Citation Nr: 21025355 Decision Date: 04/27/21 Archive Date: 04/27/21 DOCKET NO. 17-31 095 DATE: April 27, 2021 ORDER Entitlement to service connection for a cervical spine disability is denied. Entitlement to service connection for a lumbar spine disability is denied. Entitlement to service connection for a right knee disability is denied. Entitlement to service connection for a left shoulder disability is denied. Entitlement to service connection for a right shoulder disability is denied. FINDINGS OF FACT 1. The Veteran’s cervical spine disability (degenerative disc disease and arthritis) was not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established and the disability is attributable to intercurrent causes; the disability is not otherwise etiologically related to an in-service injury or disease. 2. The Veteran’s lumbar spine disability (degenerative disc disease and arthritis) was not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established and the disability is attributable to intercurrent causes; the disability is not otherwise etiologically related to an in-service injury or disease. 3. The Veteran’s right knee disability was not shown as chronic in service and arthritis did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established and the disability is attributable to intercurrent causes; the disability is not otherwise etiologically related to an in-service injury or disease. 4. The Veteran’s right shoulder disability was not shown as chronic in service and arthritis did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established and the disability is attributable to intercurrent causes; the disability is not otherwise etiologically related to an in-service injury or disease. 5. The Veteran’s left shoulder disability was not shown as chronic in service and arthritis did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established and the disability is attributable to intercurrent causes; the disability is not otherwise etiologically related to an in-service injury or disease. CONCLUSIONS OF LAW 1. The criteria for service connection for a cervical spine disability are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 2. The criteria for service connection for a lumbar spine disability are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 3. The criteria for service connection for a right knee disability are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 4. The criteria for service connection for a right shoulder disability are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 5. The criteria for service connection for a left shoulder disability are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from December 1972 to December 1976. This case comes to the Board of Veterans’ Appeals (Board) on appeal from an Agency of Original Jurisdiction (AOJ) decision dated in August 2013. The Veteran testified before the undersigned Veterans Law Judge at an April 2019 hearing; a transcript of the hearing is of record. This case was previously remanded to the AOJ in August 2019, for additional development, and was subsequently returned to the Board. The Veteran perfected an appeal as to the issue of service connection for a cervical spine disability (residuals of a neck injury). 38 U.S.C. § 7105; 38 C.F.R. § 19.20. With regard to his claims of service connection for a lumbar spine disability, a right knee disability and right and left shoulder disabilities, the AOJ certified these issues to the Board, in addition to the cervical spine issue, and the Board took testimony on these five issues. In light of this procedural posture, the Board accepts jurisdiction of the appeal of the claims of service connection for a lumbar spine disability, a right knee disability and right and left shoulder disabilities. See Percy v. Shinseki, 23 Vet. App. 37 (2009) (a timely substantive appeal is not a jurisdictional requirement for the Board’s consideration of a Veteran’s claim). The Board notes that the Veteran is unrepresented in this appeal. The record reflects that in letters dated in December 2019, September 2020, and March 2021, VA notified the Veteran that his previous attempts to appoint a Veterans Service Organization (VSO) as his representative were invalid because the VA Form 21-22 was not signed by the selected VSO, and enclosed a blank VA Form 21-22. See 38 C.F.R. § 14.631(a). Since then, the Veteran has not completed and returned a VA Form 21-22 that is signed by a representative. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three elements required to establish service connection are: (1) 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 in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). Regulations also provide that service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303 (d). Certain chronic diseases, including arthritis, will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). 1. Service connection for a cervical spine disability 2. Service connection for a lumbar spine disability The Veteran contends that he has current disabilities of the cervical spine and lumbar spine due to injuries in service. He contends that he incurred neck and back disabilities when he was hit by a car while he was riding a bicycle at Keesler Air Force Base in August 1973. He testified that that during the bicycle accident, he fell on his head, “driving his neck up.” See his statements dated in February, March and April 2012, July 2014 notice of disagreement, May 2017 substantive appeal, and April 2019 Board hearing transcript. Alternatively, he contends that his low back disability is due to lifting and moving things in service. At the hearing, he reported two or three in-service back injuries: one while removing radios from fighter jets, and another while he was moving something. See hearing transcript, pages 14-16. He also noted that he was treated for lumbar spine problems in service after his separation examination. In April 2017, he asserted that during service, he was denied medical attention on several occasions which compounded his health problems, his separation examination did not record his problems accurately, and his neck injury deteriorated over the years. At the Board hearing, he stated that he had a stiff neck and neck pain ever since the bicycle accident, and his neck condition progressively worsened until he had surgery on his cervical spine in 2000. He said his current medical providers have told him that his current cervical spine problems could be related to the in-service injury, but they could not provide a medical opinion because of the length of time since the injury, and “because they just don’t have evidence to show it.” See hearing transcript, page 9. The Veteran has current diagnoses of arthritis of the cervical and lumbar spine. See August 2012 VA examination, November 2010 VA magnetic resonance imaging (MRI) scan, December 2010 private X-ray study and MRI scan, and December 2012 VA outpatient treatment record and X-ray study. Arthritis is an enumerated condition under 38 C.F.R. § 3.309 (a); Walker, 708 F.3d 1331. However, the disabilities were not shown as chronic in service, arthritis did not manifest to a compensable degree within the presumptive period, and arthritis was not noted in service with attributable continuity of symptomatology. VA and private treatment records show the Veteran was not diagnosed with arthritis of the cervical spine until January 1999, decades after his separation from service and decades outside of the applicable presumptive period, and was not diagnosed with arthritis of the lumbar spine until January 2004. Service treatment records reflect that in August 1973, the Veteran complained of posterior neck pain and left thumb pain, and reported that he was struck in the back by a car while he was riding a bike, and that his thumb hit the curb. On examination, there was full range of motion of the neck, and the thumb was okay. The diagnostic impression was contusion and strain. In June 1974, the Veteran reported that he pulled his back the previous night. The diagnostic impression was right lumbosacral strain, with no neurologic deficit. Ten days later, he was seen for a recurring back problem, the diagnostic impression was lumbosacral muscular sprain. A June 1974 physical therapy note reflects that the Veteran was referred for instruction in Williams flexion exercises, one week after a lifting injury (the Veteran reported that he lifted a washing machine). In February 1975, he complained of right-sided low back pain for four months after lifting a washing machine. The diagnostic assessment was back strain. In a report of medical history completed in late September 1976, the Veteran reported a history of swollen or painful joints, ear, nose and throat trouble, and recurrent back pain. He denied headaches and a head injury. On separation examination in late September 1976, there were no pertinent abnormalities, and the Veteran’s spine had full range of motion without deformity. The examiner noted that he had recurrent back pain following injury two years ago during exercise, but no treatment was required, and it was non-disqualifying. In early October 1976, he complained of low back pain, increased with physical labor. On examination, there was full range of motion, no paravertebral muscle spasm, and negative straight leg raising tests. The diagnostic impression was no apparent problem. An October 1976 X-ray study of the lumbosacral spine was performed for the Veteran’s complaints of right-sided low back pain for one and one-half years, and showed no significant abnormalities. He was referred for physical therapy, and the provisional diagnosis was low back pain. A physical therapy note reflects that he was given instruction in William’s flexion exercises. Post-service private medical records show that the Veteran has reported and been treated for job-related injuries to his right shoulder, neck, and low back while working in construction. In a Workmen’s Compensation Questionnaire, the Veteran reported that in September 1983, a scaffold fell while he was standing on it, and he hit the corner of a step with his right shoulder. He also reported that a tree fell on his low back in 1979. In November 1986, a private chiropractor, M.E., D.C., diagnosed an acute right cervical sprain, and reported treating the Veteran since October 1986. In a January 1987 neurological examination report, the Veteran reported that his insurance was verified by Worker’s Compensation, and said he had two prior operations on his right shoulder. He also reported that he had a prior accident in 1979 in which a tree fell across his lower back. He denied current low back problems currently, and said his low back was doing well. In February 1987, a private chiropractor, G.L., D.C. stated that he treated the Veteran for a neck and shoulder problem since January 1987. Attempts to obtain the Veteran’s workers’ compensation records have been unsuccessful, and he has not responded to the AOJ’s February 2020 request for such records. Private medical records from a private chiropractor, D.B., D.C. dated from 1994 to 2001 reflect treatment for complaints of neck, back and right shoulder pain. In a January 1994 application for treatment, the Veteran reported that his low back was injured in 1979 when a tree fell on it. He complained of constant pain in his upper back and neck, and said this problem started in 1983 when he broke his right humerus after falling two stories onto a set of steps and also dislocated his vertebrae. He said he had this pain off and on since his shoulder was broken in 1983. He reported prior surgery for a fracture of the right humerus. When asked if he had any accidents or falls, etc. that might have caused his problem, he only reported the 1983 incident. He reported prior treatment for this condition from1984 to 1985 by another chiropractor, Dr. L. In a January 1994 case history, D.B., D.C. indicated that the Veteran complained of constant neck and mid-thoracic spine pain, and headaches. The only accident or injury listed was the Veteran's 1983 fall from the second floor and landing on his right side, fracturing his right humerus and injuring his neck. The Veteran also complained of right shoulder pain. He was diagnosed with lumbalgia and cervicalgia in December 1997. In August 1998, he reported that he fell and landed on his right shoulder, and had an increase in neck pain. A January 1999 private medical record from Southern Bone & Joint Specialists reflects that the Veteran complained of left neck pain with left shoulder blade pain; he said it intermittently bothered him for several years. He reported that in 1983, he fell about two stories onto his right shoulder and had a right shoulder fracture, and since then had pain in his left neck and shoulder blade area. The physician diagnosed severe cervical strain with probable cervical spondylosis. An April 1999 MRI scan of the cervical spine shows that the Veteran complained of neck pain radiating to both shoulders; the impression was multi-level cervical spondylosis with resulting canal stenosis and possible disc herniation. A January 2001 MRI scan of the cervical spine showed spondylitic changes at multiple levels and moderate central canal stenosis. The Veteran underwent cervical spine surgery in late January 2001 for cervical spondylosis and disc protrusion, specifically an anterior cervical discectomy and fusion at C5-6 and C6-7, a bone graft, and anterior cervical plating at C5-6 and C6-7. By a letter to the Veteran dated in April 2001, an insurance company noted that private medical records from Southeast Alabama Medical Center dated in January 1999 showed that at that time, he reported a history of left neck pain which had been occurring off and on for 15 years (i.e., since 1984). In June 2001, D.B., D.C. stated that he had treated the Veteran since 1994, his condition had deteriorated over the past year, and he had spinal disc surgery with fusion. By a letter dated in January 2004, D.B., D.C. noted that the Veteran had a work-related low back injury in January 2004. He noted that an X-ray study showed moderate degeneration of lumbar intervertebral discs, osteophytes, and normal lumbar lordosis. The diagnostic assessment was lumbar sprain producing low back pain. A February 2004 Worker’s Compensation Questionnaire reflects that the Veteran reported that he injured his low back at work in January 2004. While the Veteran is competent to report experiencing symptoms of neck and back pain since service and consistently since service, the Board finds the reports of continuity of symptomatology are not credible. The Veteran’s reports are internally inconsistent with his reports in contemporaneous treatment records, which show that he did not report neck or cervical spine pain at separation in 1976, and initially reported the onset of neck pain as 1983, outside of the presumptive period. Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006). With regard to the low back, although the Veteran was treated for complaints of low back pain in service, an October 1976 X-ray study of the lumbar spine was negative, he consistently reported a post-service low back injury in 1979, denied low back pain during post-service treatment for neck pain in 1987 and 1994, and subsequently related his low back pain to a work-related back injury in January 2004. At that time, his treatment provider, D.B., D.C. indicated that he had treated the Veteran since 1994, and throughout the course of his treatment, his chief complaint had consistently been neck pain and headaches, and low back pain had never been a major issue until his recent low back injury in January 2004. In determining whether statements made by a Veteran are credible, the Board may consider internal consistency, facial plausibility, consistency with other evidence, and statements made during treatment. See Macarubbo v. Gober, 10 Vet. App. 388 (1997). The Veteran did not claim that he had neck pain that is related to service until a July 2010 informal VA disability compensation claim, and did not claim that he had low back pain that is related to service until March 2012, and the Board finds the current statements of lesser probative value when contrasted with the histories he previously provided. See Pond v. West, 12 Vet. App. 341 (1999). The Board notes that the Veteran has made conflicting statements regarding his in-service neck and back injuries, and regarding the date of onset of his symptoms, which reduces the credibility of his current assertions. An August 2010 VA outpatient treatment record reflects that he reported that during the in-service bicycle accident, he went over the bicycle handles, landed on his head, and was knocked unconscious, and when he regained consciousness he walked three miles back to the base. However, service treatment records are negative for a head injury, and in the August 1973 treatment note, he only reported neck and thumb pain. He did not report any head injury during treatment at the time of the accident, and a head injury was not diagnosed. At an August 2012 VA examination, the Veteran reported that he fell from a bicycle in service and was told he had impacted some discs in the neck. He stated that he had neck pain since then, cervical spine surgery in 1998, and pain and headaches since 2009. At the August 2012 VA examination, the Veteran reported that he hurt his back pulling a radio from an aircraft. He did not mention any low back injury during the 1973 bicycle accident. An April 2013 VA outpatient treatment record reflects that the Veteran reported that he had neck and back disease related to an injury in service 40 years ago. He also stated that his lumbar spine was “degenerated” due to a tree falling on him in 1979. In his July 2014 notice of disagreement, the Veteran asserted that after his bicycle accident, he was taken to the hospital on base and was told that the disks in his neck were compacted, and wore a neck brace for a couple of weeks. In contrast, at the Board hearing, he testified that after the accident, he walked three miles back to base, and was treated in the emergency room, where they diagnosed a sprained neck and gave him a neck collar, but an X-ray study was not done. The Board gives more probative weight to competent medical evidence, which establishes that these symptoms are instead attributable to post-service injuries, including a serious fall in 1983 and a work-related low back injury in 2004. See August 2012 VA examination and private medical records from D.B., D.C. and Southern Bone & Joint Specialists. Service connection for disabilities of the cervical spine and lumbar spine may still be granted on a direct basis; however, the preponderance of the evidence is against finding that a medical nexus exists between the Veteran’s disabilities of the cervical spine and lumbar spine and an in-service injury, event or disease. 38 U.S.C. §§ 1110, 1131; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303. The record contains conflicting medical opinions regarding whether the Veteran’s neck and back disabilities are at least as likely as not related to an in-service injury, event, or disease. Private practitioner M.A., M.D., opined that they are. In May 2019, he stated that he had reviewed the Veteran’s service treatment records and opined that his neck and back disabilities were caused by or the result of working on jets and as a radio repairman. The entire rationale was “permanent damage.” The Board finds that this opinion is less probative than the VA examiners’ opinions, as it is conclusory in nature and did not address an in-service X-ray study of the lumbar spine showing no abnormalities, or the post-service injuries to the lumbar spine and cervical spine in 1979, 1983, and 2004. Accordingly, as this opinion did not provide an adequate rationale, it is afforded less probative weight. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). The August 2012 and March 2020 VA examiners opined that the current disabilities of the cervical and lumbar spine are not related to service. The August 2012 VA examiner diagnosed cervical spine degenerative disc disease, and in a September 2012 addendum medical opinion, opined that the Veteran’s current cervical spine condition was not caused by the complaint of cervical spine pain in October 1974. The rationale was that there was no objective evidence of onset of a chronic neck problem in service, or evidence of any cervical disc injury during service. The examiner stated that the in-service diagnosis was neck strain, which is generally a self-limited condition that resolves without long term sequelae, and there was no objective evidence to indicate otherwise. The examiner stated that the separation examination and report of medical history were completely silent regarding any chronic neck condition. The examiner also noted the length of time between complaints in service and onset of neck problems as documented in the medical record, and the examiner opined that the neck symptoms complained of several years later could not reasonably be connected to service when there were multiple other aging, occupational, and daily activity factors in the intervening years. In August 2012, the examiner opined that the Veteran's current low back disability is less likely as not incurred in or caused by low back condition that occurred throughout service. The rationale was the length of time between the complaints in service and onset of low back problems as documented in the medical record, and the lack of evidence of low back injury or trauma in service severe enough to cause the current back condition. His in-service diagnosis was muscular back strain, which was generally a self-limited condition that resolved without long term sequelae, and there was no objective evidence to indicate otherwise. The examiner stated that it was unknown whether there was intercurrent injury. The March 2020 VA examiner opined that upon review of records, the Veteran’s claimed disabilities of the cervical and lumbar spine are less likely than not related to an in-service bicycle injury. The rationale was that the records available for review do not show chronicity of care for his neck and back condition since his 1976 discharge from service to establish and substantiate that his current condition was incurred or caused by an event or injury in service. The VA examiners’ opinions are collectively probative, because they are based on an accurate medical history and provide explanations that contain clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). While the Veteran believes his cervical spine and lumbar spine disabilities are related to an in-service injury, event, or disease, including a bicycle accident and lifting injuries, he is not competent to provide a nexus opinion in this case. This issue is also medically complex, as it requires specialized medical education and the ability to interpret complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence. For the foregoing reasons, the preponderance of the evidence is against the claims for service connection for disabilities of the cervical and lumbar spine and the claims must be denied. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. 3. Service connection for a right knee disability The Veteran contends that he has a current right knee disability due to injuries in service. See his statement dated in March 2012, August 2012 VA examination, and April 2019 Board hearing transcript. At the August 2012 VA examination, the Veteran reported that he damaged some cartilage in the right knee while taking the radio out of an aircraft. At the Board hearing, he testified that during service he slipped on a wet ladder, missed two or three rungs, went down on his right knee, and hyperextended it. See hearing transcript, page 16. He stated that he hurt his right knee in service two or three times, including by stepping in a hole, and also injured his knee after service, and underwent right knee surgery in 2008. At that time his surgeon reportedly told him he had old scar damage in the knee as well as torn cartilage. The Veteran has a current diagnosis of bilateral osteoarthritis of the knees as evidenced by a March 2020 private medical record. Arthritis is an enumerated condition under 38 C.F.R. § 3.309(a); Walker, 708 F.3d 1331. However, arthritis of the right knee was not shown as chronic in service, did not manifest to a compensable degree within a presumptive period, and was not noted in service with attributable continuity of symptomatology. VA and private treatment records are negative for complaints of right knee pain until 2007, was not diagnosed with a tear of medial meniscus of the right knee until May 2008, decades after his separation from service, and was not diagnosed with arthritis of the right knee until October 2019, decades outside of the applicable presumptive period. See private medical records from S.T.M., APRN. An October 1973 service treatment record reflects that the Veteran reported that he injured his right knee; the diagnostic impression was mild sprain of the right knee. In a report of medical history completed in late September 1976, the Veteran reported a history of swollen or painful joints, and leg cramps. He denied a trick or locked knee. On separation examination in late September 1976, there were no pertinent abnormalities. The examiner noted that the Veteran reported that his knees were painful occasionally, which the examiner stated was not disqualifying. Service treatment records are negative for a diagnosis of a right knee disability. While the Veteran is competent to report experiencing symptoms of right knee pain since service, the Board finds the reports of continuity of symptomatology are not credible. The Veteran’s reports are internally inconsistent with his reports in contemporaneous treatment records. Private medical records from multiple providers dated from 1986 to 2006 are negative for treatment or complaints of a right knee disability, despite treatment for other orthopedic conditions. Private medical records dated from 2003 to 2010 from M.A., M.D., are negative for complaints or treatment of a right knee condition until April 2007. In May 2007, the Veteran reported that his right heel was not improving and now his knee was starting to hurt. An August 2007 private medical record from D.B., D.C. reflects that the Veteran reported that he had right knee pain since June 2007, and had the same symptoms several years ago. D.B. indicated that the etiology was favoring due to heel spur, and diagnosed myofascial pain of the right foot. The Board gives more probative weight to competent medical evidence, which establishes that these symptoms are instead attributable to an intercurrent right knee injury in May 2008. A November 2008 accidental injury claim form from a private physician, Dr. M., reflects that the Veteran injured his right knee on May 27, 2008 stepping in a hole at home. Dr. M. indicated that the Veteran complained of right knee pain, and indicated that the symptoms first appeared on May 27, 2008. He stated that the disability was due to accident or injury, and diagnosed a tear of the medial meniscus. The Veteran underwent arthroscopy of the medial meniscus of the right knee in October 2008. In June 2010, Dr. A. stated that he had not seen the Veteran for three years, and he had since had arthroscopic right knee surgery. A July 2010 VA physician history and physical note reflects that the Veteran presented to establish VA primary care and reported a history of right knee arthroscopy in 2008 due to a torn cartilage. The physician diagnosed degenerative joint disease, diffusely. His active problems subsequently included degenerative joint disease of multiple sites. Service connection for a right knee disability may still be granted on a direct basis; however, the preponderance of the evidence is against finding that a medical nexus exists between the Veteran’s right knee disability and an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303. The Board concludes that, while the Veteran has a current diagnosis of a right knee disability (medial meniscus tear status post-surgical repair, and arthritis), and evidence shows that he was treated for right knee strain on one occasion in service, the preponderance of the evidence weighs against finding that the Veteran’s right knee disability began during service or is otherwise related to an in-service injury, event, or disease. Taken together, the August 2012 and March 2020 VA medical opinions of record establish that the Veteran’s right knee disability is not at least as likely as not related to an in-service injury, event, or disease, including the right knee strain in service. The August 2012 VA examiner opined that the Veteran’s current right knee disability was not at least as likely as not related to his complaint of right knee pain with no objective evidence of injury. The rationale was that there was no objective evidence of onset of a chronic right knee condition in the service, there was no objective evidence of any right knee condition in service or in close proximity to service and no objective evidence of right knee injury or trauma in service. The examiner noted that during the separation examination, the examiner noted “knee pain on occasion” without mention of any right knee chronic condition or findings, trauma, or injury, and an examination of the lower extremities was normal. The examiner stated that intercurrent injury was unknown. The examiner also noted the length of time between complaints in service and onset of right knee problems as documented in the medical record. The March 2020 VA examiner opined that it is less likely than not that the Veteran’s current right knee condition is related to an October 1973 right knee condition with sprain. The rationale was that upon review of records, the Veteran was treated in service for right knee strain, but there were no findings or records indicating a permanent residual or chronic condition. The records available for review did not show chronicity of care for any right knee condition since being discharged from service in 1976 up until his right knee injury for which he underwent surgery in 2008, to establish and substantiate that the right knee condition was incurred or caused from or by an event or injury in service. The VA examiners’ opinions are collectively probative, because they are based on an accurate medical history and provide explanations that contain clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). While the Veteran believes his right knee disability is related to an in-service injury, event, or disease, including a right knee strain, he is not competent to provide a nexus opinion in this case. This issue is also medically complex, as it requires specialized medical education and the ability to interpret complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence. For the foregoing reasons, the preponderance of the evidence is against the claim for service connection for a right knee disability and the claim must be denied. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. 4. Service connection for a left shoulder disability 5. Service connection for a right shoulder disability The Veteran contends that he has current right and left shoulder disabilities, including arthritis, due to injuries in service. At the April 2019 Board hearing, he testified that he injured his shoulders in service while carrying a 40-pound radio down a ladder when it was windy, which “really ripped my shoulders up.” See April 2019 Board hearing transcript, page 16. The Veteran has a current diagnosis of degenerative joint disease, diffusely, as evidenced by a July 2010 VA outpatient treatment record. Arthritis is an enumerated condition under 38 C.F.R. § 3.309(a); Walker, 708 F.3d 1331. However, arthritis of the shoulders was not shown as chronic in service, did not manifest to a compensable degree within a presumptive period, and was not noted in service with attributable continuity of symptomatology. VA and private treatment records show the Veteran was not diagnosed with a right shoulder disability until he was injured in a fall in 1983, years after his separation from service and years outside of the applicable presumptive period, and arthritis of the shoulders was not diagnosed until years later. While the Veteran is competent to report having experienced symptoms of bilateral shoulder pain since service, the Board finds the reports of continuity of symptomatology are not credible. The Veteran’s reports are internally inconsistent with his reports in contemporaneous treatment records. Service treatment records are entirely negative for complaints, treatment or diagnosis of a shoulder injury or disability. In a report of medical history completed in late September 1976, the Veteran reported a history of swollen or painful joints, but denied a history of painful or trick shoulder. On separation examination in late September 1976, there were no pertinent abnormalities. Post-service private medical records reflect that in a Workmen’s Compensation Questionnaire, the Veteran reported that in September 1983, a scaffold fell while he was standing on it, and he hit the corner of a step with his right shoulder. In January 1987, the Veteran complained of right shoulder pain since a fracture in 1983. He said he first noticed a right shoulder and arm problem in 1983, and complained of right shoulder joint pain since a fracture in 1983. He complained of pain in the right neck and right trapezius area. In a January 1987 neurological examination report, the Veteran reported two prior operations on his right shoulder. A private chiropractor, G.L., D.C. stated that he treated the Veteran for a neck and shoulder problem since January 1987. Private medical records from a private chiropractor, D.B., D.C. dated from 1994 to 2001 reflect treatment for complaints of neck and back pain. In a January 1994 application for treatment, the Veteran complained of constant pain in his upper back and neck, and said this problem started in 1983 when he broke his right humerus after falling two stories onto a set of steps and also dislocated his vertebrae. He said he had this pain off and on since his shoulder was broken in 1983. He reported prior surgery for a fracture of the right humerus. When asked if he had any accidents or falls, etc. that might have caused his problem, he only reported the 1983 incident. He reported prior treatment for this condition in 1984-1985 by another chiropractor, Dr. L. In August 1998, he reported that he fell and landed on his right shoulder, and had an increase in neck pain. He also complained of bilateral shoulder pain, including the left rotator cuff. A January 1999 private medical record from Southern Bone & Joint Specialists reflects that the Veteran complained of left neck pain with left shoulder blade pain; he said it intermittently bothered him for several years. He reported that in 1983, he fell about two stories onto his right shoulder and had a right shoulder fracture, and since then had pain in his left neck and shoulder blade area. The physician diagnosed severe cervical strain with probable cervical spondylosis. An April 1999 MRI scan of the cervical spine shows that the Veteran complained of neck pain radiating to both shoulders; the impression was multi-level cervical spondylosis with resulting canal stenosis and possible disc herniation. A January 2001 MRI scan of the cervical spine showed spondylitic changes at multiple levels and moderate central canal stenosis. Private medical records from Tallahassee Orthopedic Clinic dated from June to December 2010 reflect treatment for neck and shoulder pain, which he had for decades. The Veteran reported a history of right shoulder fracture involving the humerus, for which he had surgery. In December 2010, the Veteran reported that a fall caused a right shoulder fracture in 1983. On examination, there was bilateral shoulder pain. The diagnostic impression was cervical degenerative disc disease. VA outpatient treatment records dated since 2010 reflect treatment for complaints of shoulder pain since he fell two stories and broke his right shoulder and shattered his right humerus, which was repaired with a metal plate. A July 2010 VA outpatient treatment record reflects that he underwent open reduction and internal fixation of the right shoulder in 1983. The March 2020 VA examiner opined that the Veteran’s bilateral shoulder condition is not at least as likely as not related to an in-service injury, event, or disease, including the in-service bicycle accident. The rationale was that the service treatment records are silent for Veteran being seen for any shoulder condition while in service, and the records available for review do not show chronicity of care for any left shoulder condition since being discharged from service in 1976 to establish and substantiate that the left shoulder condition was incurred or caused from or by an event or injury in service. With regard to the right shoulder, the examiner noted that the Veteran had a history of a fall which caused a right shoulder fracture in 1983 and subsequent surgery which is the more likely cause for his current right shoulder condition. The examiner’s opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). While the Veteran believes his right and left shoulder disabilities are related to an in-service injury, event, or disease, including a bicycle accident and an injury while carrying a radio, he is not competent to provide a nexus opinion in this case. This issue is also medically complex, as it requires specialized medical education and the ability to interpret complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence. For the foregoing reasons, the preponderance of the evidence is against the claims for service connection for disabilities of the right and left shoulders and the claims must be denied. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. S. L. Kennedy Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. L. Wasser, 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.