Citation Nr: 21024226 Decision Date: 04/22/21 Archive Date: 04/22/21 DOCKET NO. 15-43 642 DATE: April 22, 2021 ORDER Entitlement to service connection for tinnitus is denied. Entitlement to service connection for a skin disorder is denied. Entitlement to service connection for cervical spine disorder is denied. Entitlement to service connection for right knee disorder is granted. Entitlement to service connection for left ankle disorder is granted. Entitlement to service connection for right foot disorder, claimed as fallen arches, is denied. Entitlement to service connection for left foot disorder, claimed as fallen arches, is denied. Entitlement to service connection for low back disorder, claimed as bulging disc L1-L2, herniated discs L4-L5 is denied. Entitlement to service connection for sciatic nerve disorder, including as secondary to a low back disorder is denied. FINDINGS OF FACT 1. The evidence of record does not show the onset of the Veteran's tinnitus was due to active duty service or resulted from disease or injury in service. 2. The evidence does not support a finding that the Veteran has a current skin disorder that was incurred in or caused by service. 3. The evidence does not establish that the Veteran has a cervical spine disorder that is causally related to her active service. 4. The evidence is at least in equipoise as to whether the Veteran's right knee disorder began during active service and has been continuous to the present. 5. The evidence is at least in equipoise as to whether the Veteran’s left ankle disorder began during active service and has been continuous to the present. 6. The weight of the evidence is against finding that the Veteran's current bilateral foot disorder is related to service. 7. The weight of the evidence is against finding that the Veteran's current low back disorder is related to service. 8. The weight of the evidence is against finding that a sciatic nerve disorder is related to the Veteran’s service or caused or aggravated by a service-connected disability. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for tinnitus have not been met. 38 U.S.C. §§ 1131, 1137, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309. 2. The criteria for entitlement to service connection for a skin disorder have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. § 3.303. 3. The criteria for entitlement to service connection for cervical spine disorder have not been met. 38 U.S.C. §§ 1131, 1137, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309. 4. The criteria for entitlement to service connection for right knee disorder have been met. 38 U.S.C. §§ 1131, 1137, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309. 5. The criteria for entitlement to service connection for left ankle disorder have been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. § 3.303. 6. The criteria for entitlement to service connection for bilateral foot disorder, claimed as fallen arches have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. § 3.303. 7. The criteria for entitlement to service connection for low back disorder, claimed as bulging disc L1-L2, herniated discs L4-L5 have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. § 3.303, 3.307, 3.309. 8. The criteria for entitlement to service connection for sciatic nerve disorder, including as secondary to a low back disorder have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty service from October 1980 to June 1985. These matters were previously before the Board of Veterans’ Appeals (Board) in November 2018 and remanded to a Department of Veterans Affairs (VA) Regional Office (RO) for additional development. SERVICE CONNECTION Service connection will be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). To establish service connection, the evidence generally must show: (1) the existence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Certain chronic diseases (to include tinnitus, as organic disease of the nervous system and arthritis) may be service connected on a presumptive basis if manifested to a compensable degree within a specified period of time post-service (one year each for tinnitus and arthritis). 38 U.S.C. § 1137; 38 C.F.R. §§ 3.307, 3.309. Nexus of a chronic disease to service may be established by showing continuity of symptomatology following service. Walker v. Shinseki, 708 F.3d 1331, 1338-40 (Fed. Cir. 2013). Disability which is proximately due to or the result of a service-connected disease or injury shall also be service connected. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists; and (2) that the current disability was either (a) caused or (b) aggravated by a service-connected disability. 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439, 448 (1995). 1. Entitlement to service connection for tinnitus The Veteran reports she currently has recurrent tinnitus. She asserts that ringing started in her ears during active duty service in 1983, and she now experiences a buzzing sound or strong wind noise in her ear. The Veteran's military occupational specialty was personal affairs specialist. See DD Form 214. The Veteran has not claimed that she was exposed to hazardous occupational noise in carrying out her duties as a personal affairs specialist. Moreover, her service treatment records are negative for any complaints, treatment, or diagnosis of tinnitus during service. During her service separation examination in February 1985 the Veteran reported she had no ear trouble or hearing loss and on clinical evaluation her ears and drums were normal. However, a comparison of audiometer testing at enlistment and separation from service indicates some degree of noise exposure therein, as evidence by a positive, yet insignificant, threshold shift from the time of entry to separation from service at the 500 Hertz range. Pursuant to the November 2018 Board remand, an opinion was rendered determining if tinnitus began during active service, is related to an incident of service, to include in-service noise exposure, or began within one year after discharge from active service. An October 2019 VA-contract medical opinion provider opined that the Veteran’s tinnitus is less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. The rationale for the opinion is there is no evidence of a diagnosis of tinnitus or evidence to confirm or deny the Veteran’s report of onset of tinnitus. The examiner further noted that, regardless of onset, it is less likely as not that the Veteran’s tinnitus was related to a military event including conceded military noise exposure as there was no significant permanent shift in hearing thresholds beyond test variability at any frequency in either ear. The shift noted in the Remand is at 500 Hertz and is 10 decibels, which is not significant. There is no shift at all in the other frequencies, and improvement was seen in the frequencies affected by noise from enlistment to separation. This is objective evidence of no permanent auditory damage from conceded noise on active duty. There is no report of tinnitus in the service treatment records or at separation or in records reviewed prior to the claim. Although noise exposure is conceded, and the relationship of noise, auditory damage and tinnitus is established, auditory damage and tinnitus are not conceded based on noise alone. There must be a nexus of auditory damage on active duty to relate current tinnitus to military noise. The examiner found that the evidence is against a nexus in this case. On November 2020 VA-contract hearing loss and tinnitus examination, the Veteran reported ringing in her ears during service. She states she now experiences a buzzing sound or strong wind noise intermittently in both ears. The examiner opined that the Veteran’s tinnitus is less likely than not (less than 50 percent probability) caused by or a result of military noise exposure. The examiner’s rationale for the opinion is that there is no evidence of tinnitus complaints while the Veteran was in service, and there is no evidence of significant auditory damage. Therefore, it is less likely than not that tinnitus is a result of military noise exposure. After review of all the evidence of record, with particular attention to that discussed above, the Board finds that the preponderance of the evidence weighs against finding that the Veteran has tinnitus that was incurred during or as a result of her active duty service. As noted, the record is silent for any post-service treatment for tinnitus during or within one year of the Veteran’s service separation or thereafter. The Board notes that the absence of evidence of post-service treatment for tinnitus after the Veteran's discharge from active duty service is not the only factor relied upon by the Board in making this finding, but it is only one of several factors - including the most recent VA-contract opinions. Both VA-contract opinions are unfavorable for the Veteran’s tinnitus claim. The Board finds the opinions probative evidence in deciding this matter. The medical opinion providers reviewed the Veteran’s record and provided rationales for the opinions. The November 2020 examiner also interviewed and examined the Veteran. The Veteran has competently and credibly stated that she began experiencing symptoms of tinnitus in service which have continued since that time. The Board acknowledges that tinnitus is capable of lay observation. Charles v. Principi, 16 Vet. App. 370 (2002). Nevertheless, the Board finds that the lay evidence of record, although credible and competent, is outweighed by the absence of any complaints of tinnitus or findings of any significant level of hearing loss during or after her active duty service and the unfavorable VA medical opinions. As such, the Board finds that the Veteran is not entitled to service connection for tinnitus, the benefit-of-the-doubt rule is not for application, and the claim must be denied. 2. Entitlement to service connection for a skin disorder The Veteran asserts that she had vaginal warts in service that were treated. After her discharge from service, she had a wart removed from her left forearm and two warts removed from her right upper arm. She believes the post-service warts are related to the in-service vaginal warts, and, therefore, service connection for a skin disorder is warranted. The Veteran’s service treatment records show that she was seen at an obstetrics and gynecology clinic in November 1984, and, on observation, she had venereal warts on her labia majora and at the base of the perineum. The assessment was condyloma acuminatum [genital warts] treated with podophyllin. On December 2013 VA skin diseases examination, the Veteran reported she had a wart removed from her left forearm in 2010. A biopsy in 2010 revealed she had lichen simplex chronicus. In addition, she had two warts (hard, black, elevated lesions) removed from her right upper arm in July 2013 by a private dermatologist after they did not respond to a steroid tape. She further reported that she had vaginal warts during military service and believes the other warts are connected to the vaginal warts. On physical examination, the Veteran did not have any of the noted visible skin conditions. The diagnosis was warts. The examiner opined that the claimed wart condition is less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The rationale for the opinion was that there was no mention of vaginal warts on review of multiple gynecologic examinations in the claims file, including 1983 and 1984 annual examinations and service separation examination. Pursuant to the November 2018 Board remand, a supplemental opinion was requested to determine if there is a link between the claimed skin disorder and the Veteran’s active duty service. In an October 2019 VA-contract medical opinion, the medical opinion provider opined that the Veteran’s skin disorder is less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. The rationale for the opinion is that the strain HPV [human papilloma virus] that causes genital warts is spread only through sexual contact and is unrelated to the strain that causes plantar warts or flat warts located on other skin areas. It is contracted through skin-to-skin sexual contact – vaginal, anal, or oral. No nexus for warts on the other areas of the body exists. At a March 2020 VA physical medicine rehabilitation follow-up visit, evaluation of the skin revealed there were no lesions or cuts on the skin. A June 2020 VA emergency department note shows an evaluation of the skin with no evidence of rashes or obvious skin and skin structure infections. Based upon the foregoing, a skin disorder related to the Veteran’s military service has not been established, and service connection for a skin disorder is not warranted. Even though the evidence shows that the Veteran had vaginal warts during service, such is not service-related because they are not the result of disability resulting from disease or injury incurred in or aggravated by the Veteran’s active service. The October 2019 VA-contract medical opinion provider explained that genital warts are caused by the strain HPV and is spread only through sexual contact. The medical opinion provider further noted that the post-service warts described by the Veteran were unrelated to the in-service genital warts. Furthermore, it appears that the genital warts were acute and transitory and without residuals, as there was no mention of warts or any skin disorder when the Veteran was examined at the time of service separation. After discharge from service, the earliest treatment for a skin disorder was in 2007, as noted in an August 2010 VA dermatology outpatient report, which reflects that the Veteran was evaluated for dark itchy spots on her arms. This represents over 20 years without treatment or any mention of a skin disorder. The absence of any medical records of a diagnosis or treatment for such a lengthy period after service discharge can be probative evidence against a claim for service connection. In addition, there is no competent, credible evidence of a nexus between the claimed skin disorder and the Veteran’s service. The December 2013 VA examiner and the October 2019 VA-contract medical opinion provider opined that the Veteran’s skin disorder is less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The Board finds the October 2019 VA-contract medical opinion provider’s opinion probative, as the provider reviewed the Veteran’s record and provided a thorough rationale for the opinion. The Board acknowledges the Veteran's assertions that her skin disorder is related to service and finds that she is not competent to render such an opinion. Although lay persons are competent to provide opinions on some medical issues, the specific issue in this case, the etiology of the claimed skin disorder, falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F. 3d 1372, 1377 (2007). Accordingly, the claim of entitlement to service connection for a skin disorder is denied. The preponderance of the evidence is against the claim; thus, the benefit-of-the-doubt rule is not for application. 3. Entitlement to service connection for cervical spine disorder The Veteran contends service connection is warranted for a cervical spine disorder because she injured her neck in a motor vehicle accident in service in 1982. The Veteran stated she experienced occasional pain in her neck throughout her military service to the present time. Service treatment records show the Veteran was seen at a health clinic in April 1982 with complaints of neck pain after involvement in an automobile accident two days earlier. No fractures were seen on x-rays of the cervical spine. The assessment was cervical strain secondary to a motor vehicle accident. No additional treatment was provided for the Veteran’s cervical spine for the remaining three years on active duty after the accident. Her service separation examination shows she had a normal spine and other musculoskeletal on clinical evaluation. There is no record of post-service treatment for the claimed cervical spine disorder until 1999, 14 years after discharge from the service, when the Veteran was again involved in a motor vehicle accident. X-rays after the 1999 motor vehicle accident show degenerative joint disease of the cervical spine. Consequently, service connection for a chronic cervical spine disorder on the basis that it became manifest in service and persisted, or on a presumptive basis, as a chronic disease, is not warranted. In June 2012 the Veteran was seen at a VA medical center (VAMC). It was noted that addendum neurodiagnostic and pain management reports were received from Dr. SJK. Dr. SJK, in pertinent part, diagnosed cervical strain. Although a cervical spine disorder is diagnosed, there is no evidence of a causal nexus to service. On December 2013 VA neck/cervical spine conditions examination, the examiner diagnosed history of cervical sprain after motor vehicle accident in 1999 and normal neck examination at present with no pain or dysfunction. The examiner noted the Veteran had a normal service separation examination, and the present examination was normal. The examiner noted that a medical opinion was not necessary. Pursuant to the November 2018 Board remand a supplemental opinion was requested to determine if there is a link between the claimed neck/cervical spine disorder and the Veteran’s active duty service. In an October 2019 VA-contract medical opinion a medical opinion provider opined that the Veteran’s neck/cervical spine disorder is less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. The rationale for the opinion was that during service the Veteran’s neck condition was acute. There is no evidence of chronicity of care after active duty through at least the 1999 motor vehicle accident. The medical provider noted that the 1999 x-rays showing degenerative joint disease of the cervical spine have not been located, and degenerative joint disease is not otherwise diagnosed to date in the available records. There is no reference after active duty to a cervical strain until 2012. A nexus has not been established. The Board finds the October 2019 VA-contract medical opinion provider’s opinion probative, as the provider reviewed the Veteran’s record and provided a thorough rationale for the opinion. The Board acknowledges the Veteran’s assertions that the claimed cervical spine disorder is related to service and finds that she is not competent to render such an opinion. Although lay persons are competent to provide opinions on some medical issues, as to the specific issue in this case, etiology of the claimed cervical spine disorder, falls outside the realm of common knowledge of a lay person. See Jandreau, 492 F.3d at 1377. Accordingly, the claim of entitlement to service connection for cervical spine disorder is denied. The preponderance of the evidence is against the claim; thus, the benefit-of-the-doubt rule is not for application. 4. Entitlement to service connection for right knee disorder The Veteran has current diagnoses of chronic mild residual bilateral knee sprain and degenerative joint disease of the knees. She contends service connection is warranted for a right knee disorder because her right knee was injured from repeated stress of physical training, sports activities and performing work related duties during military service. Service treatment records show the Veteran was seen at a military medical center in November 1980 and reported pain of the knees, ankles, and calves. The assessments were shin splints and knee pain. In April 1982, the Veteran was involved in a motor vehicle accident and treated in emergency care for injury to her right leg from the middle of the calf to the mid-thigh. X-rays of the right knee revealed no significant abnormalities. The diagnosis was soft tissue injury. She was released from emergency care in good condition. In June 2012 the Veteran was seen at a VAMC. It was noted that addendum neurodiagnostic and pain management reports were received from Dr. SJK. Dr. SJK, in pertinent part, diagnosed right knee effusion. In addition, a report from Dr. DL revealed a diagnosis of knee pain. On December 2013 VA knee and lower leg conditions examination, the Veteran reported she sustained injury to her knees because of physical training, which was reported and treated conservatively. X-rays during service were normal. The Veteran stated her knees were further aggravated by repeated stress of physical training, sports activities and performing work-related duties. She stated she had occasional pain in her knees throughout military service to the present. Image studies of the knees showed degenerative or traumatic arthritis, bilaterally. Following the examination, the examiner diagnosed chronic mild residual bilateral knee sprain and degenerative joint disease of the knees. The examiner noted that the Veteran sustained injury to her knees due to physical training. Her service separation examination showed normal findings. The examiner stated that the Veteran’s medical history and present medical examination confirms the rationale. Pursuant to the November 2018 Board remand, a supplemental opinion was requested to determine if there was a link between the claimed right knee disorder and the Veteran’s active duty service. In an October 2019 VA-contract medical opinion, the medical opinion provider opined that the Veteran’s knee is less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. The rationale for the opinion is that during service, the Veteran’s knee disorder was acute only in 1980, and the motor vehicle accident noted soft tissue injuries only; there were no orthopedic injuries. There is no evidence of chronicity of care on active duty, at service separation, or in post active duty records. The first signs of knee degenerative joint disease were in October 2011, when knee pain was noted. This was well after active duty. A nexus has not been established. On review and when weighing the evidence of record, the Board finds at most the evidence for and against the Veteran's claim for service connection for a right knee disorder is in relative equipoise. The December 2013 VA examiner diagnosed a chronic mild residual bilateral knee sprain and degenerative joint disease of the knees and noted that the Veteran sustained injury to her knees due to physical training. The Board has considered the negative nexus opinion of the October 2019 VA-contract medical opinion provider and finds that such opinion must be considered in the context of competent medical evidence of record that diagnosed a knee disorder after review of the Veteran’s records and physical examination, as well as consideration of the competent and credible statements of the Veteran regarding in-service and post-service symptoms, all of which support a finding that the Veteran’s right knee disorder began in service and has persisted since that time. As such, resolving all doubt in favor of the Veteran, the Board finds that a nexus has been established between the Veteran's right knee disorder and her active service. Accordingly, entitlement to service connection for a right knee disorder is warranted. 5. Entitlement to service connection for left ankle disorder The Veteran has current diagnoses of chronic mild residual bilateral ankle sprain resolved from 1981 and chronic mild residual bilateral ankle sprain [active] from 2011. She contends service connection is warranted for a left ankle disorder because her left ankle was injured from repeated stress of physical training, sports activities, and performing work related duties during military service. On December 2013 VA ankle conditions examination, the Veteran reported she sustain injury to her left ankle during physical training. She stated her left ankle was further aggravated by repeated stress of physical training, sports activities, and performing work-related duties. She related that she had occasional pain in her left ankle throughout her military service and to the present time. The left ankle bony structures appeared unremarkable on September 2013 x-rays of the left ankle. The diagnosis was chronic mild residual bilateral ankle sprain. The examiner noted the Veteran sustained injury to her ankles in service. The examiner noted that the claims file and service separation examination showed normal findings. The examiner further noted that the Veteran’s medical history and present medical examinations confirmed the rationale. Pursuant to the November 2018 Board remand, a supplemental opinion was requested to determine if there is a link between the claimed left ankle disorder and the Veteran’s active duty service. In an October 2019 VA-contract medical opinion, the medical provider opined that the Veteran’s ankle disorder is less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. The rationale for the opinion was that during service the Veteran’s ankle disorder was acute only in 1980. There is no evidence of chronicity of care for an ankle disorder related to a motor vehicle accident on active duty (no ankle or orthopedic condition in general) on exit or after active duty until 2012. A June 2013 VA note indicates a left ankle injury in August 2012, which is well after active duty and unrelated. A nexus has not been established. On review and when weighing the evidence of record, the Board finds at most the evidence for and against the Veteran’s claim for service connection for a left ankle disorder is in relative equipoise. The December 2013 VA examiner diagnosed a chronic mild residual bilateral ankle sprain and noted that the Veteran sustained injury to her ankles due to physical training. The Board has considered the negative nexus opinion of the October 2019 VA-contract medical opinion provider and finds such opinion must be considered in the context of competent medical evidence of record that diagnosed an ankle disorder after review of the Veteran’s records and physical examination, as well as consideration of the competent and credible statements of the Veteran regarding in-service and post-service symptoms, all of which support a finding that the Veteran’s left ankle disorder began in service and has persisted since that time. As such, resolving all doubt in favor of the Veteran, the Board finds that a nexus has been established between her left ankle disorder and her active military service. Accordingly, entitlement to service connection for a left ankle disorder is warranted. 6. Entitlement to service connection for bilateral foot disorder, claimed as fallen arches The Veteran has a current diagnosis of bilateral flat foot. She contends her bilateral foot disorder, claimed as fallen arches, was injured in service. Specifically, she asserts she sustained injury to her feet from repeated stress during physical training, sports activities and performing work-related duties during service. Service treatment records are negative for any complaints, treatment, or diagnosis of a bilateral foot disorder. On her February 1985 service separation medical history report, the Veteran indicated she did not have foot trouble. Her service separation medical examination report revealed normal feet on clinical evaluation. Post-service in October 2011, the Veteran was seen at a VA primary care follow-up visit and reported she was still having right foot pain. On December 2013 VA foot examination, the Veteran reported she had occasional pain in her feet throughout her military service to the present time. Following examination of the feet, the examiner diagnosed history of bilateral foot sprain in 1981, resolved with normal foot examination at present with no pain or dysfunction. The examiner noted that the Veteran had a normal service separation examination and a normal examination at present. Therefore, no medical opinion is necessary. Pursuant to the November 2018 Board remand, a supplemental opinion was requested to determine if there is a link between the claimed bilateral foot disorder and the Veteran’s active duty service. In an October 2019 VA-contract medical opinion, the medical opinion provider opined that the Veteran’s bilateral foot disorder is less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. The rationale for the opinion is that symptoms are subjective only. Objective examination was normal. There is no objective evidence of a chronic foot/fallen arches disorder on active duty, at service separation, in post active duty, or on the current examination. There are no treatment notes diagnosing fallen arches. The only references are in the Veteran’s correspondence or associated with the claim. A nexus to active duty either activities on active duty or a motor vehicle accident while on active duty has not been established. The medical opinion provider further noted that acquired pes planus (fallen arches) most commonly occurs secondary to posterior tibial tendon dysfunction (PTD) per the literature. No diagnosis of PTD has been rendered to date or as the result of a motor vehicle accident. No nexus to a motor vehicle accident could be made. On November 2020 VA-contract foot conditions examination, the Veteran reported that she noticed pain in her feet in 1980 during boot camp. Following examination of the Veteran’s feet, the examiner diagnosed bilateral flat foot. The examiner opined that the Veteran’s bilateral flat foot disorder was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. The rationale for the opinion was that the Veteran’s enlistment examination was silent for any mention of fallen arches or flat feet. Post-service treatment records are negative for any diagnosis of or treatment for fallen arches. The Board finds the preponderance of evidence is against a finding of an in-service disease or injury with respect to the Veteran's service connection claim for a bilateral foot disorder. Service treatment records provide no indication that the Veteran had or was treated for a foot disorder in service. The evidence shows that the first post-service mention of a foot disorder was in 2008, which is 23 years after service separation, and such lengthy period without any complaints, treatment, or a diagnosis is probative evidence against the claim for service connection. (See private treatment records of Dr. LY). Consequently, service connection for a chronic bilateral foot disorder on the basis that it became manifest in service and persisted is not warranted. The Board notes that while the Veteran has been diagnosed with having flat feet, there is no competent medical evidence of a link between the claimed bilateral foot disorder and service. The November 2020 VA-contract examiner opined that the Veteran’s bilateral flat foot disorder was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The Board finds this opinion probative, as the examiner reviewed the Veteran’s record and provided a thorough rationale for the opinion. The only evidence supporting a link between the claimed bilateral foot disorder and the Veteran’s service is the Veteran’s own assertions, which do not constitute competent medical evidence. The question of whether the Veteran has a disability related to her service falls outside the realm of common knowledge of a lay person. An opinion regarding the etiology of the Veteran’s bilateral foot disorder requires the expertise of a medical professional, particularly where, as in this case, there has been a significant passage of time without any documentation of any symptomatology. Therefore, the Veteran is not competent to provide an opinion on etiology. While the Veteran can report symptoms that she experiences, she does not have the necessary training to make medical opinions. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Accordingly, the claim of entitlement to service connection for a bilateral foot disorder is denied. The preponderance of the evidence is against the claim; thus, the benefit-of-the-doubt rule is not for application. 7. Entitlement to service connection for low back disorder, claimed as bulging disc L1-L2, herniated discs L4-L5 8. Entitlement to service connection for sciatic nerve disorder, including as secondary to a low back disorder The Veteran has current diagnoses of mechanical back pain syndrome, lumbosacral sprain/strain, degenerative disc disease, foraminal lateral recess/central stenosis, intervertebral disc syndrome, and radiculopathy. She contends that service connection is warranted for her low back disorder because she injured her back in service in a motor vehicle accident in 1982, and her back injury was further aggravated by repeated stress of physical training, sports activities, and performing work-related duties during service. She stated she experienced occasional pain in her back throughout military service to the present. Service treatment records are negative for any complaints, treatment, or diagnosis of a chronic low back disorder. Low back pain was noted in an August 1982 in-service health clinic report regarding complaints of stomach cramps and diarrhea related to menstrual cramps. There is no record of a back injury in 1982 associated with a motor vehicle accident or other incident in service. The Veteran’s 1985 separation medical history report indicated she had not had recurrent back pain, and, on clinical evaluation, the spine and other musculoskeletal were normal. Evidence shows that the earliest post-service notation of a back injury is in 1999. The Veteran reported being in a car accident in 1999, and she sustained a back injury resulting in a herniated disc at L4-L5. This first mention of a post-service back injury in 1999 is 14 years after the Veteran’s discharge from service and is probative evidence against her service connection claim. Consequently, service connection for a chronic low back disorder on the basis that it became manifest in service and persisted or on a presumptive basis, as a chronic disease, is not warranted. Additionally, and to the extent the Veteran claims continuity of symptoms of a low back disorder since service, there is other evidence of record that weighs against service connection on that basis. For example, the Veteran was seen by her private physician, Dr. LY, in August 2014. Her chief complaint at that time was low back pain. It was noted that the Veteran had been complaining of low back pain since 2010. She originally hurt her back at work in 2008 and had residual pain. She reinjured her low back at work in 2011 (she was assaulted by a 70-year old lady); she had physical therapy but sustained nerve damage. She experienced numb and tingling pain in the low back with pain radiating to the left foot and left leg. She filed worker compensation claims for those work-related incidents. Given these post-service incidents, the Veteran has not shown that she received treatment for a low back disorder that began in service to warrant service connection for the claimed disorder on the basis of continuity of symptomatology following service. The evidence shows further that the Veteran underwent a VA back conditions examination in December 2013. The examiner diagnosed chronic mild residual back sprain, herniated disc of the back, and degenerative joint disease of the lumbar spine. The examiner noted that the Veteran sustained injury to her back because of a motor vehicle accident. Her claims file and service separation examination show normal findings. The examiner noted that the Veteran’s medical history and present medical examination confirms the rationale. In a private Disability Benefits Questionnaire (DBQ) for the back dated in August 2016 and received at the RO in September 2016, the Veteran described having a motor vehicle accident-related injury to her low back. Following examination of the back, the examiner diagnosed mechanical back pain syndrome, lumbosacral sprain/strain, degenerative disc disease, foraminal/lateral recess/central stenosis, intervertebral disc syndrome, and radiculopathy. There was involvement of L4/L5/S1/S2/S3 nerve roots/sciatic nerve. Pursuant to the November 2018 Board remand, a supplemental opinion was requested to determine if there is a link between the claimed low back disorder and the Veteran’s active duty service. In an October 2019 VA-contract medical opinion the medical opinion provider opined that the Veteran’s low back disorder is less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. The rationale for the opinion is that during service there is no evidence of chronicity of care or a lumbar orthopedic diagnosis. Low back pain attributed to menstrual cramps in 1982 and the motor vehicle accident reported no low back issues. The Veteran’s separation examination is silent for a low back disorder. In 1999, the Veteran was in another motor vehicle accident, and x-rays after the motor vehicle accident showed herniated lumbar discs. Osteoarthritis of the lumbar spine was diagnosed in 2011, well after one year after active duty. A nexus to active duty has not been established. The Veteran’s current back condition is due to post active duty motor vehicle accident in 1999. In December 2020, the Veteran had a VA chiropractic examination. Her chief complaint was bilateral lower back pain, stiffness, and restricted range of motion. She reported she had radiating pain down the back of her right leg to her knee. The diagnoses were lumbar segmental dysfunction, sacroiliac instability, lumbar radiculopathy, and muscle spasm of the back. On review, the Board finds the record is consistent on the fact that the Veteran sustained injury to her back many years after service, and no link to service has been established. Earlier examination reports of record, namely, the December 2013 VA back conditions examination report and the August 2016 private DBQ for the back, are inadequate for deciding this matter because an adequate opinion and rationale were not provided in the reports; therefore, they are accorded little probative value. The competent medical evidence of record is not in favor of nor establishes a nexus between the Veteran’s low back disorder and her military service. Specifically the October 2019 VA-contract medical opinion provider opined that the Veteran’s low back disorder is less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The Board finds this opinion probative as the provider reviewed the Veteran’s record and provided a thorough rationale for the opinion. As to the Veteran’s assertions that she injured her back in service in a motor vehicle accident in 1982 and that her back injury was further aggravated by repeated stress of physical training, sports activities, and performing work-related duties during service, the Board finds the Veteran’s assertions not credible. Her assertions are not found credible based in part on affirmative evidence to the contrary. Her service treatment and medical records are devoid of any reference to a chronic low back disorder during service. The Veteran’s assertions are also not found credible because for many years after service there were no complaints, treatment or diagnosis of a low back disorder until she received treatment for her back in 2008 and 2011 due to on-the-job back injuries for which she filed workers compensation claims. Moreover, the Veteran’s lay assertions regarding the etiology of the claimed low back disorder are not competent. Although lay persons are competent to provide opinions on some medical issues, the specific issue in this case, the etiology of the Veteran's low back disorder, falls outside the realm of common knowledge of a lay person. Jandreau, 492 F.3d at 1377, 1377 n.4. Regarding sciatic nerve disorder, the Veteran does not claim that she has a sciatic nerve disorder related to service but claims entitlement to service connection for a sciatic nerve disorder on a secondary basis due to the claimed low back disorder. Thus, entitlement to service connection for sciatic nerve disorder based on a direct theory of entitlement is not warranted. Further, the Board acknowledges that the Veteran claims that she has a sciatic nerve disorder that is secondary to her claimed low back disorder. However, because the Board has denied service connection for a low back disorder, her claim based on secondary service connection for sciatic nerve disorder must also fail, as the Veteran is not service connected for the claimed primary disability. See 38 C.F.R. § 3.310. Accordingly, as the preponderance of the evidence is against the Veteran's claim, the "benefit of the doubt" rule does not apply. The claim is denied. 38 U.S.C. § 5107(b). A. C. MACKENZIE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Young, 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.