Citation Nr: 21024189 Decision Date: 04/22/21 Archive Date: 04/22/21 DOCKET NO. 15-42 640 DATE: April 22, 2021 ORDER Entitlement to service connection for a left shoulder disability is denied. Entitlement to service connection for a right shoulder disability is denied. Entitlement to service connection for a right hip disability is denied. Entitlement to service connection for irritable bowel syndrome (IBS), also claimed as secondary to medication is denied. Entitlement to service connection for hemorrhoids is denied. Entitlement to service connection for traumatic brain injury (TBI) is denied. Entitlement to service connection for migraine headaches, to include as secondary to TBI, is denied. Entitlement to service connection for vertigo, to include as secondary to TBI and migraines headaches, is denied. REMANDED Entitlement to an initial rating higher than 10 percent prior to September 8, 2016, and a rating higher than 10 percent since September 8, 2016, for left knee patellofemoral pain syndrome (left knee disability) is remanded. FINDINGS OF FACT 1. The Veteran’s currently diagnosed left shoulder disability was not manifest during service or for many years thereafter, and the competent and credible evidence fails to an establish an etiological relationship between this disability and his active service. 2. The Veteran’s right shoulder disability clearly and unmistakably existed prior to service and clearly and unmistakably was not aggravated by active service. 3. The Veteran’s currently diagnosed right hip disability was not manifest during service or for many years thereafter, and the competent and credible evidence fails to establish an etiological relationship between this disability and his active service. 4. The Veteran’s currently diagnosed IBS was not manifest during service or for many years thereafter, and the competent and credible evidence fails to establish an etiological relationship between this disability and his active service. 5. The Veteran’s currently diagnosed hemorrhoids was not manifest during service or for many years thereafter, and the competent and credible evidence fails to establish an etiological relationship between this disability and his active service. 6. The Veteran’s currently diagnosed TBI was not manifest during active military service or for many years thereafter, and the competent and credible evidence fails to establish etiological relationship between this disability and his active service or any service-connected disability. 7. The Veteran’s currently diagnosed migraine headaches were not manifest during service or for many years thereafter, and the competent and credible evidence fails to establish etiological relationship between this disability and his active service or any service-connected disability. 8. The Veteran’s currently diagnosed vertigo was not manifest during service or for many years thereafter, and the competent and credible evidence fails to establish etiological relationship between this disability and his active service or any service-connected disability. CONCLUSIONS OF LAW 1. A left shoulder disability was not incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1111, 1131, 1132, 5103(a), 5103A; 38 C.F.R. §§ 3.159, 3.303, 3.304. 2. A right shoulder disability was not incurred in or aggravated by service and may not be presumed related to service. 38 U.S.C. §§ 1110, 1111, 1131, 1132, 5103(a), 5103A; 38 C.F.R. §§ 3.159, 3.303, 3.307, 3.309. 3. A right hip disability was not incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1111, 1131, 1132, 5103(a), 5103A; 38 C.F.R. §§ 3.159, 3.303, 3.304. 4. IBS was not incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1111, 1131, 1132, 5103(a), 5103A; 38 C.F.R. §§ 3.159, 3.303, 3.304. 5. Hemorrhoids were not incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1111, 1131, 1132, 5103(a), 5103A; 38 C.F.R. §§ 3.159, 3.303, 3.304. 6. A TBI was not incurred in or aggravated by service and may not be presumed related to service. 38 U.S.C. §§ 1110, 1111, 1131, 1132, 5103(a), 5103A; 38 C.F.R. §§ 3.159, 3.303, 3.307, 3.309. 7. Migraine headaches were not incurred in or aggravated by active military service and may not be presumed related to service or any service-connected disability. 38 U.S.C. §§ 1110, 1111, 1131, 1132, 5103(a), 5103A (2012); 38 C.F.R. §§ 3.159, 3.303, 3.307, 3.309, 3.310. 8. Vertigo was not incurred in or aggravated by service and may not be presumed related to service or any service-connected disability. 38 U.S.C. §§ 1110, 1111, 1131, 1132, 5103(a), 5103A; 38 C.F.R. §§ 3.159, 3.303, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Marines from July 2000 to July 2004. These matters are on appeal from a November 2011 rating decision. In March 2019, the Veteran testified at a Central Officer hearing before the undersigned Veterans Law Judge of the Board. A transcript of this hearing is associated with the record. In June 2019, the Board remanded these matters for further development. The service connection claims are now ready for adjudication. Service Connection Claims Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303 (a). Service connection requires competent evidence showing: (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. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); see also Caluza v. Brown, 7 Vet. App. 498 (1995). In addition, certain diseases, such as arthritis and organic diseases of the nervous system, are presumed to have been incurred in service if manifested to a compensable degree within one year after service. The presumption is rebuttable by probative evidence to the contrary. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309(a). When chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support a claim for such diseases. 38 C.F.R. § 3.303 (b); see Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Service connection may also be established on a secondary basis for a disability which is aggravated by, proximately due to, or the result of a service-connected disease or injury. 38 C.F.R. § 3.310. Any additional impairment of earning capacity resulting from an already service-connected condition, regardless of whether or not the additional impairment is itself a separate disease or injury caused by the service-connected condition, should also be compensated. Allen v. Brown, 7 Vet. App. 439 (1995). 1. Left shoulder disability The Veteran contends that he has a left shoulder disability that is related to combat training during service. The service treatment records (STRs) are void of findings, complaints, symptoms, or diagnosis related to a left shoulder disability. In a March 2004 separation report of medical history, the Veteran stated that he was in good health. On April 2011 VA joints examination the Veteran stated that his left shoulder caused generalized aches at the acromioclavicular (AC) joint, but did not recall injuring the left shoulder. After a thorough review of the claims file and an examination of the Veteran, the assessment was left shoulder anterior injury which the examiner opined was not related to service. The rationale was that he was never seen for his left shoulder or had left shoulder complaints during service. There was minor enlargement of the AC joint, but it did not restrict range of motion and was not related to service. VA treatment records do not indicate any diagnosis of or treatment for a left shoulder disability, but do include a July 2005 which indicates a right shoulder injury due to a fall while skateboarding. In a June 2013 private medical opinion Dr. R.S.H. opined that the Veteran’s left shoulder disability seemed likely related to his service, but provided no rationale in support of the medical opinion. In another June 2013 private medical opinion, Dr. M.O. opined that carrying and wearing combat equipment added stress and wear and tear of the Veteran’s joints. At the March 2019 Board hearing, the Veteran testified that he sustained injury to his shoulders during combat training when his shoulders hit the ground. In an October 2020 addendum, the April 2011 VA examiner opined that the Veteran’s claimed left shoulder disability was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The rationale was that there was no evidence that the Veteran had any injury during service to the left shoulder. The Veteran stated that he had combativeness during service and injured his left shoulder, but the examiner noted that he had no complaints of left shoulder pain during service or any left shoulder treatment prior to the 2011 VA examination. Therefore, there is no evidence of any chronicity associated with the left shoulder. The examiner further opined that it is less likely than not that the Veteran’s left shoulder disability had any onset in, or etiology related to, his active duty service or combat training during service and stated that the etiology of the left shoulder disability is consistent with the July 2005 skateboard accident. In October 2020 the RO requested correction of some of the information provided in the VA examiner’s October 2020 VA medical opinion. Specifically, the examiner referenced the Veteran’s separation from service in 1985, but he actually separated in July 2004. His opinion also referenced a 25-year gap between 1985 and his shoulder disability in 2011, so an addendum was requested. In a November 2020 addendum the VA examiner addressed the inaccurate information in the October 2020 VA medical opinion. The examiner acknowledged that the Veteran separated in July 2004 and clarified that he had not been treated for complaints of shoulder pain during service. The examiner also noted that there was a 2 to 5 year gap, not 25-year gap, between 2000 (when he entered into service) and the 2005 skateboarding accident. These clarifications did not change his October 2020 medical opinion and cured the deficiencies found in the October 2020 VA medical opinions. The Board finds that the April 2011 VA medical examination and opinion and October and November 2020 VA medical opinions provide highly probative and overwhelming evidence against this claim. In April 2011, a VA examiner reviewed the claims file, considered the Veteran’s documented and reported history, and performed a thorough evaluation. The VA examiner opined that the Veteran’s claimed left shoulder disability was not related to his service and explained that the etiology was post-service injuries. Therefore, the VA medical examination and opinions provide probative evidence against the Veteran’s claim of high probative weight. See Nieves -Rodriguez v. Peake, 22 Vet. App. 295 (2008). The Board has considered Dr. R.S.H.’s June 2013 private opinion that the Veteran’s left shoulder disability “seemed likely” related to service, but finds that this medical opinion is unsupported by any rationale. To the extent that Dr. M.O.’s June 2013 medical opinion also suggests any relationship between the Veteran’s left shoulder disability and his service, it is also unsupported by any rationale. 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); Bloom v. West, 12 Vet. App. 185, 187 (1999) (an opinion that is unsupported and unexplained is purely speculative and does not provide the degree of certainty required for medical nexus evidence); see also Nieves- Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008); Prejean v. West, 13 Vet. App. 444, 448-9 (2000) (factors for assessing the probative value of a medical opinion include the thoroughness and detail of the opinion). Moreover, to the extent that the facts supporting this opinion came from the Veteran, those facts are unsupported by the objective evidence of record. In addition, the speculative terminology “seemed likely” provides an insufficient basis for an award of service connection, limiting the probative value of the opinion. See Winsett v. West, 11 Vet. App. 420, 424 (1998). See Bostain v. West, 11 Vet. App. 124, 127-28, quoting Obert v. Brown, 5 Vet. App. 30, 33 (1993) (medical opinion expressed in terms of “may” also implies “may or may not” and is too speculative to establish medical nexus). See also Warren v. Brown, 6 Vet. App. 4, 6 (1993) (doctor’s statement framed in terms such as “could have been” is not probative); Tirpak v. Derwinski, 2 Vet. App. 609, 611 (1992) (“may or may not” language by a physician is too speculative). For these reasons, the opinions carry little probative weight. See Reonal v. Brown, 5 Vet. App. 458, 460-61 (1993). The Board finds that the claim must be denied. There is no competent medical evidence to show that the Veteran has had any left shoulder disability that was incurred in or aggravated by his service. Moreover, post-service, the record does not reflect or reference any history of a left shoulder disability until over 6 years after discharge from active service. The mere absence of medical records does not contradict a Veteran’s statements about his symptom history. See Buchanan v. Nicholson, 451 F.3d 1331, 1336 (Fed. Cir. 2006). However, if it is determined based upon reliable evidence that there was an extended period of time after service without any manifestations of the claimed condition, then that tends to weigh against a finding of a connection between the disability and service. See Maxson v. West, 12 Vet. App. 453 (1999), aff'd, 230 F.3d 1330 (Fed. Cir. 2000), aff'd sub nom. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000); see also Horn v. Shinseki, 25 Vet. App. 231, 240 n.7 (2012). The Board finds in this case that the lack of evidence of a left shoulder disability during service coupled with the fact that a left shoulder diagnosis was not made until over 6 years post-service, is sufficient to rebut a finding of service incurrence. In this case, the earliest post-service medical evidence of the Veteran’s left shoulder disability was in April 2011 which is over 6 years after service. This long period without problems weighs against the claim. Moreover, the Board finds that the Veteran’s statements relating his left shoulder disability to his service are not credible and are afforded no probative value. His contentions conflict with the absence of treatment evidence for over 6 years after service and post-service injuries related to skateboarding. Finally, there is no competent medical evidence that the Veteran has any left shoulder disability that is related to his service. 2. Right shoulder disability The Veteran contends that he has a right shoulder disability that is related to combat training during his service. He also contends that his pre-existing right shoulder disability was aggravated by service. A Veteran will be considered to have been in sound condition when examined, accepted and enrolled for service, except as to defects, infirmities, or disorders noted at entrance into service, or where clear and unmistakable (obvious or manifest) evidence demonstrates that an injury or disease existed prior thereto. See 38 U.S.C. § 1111; 38 C.F.R. § 3.304 (b). The presumption of soundness may only be rebutted by clear and unmistakable evidence that the Veteran’s disability was both preexisting and not aggravated by service. Wagner v. Principi, 370 F.3d 1089 (Fed. Cir. 2004); 38 C.F.R. § 3.304 (b). This statutory provision is referred to as the ‘presumption of soundness.’ Horn v. Shinseki, 25 Vet. App. 231, 234 (2012). In VAOGCPREC 3-2003, VA’s General Counsel reinforced that the presumption of soundness is rebutted only where clear and unmistakable evidence shows that the condition existed prior to service and that it was not aggravated by service. The General Counsel concluded that38 U.S.C. § 1111 requires VA to bear the burden of showing the absence of aggravation in order to rebut the presumption of sound condition. See Wagner v. Principi, 370 F.3d 1089 (Fed. Cir. 2004). Therefore, where there is evidence showing that a disorder manifested or was incurred in service, and this disorder is not noted on the Veteran’s entrance examination report, this presumption of soundness operates to shield the Veteran from any finding that the unnoted disease or injury preexisted service. See Gilbert v. Shinseki, 26 Vet. App. 48, 52-53 (2012); see also 38 C.F.R. § 3.304 (b) (‘Only such conditions as are recorded in examination reports are considered as noted.’). This presumption is only rebutted where the evidence clearly and unmistakably shows that the Veteran’s disability (1) existed before acceptance and enrollment into service and (2) was not aggravated by service. See Wagner, 370 F.3d at 1096; Bagby v. Derwinski, 1 Vet. App. 225 (1991). The two parts of this rebuttal standard are referred to as the ‘preexistence prong’ and the ‘aggravation prong.’ Horn, 25 Vet. App. at 234. The aggravation prong may be met by establishing that there was no increase in disability during service or that any increase in disability was due to the natural progress of the preexisting condition. Wagner, 370 F.3d at 1096; see also 38 U.S.C. § 1153. If this burden is met, then the Veteran is not entitled to service-connected benefits, and, conversely, where the presumption is not rebutted, the Veteran’s claim is one for service connection, and not aggravation. Wagner, 370 F.3d at 1096. Accordingly, no deduction for the degree of disability existing at the time of entrance shall be made if a rating is awarded. 38 C.F.R. § 3.322 (‘In cases involving aggravation by active service, the rating will reflect only the degree of disability over and above the degree of disability existing at the time of entrance into active service...’). In situations where a pre-existing injury or disease is established, the presumption of aggravation provides that the pre-existing injury or disease will be considered to have been aggravated by active service where there is an increase in disability during service, unless clear and unmistakable evidence shows that the increase in disability is due to the natural progress of the disease. See 38 U.S.C. § 1153; 38 C.F.R. § 3.306. Aggravation is characterized by an increase in the severity of a disability during service, and a finding of aggravation is not appropriate in cases where the evidence specifically shows that the increase is due to the natural progress of the disease. Furthermore, temporary or intermittent flare-ups of a pre-existing disease during service are not sufficient to be considered aggravation of the disease unless the underlying condition, as contrasted to symptoms, worsens. See Davis v. Principi, 276 F.3d 1341, 1345 (Fed. Cir. 2002); Jensen v. Brown, 4 Vet. App. 304, 306 -07 (1993); Hunt v. Derwinski, 1 Vet. App. 292 (1991); 38 C.F.R. § 3.306 (a). Aggravation may not be conceded where the disability underwent no increase in severity during service on the basis of all the evidence of record pertaining to the manifestations of the disability prior to, during, and subsequent to service. See 38 U.S.C. § 1153; 38 C.F.R. §§ 3.304, 3.306(b). The STRs include a May 2000 enlistment report of medical history which indicates that the Veteran received 10 stitches in his right shoulder from a nail in a board at age 15. However, a May 2000 enlistment examination indicates a normal clinical evaluation of the upper extremities. The Board thus finds that there is no clear and unmistakable evidence that a right shoulder disability pre-existed service, so the presumption of soundness applies. the presumption of soundness at entry applies. See Doran v. Brown, 6 Vet. App. 283, 286 (1994); 38 C.F.R. § 3.306. Thus, in order to rebut the presumption of soundness, VA must prove that there is evidence both that the Veteran’s right shoulder disability clearly and unmistakably existed prior to service and that it was not aggravated therein. VAOPGCPREC 03-2003 (July 16, 2003). The Board finds that both of these criteria have been met and that the presumption of soundness, as it pertains to the Veteran’s right shoulder disability, has been rebutted. As to the ‘preexistence prong,’ the record includes an October 2020 VA medical opinion that, the examiner explained that the surgical treatment prior to service returned his function, but the right shoulder was not normal. Given the foregoing, the Board finds that the evidence clearly and unmistakably shows that the Veteran had a right shoulder disability, prior to his active duty service. Wagner, supra; Horn, supra. With regard to the ‘aggravation prong,’ the Board finds that based on the VA examiner’s opinions, discussed in greater detail below, there is clear and unmistakable evidence that the Veteran’s preexisting right shoulder disability was not aggravated during military service beyond its natural progression. Private treatment records include a July 1999 X-ray examination indicates a diagnosis of apparent mild capsulitis. In December 1999, the Veteran underwent an anterior-inferior capsulorrhaphy, right shoulder. A January 2000 progress note indicates an assessment of three and one-half weeks status post right shoulder anterior stabilization for recurrent dislocation. Post-service VA treatment records include a July 2005 report which indicates that the Veteran suffered a fall while skateboarding and landed on his outstretched right arm. The assessment was nondisplaced intraarticular right radial head fracture. Additional private treatment records include a June 2010 note which reflects a history of right shoulder instability first noticed 10 years ago when he thought he may have dislocated it in boot camp. Another record states that the right shoulder first dislocated in 1998 during high school and 7 to 8 times since that time. Mild posterior instability of the right shoulder was diagnosed. On April 2011 VA joints examination the examiner noted that there were no findings in the record associated with the Veteran’s right shoulder with the exception of a surgical scar. Prior to service the Veteran underwent anterior capsular reconstruction, but stated that the shoulder was now good. The right shoulder occasionally popped, but the Veteran stated that he was never treated for his right shoulder during service. After a thorough review of the claims file and an examination of the Veteran, the examiner diagnosed status post anterior capsular reconstruction and opined that there was no evidence of aggravation of the preexisting right shoulder injury. He found no evidence of anything, but normal function in the shoulder. The examiner further opined that there was no aggravation of the right shoulder associated with his service as his function was normal. In a June 2013 private medical opinion Dr. R.S.H. opined that the Veteran’s right shoulder disability seemed likely related to his service, but provided no rationale in support of the medical opinion. In another June 2013 private medical opinion, Dr. M.O. opined that carrying and wearing combat equipment added stress and wear and tear of the Veteran’s joints. In an October 2020 addendum, on additional review of the record and the Veteran’s March 2019 testimony, the examiner explained that the right shoulder surgical treatment prior to service returned right shoulder function, but the right shoulder was not normal. The Veteran was diagnosed with status post anterior capsular reconstruction and degenerative changes were possible over time. The examiner opined that it is less likely than not that any activity during service caused any worsening of the right shoulder dislocation status post anterior capsular reconstruction. As previously addressed, in an November 2020 addendum the VA examiner acknowledged that the Veteran separated in July 2004 and clarified that he had not been treated for complaints of shoulder pain during service. The examiner also noted that there was a 2 to 5 year gap, not 25-year gap, between 2000 (when he entered into service) and the 2005 skateboarding accident. These clarifications did not change his October 2020 medical opinion and cured the deficiencies found in the October 2020 VA medical opinions. The Board finds that the April 2011 VA medical examination and opinion and October and November 2020 VA medical opinions provide highly probative and overwhelming evidence against this claim. In April 2011, a VA examiner reviewed the claims file, considered the Veteran’s documented and reported history, and performed a thorough evaluation. The VA examiner opined that the Veteran’s claimed right shoulder disability was not aggravated by or related to his service and explained that the etiology of the right shoulder disability was post-service injuries. Therefore, the VA medical examination and opinions provide probative evidence against the Veteran’s claim of high probative weight. See Nieves-Rodriguez, supra. The Board has considered Dr. R.S.H.’s June 2013 private opinion that the Veteran’s right shoulder disability “seemed likely” related to service, but finds that this medical opinion is unsupported by any rationale. To the extent that Dr. M.O.’s June 2013 medical opinion also suggests any relationship between the Veteran’s right shoulder disability and his service, it is also unsupported by any rationale. See Miller, supra.; see also Bloom, supra; Nieves-Rodriguez, supra; Prejean, supra. In addition, the speculative terminology “seemed likely” provides an insufficient basis for an award of service connection, limiting the probative value of the opinion. See Winsett, supra; Bostain, supra; Warren, supra; Tirpak, supra. Moreover, to the extent that the facts supporting this opinion came from the Veteran, those facts are unsupported by the objective evidence of record. For these reasons, the opinions carry little probative weight. See Reonal, supra. The Board finds that the claim must be denied. In this case, there is no competent medical evidence that supports the conclusion that the Veteran has any right shoulder disability that was incurred in or aggravated by his service. Moreover, post-service, the record does not reflect or reference any history of a right shoulder disability until over 6 years after discharge from active service. The mere absence of medical records does not contradict a Veteran’s statements about his symptom history. See, Buchanan supra. However, if it is determined based upon reliable evidence that there was an extended period of time after service without any manifestations of the claimed condition, then that tends to weigh against a finding of a connection between the disability and service. See, Maxson, supra; see also, Horn, supra. The Board finds in this case that the lack of evidence of a right shoulder disability during service coupled with the fact that a right shoulder diagnosis was not made until over 6 years post-service, is sufficient to rebut a finding of service incurrence. In this case, the earliest post-service medical evidence of the Veteran’s right shoulder disability was in April 2011 which is over 6 years after service. This long period without problems weighs against the claim. In addition, continuity of symptomatology has also not been established, either through the competent evidence of record or through the Veteran’s statements. Moreover, the Board finds that the Veteran’s statements relating his right shoulder disability to his service are not credible and are afforded no probative value. His contentions conflict with the absence of treatment evidence for over 6 years after service and post-service injuries related to skateboarding. Finally, there is no competent medical evidence that the Veteran has any right shoulder disability that is related to his service. 3. Right hip disability The Veteran contends that he has a right hip disability that is related to combat training during his service. The STRs are void of findings, complaints, symptoms, or any diagnosis related to a right hip disability. In a March 2004 separation report of medical history, the Veteran stated that he was in good health. In a June 2013 private medical opinion Dr. R.S.H. opined that the Veteran’s right hip disability seemed likely related to his service, but provided no rationale in support of the medical opinion. In another June 2013 private medical opinion, Dr. M.O. opined that carrying and wearing combat equipment added stress and wear and tear of the Veteran’s joints. Private treatment records include a January 2015 correspondence which indicates a complaint of hip pain. A January 2015 report indicates that the Veteran presented with a new problem of right hip pain which had been ongoing for one week. An April 2015 report indicates that the Veteran reported no injury. Right hip femoroacetabular impingement and right hip labral tear was diagnosed. The Board has considered Dr. R.S.H.’s June 2013 private opinion that the Veteran’s right hip disability “seemed likely” related to service, but finds that this medical opinion is unsupported by any rationale. To the extent that Dr. M.O.’s June 2013 medical opinion also suggests any relationship between the Veteran’s right hip disability and his service, it is also unsupported by any rationale. See Miller, supra.; see also Bloom, supra; Nieves-Rodriguez, supra; Prejean, supra. In addition, the speculative terminology “seemed likely” provides an insufficient basis for an award of service connection, limiting the probative value of the opinion. See Winsett, supra; Bostain, supra; Warren, supra; Tirpak, supra. Moreover, to the extent that the facts supporting this opinion came from the Veteran, those facts are unsupported by the objective evidence of record. For these reasons, the opinions carry little probative weight. See Reonal, supra. The Board finds that the claim must be denied. There is no competent medical evidence to show that the Veteran has had any right hip disability that was incurred in or aggravated by his service. Moreover, post-service, the record does not reflect or reference any history of a right hip disability until over 8 years after discharge from active service. The mere absence of medical records does not contradict a Veteran’s statements about his symptom history. See, Buchanan supra. However, if it is determined based upon reliable evidence that there was an extended period of time after service without any manifestations of the claimed condition, then that tends to weigh against a finding of a connection between the disability and service. See, Maxson, supra; see also, Horn, supra. The Board finds in this case that the lack of evidence of a right hip disability during service coupled with the fact that a right hip diagnosis was not made until over 8 years post-service, is sufficient to rebut a finding of service incurrence. In this case, the earliest post-service medical evidence of the Veteran’s right hip disability was in June 2013 which is over 8 years after service. This long period without problems weighs against the claim. Moreover, the Board finds that the Veteran’s statements relating his right hip disability to his service are not credible and are afforded no probative value. His contentions conflict with the absence of treatment evidence for over 8 years after service. Finally, there is no competent medical evidence that the Veteran has any right hip disability that is related to his service. 4. IBS and hemorrhoids The Veteran contends that he has IBS and hemorrhoids related to his service or secondary to medication prescribed to treat service-related disabilities. The STRs are void of findings, complaints, symptoms, or diagnosis related to any gastrointestinal disability, including IBS, or hemorrhoids. In a March 2004 separation report of medical history, the Veteran stated that he was in good health. In a June 2013 private medical opinion Dr. R.S.H. opined that his hemorrhoids and IBS seem likely related to his service. During a July 2013 Decision Review Officer (DRO) Conference the Veteran stated that he believed that his IBS and hemorrhoids were related to the food he ate in the field and/or secondary to his medications. Private treatment records include a January 2015 report which indicates a complaint of hip pain and notation that he was prescribed Mobic in hopes that it would be easier on his stomach. An October 2015 private report indicates complaints of external hemorrhoids and epigastric pain related to reflux disease. In March 2019, the Veteran testified that he had constipation that he thought was related to MREs (meals, ready-to-eat) during service. He experienced constipation and diarrhea during service and hemorrhoids due to constipation. However, he denied receiving any treatment. He further testified that his hemorrhoids may be related to drinking, but they continued after he stopped drinking. The Board has considered Dr. R.S.H.’s June 2013 private opinion that the Veteran’s hemorrhoids and IBS “seemed likely” related to service, but finds that this medical opinion is unsupported by any rationale. See Miller, supra.; see also Bloom, supra; Nieves-Rodriguez, supra; Prejean, supra. In addition, the speculative terminology “seemed likely” provides an insufficient basis for an award of service connection, limiting the probative value of the opinion. See Winsett, supra; Bostain, supra; Warren, supra; Tirpak, supra. Moreover, to the extent that the facts supporting this opinion came from the Veteran, those facts are unsupported by the objective evidence of record. For these reasons, the opinion carries little probative weight. See Reonal, supra. The Board finds that the claims must be denied. There is no competent medical evidence to show that the Veteran has had IBS or hemorrhoids that are related to his service or to any medication prescribed to treat any service-connected disability. Moreover, post-service, the record does not reflect or reference any history of IBS or hemorrhoids until over 8 years after discharge from active service. The mere absence of medical records does not contradict a Veteran’s statements about his symptom history. See, Buchanan supra; see also, Maxson, supra; see also, Horn, supra. Moreover, the Board finds that the Veteran’s statements relating his IBS and hemorrhoids to his service are not credible and are afforded no probative value. His contentions conflict with the absence of treatment evidence for over 8 years after service. The Board finds in this case that the lack of evidence of IBS and hemorrhoids during service coupled with the fact that IBS and hemorrhoids were not diagnosed until over 8 years post-service, is sufficient to rebut a finding of service incurrence. In this case, the earliest post-service medical evidence of the Veteran’s IBS and hemorrhoids were over 8 years after service. This long period without problems weighs against the claims. Moreover, the Board finds that the Veteran’s statements relating his IBS and hemorrhoids to his service are not credible and are afforded no probative value. His contentions conflict with the absence of treatment evidence for over 8 years after service. Finally, there is no competent medical evidence that the Veteran has any IBS or hemorrhoids that are related to his service. 5. TBI, migraine headaches, and vertigo The Veteran contends that he has a TBI, migraine headaches, and vertigo that are related to combat training during his service. Alternatively, he contends that he has migraine headaches and vertigo related to a TBI. The STRs are void of findings, complaints, symptoms, or any diagnosis related to TBI, migraine headaches, or vertigo. In a March 2004 separation report of medical history, the Veteran stated that he was in good health. Post-service private treatment records include a May 2013 report shows that he presented for evaluation and management of chronic neurologic symptoms. The Veteran reported onset of occasional headaches during service at age 24. In 2004, he reportedly had closed head injuries during martial arts training. He noted prolonged periods of vertigo and lightheadedness which became acutely pronounced in 2009. The physician diagnosed medication overuse headache-possible, chronic daily headache with vertigo of central origin/migraine headaches associated vertigo. Additional private treatment records indicate a history of refractory migraines since February 2018. In a May 2013 private medical opinion from Dr. M.O. the Veteran complained of migraine headaches associated with vertigo. He reported occasional headaches during service. In 2004, he developed a prolonged period of malaise, possibly after duplication of his inoculation and vaccinations as well as closed head injuries during martial arts training. He noted periods of vertigo and lightheadedness which became acutely pronounced in 2009. The assessment was medication overuse headache-possible; chronic daily headache and vertigo of central origin/migraine headaches associated vertigo. In a June 2013 private medical opinion Dr. R.S.H. stated that the Veteran presented for symptoms of dizziness which started in 2009. He was diagnosed with migraine-related vertigo. The doctor stated that the Veteran had reasonable control with medication, but his symptoms actually started with fatigue during service. The doctor was unable to identify any other specific cause. Thus, given the onset during service, and the lack of other identifiable findings, it is as likely as not that his symptoms are related to service. The doctor further opined that this includes, chronic migraine headaches and TBI which seem likely related his service. In another June 2013 private medical opinion, Dr. M.O. stated that the Veteran was evaluated from a neurologic standpoint. The physician opined that his TBI, migraine headaches, and vertigo due to migraine headaches were a likely consequence of his service. His neurologic symptoms and disability clearly arose after his multiple head injuries during training as well as on active duty. He had vestibular migraine and on further evaluation had been noted to have craniocervical instability related to a very rotated C1 (atlas) vertebrae. This caused sequela of chronic head pain and vertigo. In a July 2013 private medical opinion Dr. K.C.L. stated that the Veteran mentioned during his service the training was rigorous and some of the training involved being dropped repeatedly onto frozen ground from a height of about 4 feet. This could well be a cause of injury and trauma to the head and neck. The doctor stated that she was unable to obtain the Veteran’s prior medical records other than an MRI report so her opinion was based on a spinal examination and past experience. During a July 2013 DRO conference the Veteran stated that he believed his disabilities are the result of physical training during service where he had a TBI and residuals migraine headaches and vertigo. The Veteran confirmed that it was typical during training that complaints and injuries are not recorded, and his own were often treated with OTC medications. A July 2013 statement indicates that during the Veteran’s service he told is father that he suffered from severe headaches. In March 2019, the Veteran testified that his migraine headaches and vertigo were likely related to head injuries sustained during combat training during service, known as Tan Belt program. He testified that the MCMAP curriculum associated with the training was later revised due to the injuries associated with hit. He testified that during this training his head impacted the ground. However, he did not seek treatment during service and only took Motrin for pain. The Veteran testified that the TBI caused migraines which began around 2003 with severe pain behind his left eye. He testified that a concussion specialist/neurologist saw white spots on his brain which they related to his brain bouncing back and forth. The Veteran had chronic vertigo made worse by migraines. He testified that he used protective gear while using pugils sticks and “got his bell rung a few times.” The Veteran testified that there were two instances during which he sustained injuries, once during a headlock when he hit his head and after doing some wrestling when someone tweaked his neck and he heard a pop. Additional private treatment records include a November 2019 report which indicates a long history of migraine headaches. A December 2019 psychiatric examination indicates that the Veteran was diagnosed with attention deficit hyperactivity disorder (ADHD) at age 36 and migraines which his neurologist thought might be related to ADHD. The Veteran also stated that he had migraines associated with vertigo which were thought to be related to a brain tumor. A history of TBI and concussions from training was noted. The Board finds that to the extent that the June and July 2013 private medical opinions relate the Veteran’s TBI and migraine headaches to head trauma during service, his claimed in-service head injuries have not been corroborated by his STRs or any lay evidence (i.e., witness statements). The Board also notes that in June 2013 Dr. R.S.H. diagnosed migraine-related vertigo with symptoms that began with fatigue during service. However, the STRs are void of any findings or complaints related to fatigue. Accordingly, any medical evidence or medical opinion that finds that the Veteran has a TBI, migraine headaches, or vertigo related to an in-service injury or fatigue, based on the uncorroborated history provided by the Veteran, has limited probative value. Reonal, supra. The Board finds that the claims must be denied. In this case, there is no competent medical evidence that supports the conclusion that the Veteran has any TBI or residuals of TBI, vertigo, or migraine headaches there were incurred in or aggravated by his service. Moreover, post-service, the record does not reflect or reference any history of migraine headaches, TBI, and vertigo until 8 years after discharge from active service. The mere absence of medical records does not contradict a Veteran’s statements about his symptom history. See, Buchanan supra; see also, Maxson, supra; see also, Horn, supra. Moreover, the Board finds that the Veteran’s statements relating his migraine headaches, vertigo, and TBI to his service are not credible and are afforded no probative value. His contentions conflict with the absence of treatment evidence for over 8 years after service. The Board finds in this case that the lack of evidence migraine headaches, vertigo, and TBI during service coupled with the fact that migraine headaches, vertigo, and TBIs were not diagnosed until over 8 years post-service, is sufficient to rebut a finding of service incurrence. In this case, the earliest post-service medical evidence of the Veteran’s migraine headaches and vertigo was in May 2013 and TBI was in June 2013 which is over 8 years after service. This long period without problems weighs against the claims. In addition, continuity of symptomatology has also not been established, either through the competent evidence of record or through the Veteran’s statements. Moreover, the Board finds that the Veteran’s statements relating his migraine headaches, TBI, and vertigo to his service are not credible and are afforded no probative value. His contentions conflict with the absence of treatment evidence for over 8 years after service. Finally, there is no competent medical evidence that the Veteran has any migraine headaches, TBI, or vertigo that are related to his service. To the extent that the June 2013 private physicians related the Veteran’s vertigo to his migraines, service connection has not been granted for migraines. Likewise, although the Veteran seeks service connection for migraines and vertigo secondary to TBI, service connection for TBI has not been granted. Therefore, neither migraines or TBI may serve as a predicate service-connected disability upon which to base claims of service connection for vertigo or TBI, and the claims for migraines and vertigo based on “secondary” service connection fail as a matter of law. See 38 C.F.R. § 3.310; Sabonis v. Brown, 6 Vet. App. 426 (1994). There is no evidence to show that a service-connected disability caused or aggravated the Veteran’s vertigo or migraine headaches. Additional considerations The Board has considered the Veteran’s request for VA examinations for disabilities for which he has not undergone an examination, including his right hip, IBS, hemorrhoids, TBI, headaches, and vertigo at the March 2019 Board hearing. See, Hearing Transcript at P. 11. However, no such examinations are required. The United States Court of Appeals for the Federal Circuit (Federal Circuit) has recognized that there is not a duty to provide an examination in every case. See Waters v. Shinseki, 601 F.3d 1274 (Fed. Cir. 2010). Rather, the Secretary’s obligation under 38 U.S.C. § 5103A (d) to provide the Veteran with a medical examination or to obtain a medical opinion is not triggered unless there is an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the Veteran’s service or with another service-connected disability. See McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). Although the Veteran believes that he has a right hip disability, IBS, hemorrhoids, TBI, headaches, and vertigo which should be service connected, the fact remains that there is no objective evidence of findings, complaints, symptoms, or diagnoses related to any right hip disability, IBS, or hemorrhoids. Moreover, the contentions that TBI or TBI residuals, migraine headaches, and vertigo are related to combat training are based on uncorroborated accounts of head injuries during service. Accordingly, the Board finds that referral for a VA medical examination or opinion is not warranted. As such, the lay statements that are of record are simply insufficient to trigger VA’s duty to provide any examination with an opinion. See Waters, 601 F.3d 1274. The Board has taken the contention that the Veteran’s left and right shoulder disability, right hip disability, IBS, hemorrhoids, TBI, migraines, and vertigo were incurred in or aggravated by service, seriously. Although the Veteran might believe that he has left and right shoulder disability, right hip disability, IBS, hemorrhoids, TBI, migraines, and vertigo that are related to etiologically related to his service, the Board has closely reviewed the medical and lay evidence in the Veteran’s claims file and finds no evidence that may serve as a medical nexus between the Veteran’s service and his left and right shoulder disability, right hip disability, IBS, hemorrhoids, TBI, migraines, and vertigo. Although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), the specific issues in this case, the etiology of left and right shoulder disability, right hip disability, IBS, hemorrhoids, TBI, migraines, and vertigo, falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007) (lay persons not competent to diagnose cancer). In light of the above, the Board finds that the weight of the probative evidence is against a finding that the Veteran has left and right shoulder disability, right hip disability, IBS, hemorrhoids, TBI, migraines, and vertigo that are related to his service. REASONS FOR REMAND Left knee disability The Veteran contends that his service-connected left knee disability is more severe than his noncompensable rating prior to September 8, 2016 and 10 percent rating since September 8, 2016, would indicate. An August 2020 Decision Review Officer decision increased the rating from noncompensable (zero percent) to 10 percent, effective September 8, 2016. However, as that grant does not represent a total grant of benefits sought on appeal, the claim for increase remains before the Board. AB v. Brown, 6 Vet. App. 35 (1993). During the pendency of the appeal, the rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71a were amended effective February 7, 2021. 85 Fed. Reg. 230 (Nov. 30, 2020). The Veteran’s left knee disability is currently rated under Diagnostic Code 5260, but Diagnostic Code 5257 which rates recurrent subluxation or lateral instability of the knee now adds a rating for patellar instability and is applicable to the Veteran’s left knee claim. Specifically, an August 2010 private treatment record indicates that the Veteran was instructed on the proper use of a knee brace. In a January 2013 notice of disagreement the Veteran indicated that he uses a left knee brace. Because the record does not contain sufficient evidence to rate the Veteran’s left knee disability under the new rating criteria, a new examination is warranted. The matters are REMANDED for the following actions: 1. Contact the Veteran and request that he either submit, or provide VA sufficient information and authorization to obtain any private treatment records related to his left knee disability. In order to expedite this case, the Veteran’s representative (and/or the Veteran) is asked to obtain these records herself/himself and inform the RO/AMC that all appropriate records have been submitted in order to ensure that all pertinent records have been submitted in a highly timely manner so that the VA may adjudicate this case quickly. 2. Schedule the Veteran for a VA examination, to ascertain and evaluate the current level of severity of his service-connected left knee disability. All indicated studies and tests should be performed. The claims folder should be made available to the examiner for review of pertinent documents. The examination reports should reflect that such a review was conducted. The AOJ should ensure that the examiner provides all information required for rating purposes, under both the former and revised rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71a effective February 7, 2021. 85 Fed. Reg. 230 (Nov. 30, 2020). KELLI A. KORDICH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Adams, 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.