not document or suggest the reported in-service stressors occurred. However, the examiner did note that the Veteran’s September 2014 Statement in Support of Claim and post-service medical records suggested PTSD symptoms and behavioral changes with references to the reported in-service incident which suggested that the stressors “likely occurred and substantiates the occurrence of the current PTSD symptoms.” Lastly, at a September 2020 Board hearing, the Veteran testified that in 1980, he was stationed in Panama, and that one of the enlisted man tried to kill the NCO with a metal pipe in front of him. When the NCO fell over after being hit in the head, another enlistment man stomped on him. He reported that the incident occurred in approximately September 1980. The Veteran stated that he was thereafter threatened if he said anything. In addition, the Veteran reported that over the next few weeks he was beaten during “blanket parties” which resulted in an Article 15 in approximately November 1980. After a review of the evidence of record, the Board finds that entitlement to service connection for an acquired psychiatric disorder is not warranted. Initially, the Board notes that the Veteran’s claim of entitlement to service connection for an acquired psychiatric disorder is the type of claim that cannot be limited only to a particular diagnosis, but must be considered a claim for any mental disability that may be reasonably encompassed. Clemons v. Shinseki, 23 Vet. App. 1 (2009). The Veteran’s VA medical records clearly show a current diagnosis for PTSD, mood disorder and anxiety disorder. The Veteran’s PTSD diagnosis has also been shown to meet the DSM-V criteria. The existence of a current disability is the cornerstone of a claim for VA disability compensation. 38 U.S.C. § 1131; Degmetich v. Brown, 104 F.3d 1328 (1997) (holding that interpretation of section 1131 of the statute as requiring the existence of a present disability for VA compensation purposes cannot be considered arbitrary). In the present case, there is sufficient evidence the Veteran meets the threshold criterion for service connection of a current disability. Boyer v. West, 210 F.3d 1351 (Fed. Cir. 2000). Thus, the Veteran has a diagnosed psychiatric disorder, and the remaining question is whether such is related to service. Initially, with regard to PTSD, the Board notes that service connection generally requires medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a); a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the in-service stressor occurred. 38 C.F.R. § 3.304(f). Turning to whether there is credible supporting evidence that the claimed stressor events occurred in service, the Board finds that such allegations by the Veteran are lacking in credibility. The Board recognizes the Veteran’s lay statements as to witnessing an assault on a fellow service member, a Sergeant, as well as statements as to being the victim of several assaults, including “blanket parties,” and being repeatedly kicked in the head and stomach resulting in loss of consciousness and emergency umbilical hernia surgery. However, a review of the record shows that the Veteran’s reported stressor events have been unable to be verified. In this regard, a deferred rating decision was issued in March 2015, which noted that the Veteran reported being beaten and threatened while he was stationed Panama sometime between November 1980 and January 1981. The Veteran also reported being prosecuted for not coming forward and testifying. It was noted that a request was sent to Joint Services Records Research Center (JSRRC) to verify the Veteran’s reported stressor as a 60 day time frame was given. In a March 2015 (DPRIS) response, it was noted that information concerning the reported stressor event was unable to be located. The response further stated that if there was a criminal investigation report filed with regard to the incident, that a request would need to be made with the US Army Crime Records Center. Thereafter, VA sent letters to the US Army Crime Records Center requesting information with regard to the reported in-service stressor event in March, May, and June 2015. In a July 2015 letter, VA notified the Veteran that a determination had been made that the requested reports from the US Army Crime Records Center could not be located and were, therefore, unavailable for review. In this regard, VA noted three prior attempts to obtain the requested reports. The Board has also considered the Veteran’s lay statements as to his reported personal assault(s). However, the Board finds that the Veteran has provided several conflicting lay statements in this matter. Initially, the Board notes that the Veteran has provided conflicting statements surrounding the details of the asserted in-service attack on a Sergeant. In November 2013, the Veteran reported that he “walked in on troops trying to assassinate” a Sergeant and that he did not know what was going on. However, in a January 2014 Statement in Support of Claim, the Veteran asserted that he was assaulted several times prior to the incident in an attempt to pressure him to participate in the attack. With regard to being physically assaulted, when he initially sought mental health services, he did not report being the victim of an assault, only having been a witness to an assault. In June 2013, he reported being beaten into submission after a Sergeant was attacked to prevent him from reporting the incident. However, as noted above, in his January 2014 Statement in Support of Claim for Service Connection for PTSD, he reported being assaulted several times prior to the incident in an attempt to pressure him to participate in the attack. The Veteran also asserted that during service, he was attacked several times during “blanket parties” during which he was repeatedly kicked in the head and stomach, that he lost consciousness, and that he required an emergency umbilical hernia surgery two weeks later. However, a November 1985 VA medical record shows the Veteran specifically denied ever having sustained a head injury with loss of consciousness, and a February 1981 STR shows the Veteran reported having had an umbilical bulge all his life, and that the bulge had increased in size over the past year. Thereafter, he underwent an umbilical hernia repair procedure. There is no indication in the STRs, and the evidence does not suggest, that the in-service umbilical hernia surgery was due to being physical assaulted. The Veteran has further provided conflicting statements as to being court martialed following the in-service incident. In April 2013, he reported being court martialed because he refused to testify. In June 2013, he reported that he received an Article 15 for not reporting the incident earlier. In November 2013, he stated that he received an Article 15 because he failed to intervene during the attack. The Board also notes that the Veteran has also reported that his separation from active duty service was based on a medical discharge. However, a review of his service personnel records clearly show he was separated due to an inability to adjust to military regimentation and follow rules and regulations. See May 1981 Proposed Separation Action. Finally, The Veteran also reported that he was hospitalized twice in the 1980s and placed is a psychiatric ward at a VA medical center. However, a review of the record clearly show that he was admitted several times during this time period for substance abuse treatment, and there is no indication that he was placed in a psychiatric ward. See November 1985 VA Medical Record (noting first admission for cocaine abuse and showing Veteran denied any past psychiatric admissions). See also April 1995 VA Medical Record (noting second admission for drug rehabilitation). Accordingly, the Board finds the Veteran to be an inaccurate historian and provides his lay statements very little probative value. The Board recognizes that VA psychologists and examiners have diagnosed the Veteran with PTSD. The Board further recognizes the September and October 2015 VA examination reports etiologically linking the diagnosed PTSD to service. However, these diagnoses and etiological opinions were based solely upon the Veteran’s reported stressors which, as noted above, are found to lack credibility. The Court has explicitly stated that “[a]n opinion by a mental health professional based on a post-service examination of the veteran cannot be used to establish the occurrence of the stressor.” See Cohen v. Brown, 10 Vet. App. 142, 145 (1997); see also 38 C.F.R. § 3.304(f). Because the appeal lacks credible supporting evidence that the claimed stressor events occurred in service as required by 38 C.F.R. § 3.304(f), the claim for service connection for an acquired psychiatric disorder fails on this element and must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 2. Headache Condition The Veteran seeks entitlement to service connection for a headache condition. Specifically, the Veteran asserts that he developed a headache condition as a result of being assaulted while he was stationed in Panama during service. See June 2014 Disability Benefits Questionnaire (DBQ). The available STRs do not show any complaints or treatment for a headache condition. As further noted above, the record does not reflect that attempts were made to obtain STRs from the period of the Veteran’s Army Reserve service from June 1981 to June 1985. However, the Veteran has consistently asserted that his headache condition is directly related to physical assault(s) that occurred during his period of active duty service between 1980 and 1981. Accordingly, remanding this matter for the sole purpose of obtaining any outstanding STRs after his period of active duty service would serve no useful purpose. Post-service medical records show that in November 1985, the Veteran was admitted to a VA medical center for in-patient substance abuse treatment. He denied having had any head injury with loss of consciousness. He did report that he often had bad headaches. See VA Medical Records Received July 2014. In July 2014, the Veteran submitted a June 2014 headache DBQ completed by a VA doctor. The doctor noted a diagnosis for migraines with 1995 listed as the date of diagnosis. The Veteran reported recurrent headaches during service which began after being kicked in the head in 1981 while in Panama. The examiner noted a scar located on the right scalp. In a June 2014 VA medical record, the same doctor noted that the Veteran came in to get forms for his service connection claims. The Veteran reported multiple problems since service, many of which stemmed from an assault that reportedly occurred in Panama in 1981. In this regard, the Veteran reported witnessing another service member being attacked, and that the men responsible for the attack thereafter began to harass and beat him. The Veteran also reported being kicked in the head. Since that time, the Veteran reported ongoing issues with headaches which occurred once every two weeks. The doctor noted migraines possibly triggered by head trauma. See VA Medical Records Received April 2017. In a September 2014 Statement in Support of Claim, the Veteran stated that he sustained injuries as a result of falling off a truck, and that his service connection claims “could reasonably occurred as a result of this fall.” At a September 2020 Board hearing, the Veteran testified that he began complaining of headaches in 1980, and that he had complained about headaches since that time. In a September 2020 letter, the same VA doctor noted that the Veteran had been her patient between 2013 and 2016. She identified a June 2014 VA medical record which noted a history of the Veteran’s medical issues. It was also noted that the Veteran reported suffering from concussions and beatings to his lower back. The doctor opined that the Veteran’s chronic headaches were consistent with post-concussive headaches and were “as likely as not related to the beatings he experienced while in the military.” In addition, she opined, “[i]t is my medical opinion that these conditions were as likely as not caused by and or aggravated by his time in the military.” After a review of the evidence of record, the Board finds that entitlement to service for a headache condition is not warranted. In the present case, there is sufficient evidence the Veteran meets the threshold criterion for service connection of a current disability. Boyer v. West, 210 F.3d 1351 (Fed. Cir. 2000). Specifically, a June 2014 DBQ diagnosed the Veteran with migraines. Additionally, a September 2020 letter noted the Veteran had chronic headaches. Accordingly, the Veteran clearly has diagnoses for a headache condition and the remaining question is whether that condition is otherwise related to service. In this regard, the Board finds that the preponderance of the evidence of record does not support a finding of any in-service incident or injury that would support the Veteran’s claim on appeal. The Veteran has specifically asserted that he developed a headache condition in 1980 as a result of physical assault(s), including being subjected to “blanket parties,” and being repeatedly kicked in the head causing loss of consciousness. The available STRs and military personnel records do not document any physical assault or complaints or treatment for a head or headache condition. Instead, the only evidence before the Board in this matter are the Veteran’s lay statements. However, for reasons detailed in the section above, the Board finds the Veteran’s lay statements of little probative value as he has provided a number of conflicting statements surrounding his asserted in-service assault(s). With regard to the Veteran’s lay statements, the Board additionally finds that they are directly contradicted by the November 1985 VA medical record. Although that record shows the Veteran reported often having bad headaches, the record further shows that he specifically denied having sustained any head injury with loss of consciousness. The Board notes that statements made to clinicians for the purpose of treatment are considered reliable because one seeking medical treatment is aware of the necessity for being truthful to secure proper care. See Rucker v. Brown, 10 Vet. App. 67 (1997) (ascribing heightened credibility to statements made to clinicians for the purpose of treatment); see also Williams v. Gov. of Virgin Islands, 271 F.Supp.2d 696, 702 (V.I.2003) (noting that statements made for the purpose of diagnosis or treatment “are regarded as inherently reliable because of the recognition that one seeking medical treatment is keenly aware of the necessity for being truthful in order to secure proper care”). A review of the June 2014 VA medical record shows the Veteran had come into the VA medical center to get forms for his service connection claims. Accordingly, the Board finds the Veteran’s denial of having sustained a prior head injury with loss of consciousness in November 1985 is much more reliable than statements he made to the VA doctor in furtherance of his service connection claims on appeal, including the claim for a headache condition. The Board does recognize the June 2014 VA medical record which noted a migraine condition “possibly triggered by head trauma.” The Board additionally recognizes the September 2020 letter in which the doctor opined that the Veteran’s chronic headaches were consistent with post-concussive headaches and were “as likely as not related to the beatings he experienced while in the military.” Initially, the Board notes that speculative language such as “possibly” does not create an adequate nexus for the purposes of establishing service connection, as it does little more than suggest a possibility of a relationship. See Warren v. Brown, 6 Vet. App. 4, 6 (1993); Utendahl v. Derwinski, 1 Vet. App. 530, 531 (1991); Stegman v. Derwinski, 3 Vet. App. 228, 230 (1992); Obert v. Brown, 5 Vet. App. 30, 33 (1993). More importantly, these medical opinions are based solely on the Veteran’s lay statements, which, as noted above, are not credible. Lastly, the Board recognizes the Veteran’s September 2014 Statement in Support of Claim in which he reported having sustained injuries as a result of falling off a truck, and that his service connection claims “could reasonably occurred as a result of this fall.” However, a review of the record shows that his statement is attributable to his service connection claims for musculoskeletal conditions addressed in the Remand section below. This is apparent as the Veteran has only reported sustaining a puncture wound and extremely sharp pain in his lower and upper back as a result of this incident. He has specifically not reported sustaining a head injury during this incident. In any event, he has further provided conflicting lay statements surrounding this event. A review of his Army Reserve records show he fell off a truck and a splinter punctured his groin area. At the time of the incident, the Veteran reported that he was standing on top of a truck stringing wire when his right foot slipped, he fell through the canvas, and his left foot stayed on top. He only complained of pain in his left upper hamstring at that time. However, in a June 2015 letter, the Veteran asserted that while on annual training in 1982, he was laying telephone wire off the rear of a truck, that the truck moved unexpectedly at a high speed, and that he was thrown out the back and fell approximately 5 to 6 fell to the ground landing in some bushes. Therefore, even if the Veteran had asserted that he developed a headache condition as a result of this incident (he has not), his lay statements would be directly contradicted by the evidence of record. Accordingly, absent any competent evidence showing a headache condition that was caused by active duty service, the Board finds that the second and third Shedden requirements have not been met. Although the Veteran is entitled to the benefit-of-the-doubt where the evidence is in approximate balance, the benefit-of-the-doubt doctrine is inapplicable where, as here, the preponderance of the evidence is against the claim for service connection for a headache condition. The claim is denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 58 (1990). REASONS FOR REMAND 3-5. Lumbar Spine Disability, Bilateral Shoulder Disability, Bilateral Knee Disability The Veteran seeks entitlement to service connection for a lumbar spine disability, bilateral shoulder disability and bilateral knee disability. With regard to these service connection claims, the Veteran asserts that the conditions were caused by wear and tear during service. Specifically, the Veteran asserts that during active duty service, he carried full rucksacks and a radio, and stood guard duty for 8 hours three times per week. See September 2020 Board Hearing Transcript. In this regard, the Board notes that the Veteran’s MOS was tactical wire operator specialist. See DD 214. Alternatively, the Veteran asserts that his lumbar spine, bilateral shoulder and bilateral knee disability could have been caused by an incident that occurred during a period of ACDUTRA in 1982. As noted above, in a June 2015 letter, the Veteran asserted that while on annual training in 1982, he was thrown out the back of a truck and landed in some bushes on his back. He reported extremely sharp pain in his lower and upper back at that time. As further noted above, a review of the available STRs shows that in May 1982, the Veteran fell off a truck and punctured his groin area by a splinter. A couple days later, the Veteran complained of pain in his left upper hamstring. The Veteran reported that he was standing on top of a truck stringing wire when his right foot slipped, he fell through the canvas and his left foot stayed on top. The clinician noted a bruise and abrasion with a small puncture wound in the crease of the groin. Accordingly, there appears to be some discrepancy in the Veteran’s report of the incident. In any event, the Veteran has not been provided with a VA examination with regard to these claims on appeal. In light of the Veteran’s assertion that his lumbar spine, bilateral shoulder and bilateral knee conditions are etiologically related to wear and tear related to his MOS, in order to properly adjudicate these issues on appeal, the Board finds that VA examinations are necessary. 6. Left Hand Disability The Veteran seeks entitlement to service connection for a left hand disability. Specifically, the Veteran asserts that while he was stationed in Panama, he was repeatedly assaulted, resulting in a fractured left 4th metacarpal and requiring surgery at Mills Hospital in 1985. See September 2020 Board Hearing Transcript. Additionally, in July 2014, the Veteran submitted a June 2014 hand and finger DBQ. The DBQ noted diagnoses for fracture left 4th metacarpal with 1987 listed as the date of diagnosis, and CTS, with 1979/1980 listed as the date of diagnosis. The Veteran reported that he sought treatment for CTS in 1980, and that the condition was related to repetitive motion while installing switchboard wires. His current symptoms included pain, numbness and decreased range of motion. No finger ROM testing was conducted. However, painful ROM for left ring finger and little finger was noted. Localized tenderness was also noted for the left ring finger at the distal end of the 4th metacarpal. Other symptoms noted included left finger weakened movement, excess fatigability, incoordination, pain on movement, swelling and deformity. Muscle strength testing revealed active movement against some resistance for left hand grip. A bony lump and tenderness on the left 4th metacarpal at the site of a prior fracture was noted. In addition, a carpal tunnel release surgical scar was noted dating back to the 1980s. It is unclear to the Board what left hand condition the Veteran is seeking entitlement to service connection. In this regard, while the Veteran has reported that he fractured his left 4th metacarpal during service, he has also reported the onset of CTS during service. It is further unclear to the Board whether the Veteran underwent left hand surgery for a fractured left 4th metacarpal in the mid-1980s, or whether the surgery was related to his left CTS. In this regard, at a September 2020 Board hearing, the Veteran testified that as a result of his in-service assault, a couple bones became dislocated and grew back out of place, and that in 1985 he underwent surgery at Mills Hospital. However, a March 1995 VA drug rehabilitation record shows the Veteran provided a past medical history of undergoing left carpal tunnel surgery repair in 1986. In addition, the Veteran reported that a metal plate had been inserted in his left hand in 1988 because of a fracture. Additionally, a June 2014 DBQ noted that the date of onset of the left 4th metacarpal fracture was 1987, and that the Veteran’s sought treatment for left CTS in 1980. Accordingly, in order to properly adjudicate this claim, a remand is necessary to obtain any related medical records from Mills Hospital. Additionally, in consideration of the Veteran’s military occupation specialty (MOS) of tactical wire operator specialist, lay statements linking his current left CTS to repetitive movements related to his MOS, the Board finds that a VA examination is necessary to determine the nature and etiology of the Veteran’s left CTS. 7. Umbilical Hernia Residuals The Veteran seeks entitlement to service connection for umbilical hernia residuals. Specifically, the Veteran asserts that he while he was stationed in Panama, he was repeatedly assaulted, including being kicked in the stomach resulting in an emergency umbilical hernia repair procedure. See July 2014 Statements in Support of Claim. See September 2020 Board Hearing Transcript. As noted above, it appears that the Veteran’s STRs are incomplete. The available STRs include a May 1979 enlistment examination and an April 1980 reenlistment examination, both noting a normal abdomen. The May 1979 enlistment examination further shows the Veteran denied any stomach or intestinal trouble, or hernia. The available STRs also show that in February 1981, the Veteran reported having an umbilical bulge all of his life, and that the bulge had increased in size the past year. He underwent an umbilical hernia repair procedure that same month. Post-service records include a June 2012 VA medical record showing the Veteran complained of abdominal pain the past 3 weeks. He reported that he had similar pain when he had an umbilical hernia 30 years prior. He was diagnosed with abdominal pain with cause to be determined. See VA Medical Records Received July 2014. Lastly, at a September 2020 Board hearing, the Veteran reported pain if he lifted anything. The Veteran clearly underwent an umbilical hernia corrective procedure during service. Additionally, during the period on appeal, the Veteran has asserted, and VA medical records document, similar symptoms of an umbilical hernia condition. Accordingly, in order to properly adjudicate this issue on appeal, the Board finds that a VA examination is necessary to determine the nature and etiology of any diagnosed umbilical hernia condition. 8. Residuals of Puncture Wound and Muscle Injury, Left Groin During the period on appeal, the Veteran underwent a VA muscle injury examination in April 2015. The examiner noted a diagnosis for residuals of puncture wound and muscle injury, left groin. The examiner also noted that the Veteran did not have a history of a penetrating muscle injury. The Veteran reported an in-service injury resulting in a puncture wound to his groin and severe low back pain. He also noted a history of left testicular pain. Upon examination, the examiner noted that the Veteran had never had an injury to a muscle group of the leg, pelvic girdle or thigh. Muscle strength testing revealed less than normal strength for left hip flexion and thigh abduction. The examiner did note a residual scar, this finding appears to be based on the Veteran’s lay statements. In this regard, the examiner noted that the scar was located on the Veteran’s groin, but that the Veteran would not allow a physical examination of the groin to check the scar. At a September 2020 Board hearing, the Veteran testified that he currently received treatment for his puncture wound residuals in the form of medication for erectile dysfunction. The Veteran denied that his residual scar was painful. A review of the Veteran’s VA medical records show treatment with medication for erectile problems. See September 2016 VA Medical Record Received April 2017. A review of the record does not show that the Veteran has been provided with a VA erectile dysfunction examination. The Veteran is also advised that VA’s duty to assist in developing the facts and evidence pertinent to his claim is not a one-way street. See Wood v. Derwinski, 1 Vet. App. 190, 193 (1991) (further holding that “[i]f a Veteran wishes help, he cannot passively wait for it in those circumstances where he may or should have information that is essential in obtaining the putative evidence”). Rather, it is his responsibility to cooperate with VA, including with any efforts to provide an adequate medical examination. See Caffrey v. Brown, 6 Vet. App. 377, 383 (1994); Olson v. Principi, 3 Vet. App. 480, 483 (1992). In this instance, the Veteran must aid in the development of his claim by being cooperative during any scheduled VA examination. The matters are REMANDED for the following action: 1. With any necessary identification of sources by the Veteran, request all VA treatment records not already associated with the file from the Veteran’s VA treatment facilities, and all private treatment records identified by the Veteran not already associated with the file, including records from Mills Hospital. 2. Request the Veteran’s service treatment records from his period of Army Reserve service from June 1981 to June 1985. 3. Following completion of items 1 and 2 above, schedule the Veteran for an examination by an appropriate examiner to determine the nature and etiology of any diagnosed lumbar spine, bilateral shoulder and bilateral knee disability (or telehealth interview, review of the record, etc., if an in-person examination is not feasible). The examiner should provide the following opinions: (a) Is it at least as likely as not (50 percent or greater probability) that the Veteran has a diagnosed lumbar spine, bilateral shoulder and/or bilateral knee disability that is etiologically related to his period of service? The examiner is asked to consider the Veteran’s lay statements that he developed a lumbar spine, bilateral shoulder and bilateral knee disability as a result of wear and tear during service, including due to carrying full rucksacks, a radio, and standing guard duty for 8 hours three times per week. The examiner is also asked to consider whether any lumbar spine, bilateral shoulder and/or bilateral knee disability is etiologically related to a May 1982 fall during a period of ACDUTRA documented in the available STRs. The examiner should review pertinent documents in the Veteran’s claims file in connection with the examination. All indicated studies should be completed. Reasons should be provided for any opinion rendered. If the examiner is unable to provide an opinion without resort to speculation, an explanation as to why this is so should be provided and any additional evidence that would be necessary before an opinion could be rendered should be identified. 4. Following completion of items 1 and 2 above, schedule the Veteran for an examination by an appropriate examiner to determine the nature and etiology of any diagnosed left carpal tunnel syndrome (or telehealth interview, review of the record, etc., if an in-person examination is not feasible). The examiner should provide the following opinions: (a) Is it at least as likely as not (50 percent or greater probability) that the Veteran has left carpal tunnel syndrome that is etiologically related to his period of service? The examiner is asked to consider the Veteran’s military occupation specialty (MOS) of tactical wire operator specialist, and lay statements linking his current left CTS to repetitive movements related to his MOS. The examiner is further asked to consider any medical records showing treatment for left CTS that is obtained following this Remand. The examiner should review pertinent documents in the Veteran’s claims file in connection with the examination. All indicated studies should be completed. Reasons should be provided for any opinion rendered. If the examiner is unable to provide an opinion without resort to speculation, an explanation as to why this is so should be provided and any additional evidence that would be necessary before an opinion could be rendered should be identified. 5. Schedule the Veteran for an examination by an appropriate examiner to determine the nature and etiology of any diagnosed umbilical hernia residual (or telehealth interview, review of the record, etc., if an in-person examination is not feasible). The examiner should provide the following opinions: (a) For any umbilical hernia condition residuals found on examination, the examiner should express an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the umbilical hernia condition is etiologically related to the Veteran’s service? The examiner is asked to review the available STRs, including the May 1979 enlistment examination and the April 1980 reenlistment examination. The record further shows that in February 1981, the Veteran reported having an umbilical bulge his whole life, and that the bulge had increased in size the past year. In addition, the STRs show that the Veteran also underwent an umbilical hernia repair procedure in February 1981. The examiner should review pertinent documents in the Veteran’s claims file in connection with the examination including this Remand. All indicated studies should be completed. Reasons should be provided for any opinion rendered. The examiner must consider the medical records and lay statements, including the Veteran’s reported in-service trauma to his back. If the examiner is unable to provide an opinion without resort to speculation, an explanation as to why this is so should be provided and any additional evidence that would be necessary before an opinion could be rendered should be identified. 6. Then, schedule the Veteran for an examination by an appropriate examiner to determine the current nature and severity of his service-connected residuals of puncture wound and muscle injury, left groin, including the severity of any residual scar and whether the Veteran has any residual erectile dysfunction. The examiner should review pertinent documents in the Veteran’s claims file and this Remand in connection with the examination. All indicated studies should be completed, and all pertinent symptomatology and findings must be reported in detail. Any indicated diagnostic tests and studies must be accomplished. If the examiner is unable to conduct the required testing or concludes that the required testing is not necessary in this case, he or she should clearly explain why that is so. S. HENEKS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Lamb, 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.