Citation Nr: 21027110 Decision Date: 05/04/21 Archive Date: 05/04/21 DOCKET NO. 14-35 371A DATE: May 4, 2021 ORDER Entitlement to service connection for a low back disability is denied. FINDING OF FACT The weight of the competent and credible evidence is against finding that the Veteran's degenerative disc disease of the lumbar spine manifested in service or within one year of separation, continuity of symptomology is not established; and his low back disability is not attributable to service. CONCLUSION OF LAW The criteria for service connection for a low back disability have not been met. 38 U.S.C. §§ 1110, 1111, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303(a), 3.309 (2020). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active in the U.S. Navy from November 1976 to December 1979. This matter comes before the Board of Veterans' Appeals (Board) from a December 2011 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a Board video conference hearing before the undersigned Veterans' Law Judge in September 2017. A transcript of the hearing has been associated with the claims file. In November 2019, the Board denied service connection for a low back disability. An August 2020 order of the United States Court of Appeals for Veterans Claims (court) implemented an August 2020 Joint Motion for Remand (JMR), vacating and remanding the November 2019 Board decision that denied entitlement to service connection for a low back disability. As such the issue of entitlement to service connection for a low back disability is again before the Board. Most recently the claim was before the Board in January 2021 and was remanded for additional development and a supplemental VA examination. As the directives in the January 2021 remand having been substantially compiled with, the matter is again before the Board. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Service Connection A veteran is entitled to VA disability compensation if there is a disability resulting from personal injury suffered or disease contracted in line of duty in active service, or for aggravation of a preexisting injury suffered or disease contracted in line of duty in active service. 38 U.S.C. §§ 1110, 1131. To establish a right to compensation for a present disability, a Veteran must show: "(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service" - the so-called "nexus" requirement. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). For the showing of chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word "Chronic." When the disease identity is established (leprosy, tuberculosis, multiple sclerosis, etc.), there is no requirement of evidentiary showing of continuity. Continuity of symptomatology is required only where the condition noted during service (or in the presumptive period) is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. 38 C.F.R. § 3.303(b). Service connection for a recognized chronic disease can also be established through continuity of symptomatology. Walker v. Shinseki, 708 F.3d 1331 (2013); 38 C.F.R. §§ 3.303 (b), 3.309. Entitlement to service connection for a low back disability The Veteran contends that service connection is warranted for his current low back disability. The Veteran contends that his current low back disability began during service and is related to service. In September 2017 the Veteran testified to tripping and falling in bootcamp during a timed run and having ongoing pain in his low back. In addition, the Veteran reports his ongoing low back pain and symptomology that began in-service has continued since. The Veteran reports that his low back symptoms began in-service and persisted since, worsening over time. The Veteran is competent to describe his ongoing symptoms, in-service duties and his statements are credible. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The question for the Board is whether the Veteran has a current low back disability that began during service or is at least as likely as not caused by an in-service injury or disease. The Veteran has a diagnosis of degenerative disc disease of the lumbar spine. The Veteran's service treatment records (STRs) have been associated with the claims file. In March 1977, the Veteran was seen for low back pain, after he reported hearing something pop in his back while eating, and he was unable to move from side to side. Examination noted range of motion was decreased 5 to 10 degrees, and more pronounced on the left side. Examination noted no paresthesias, positive straight leg testing, severely limited range of motion and severe paraspinal spasms on L-5 muscles. It was noted the back had an appearance of scoliosis to the to the left. A diagnosis of a back sprain was noted. The Veteran was prescribed bed rest, valium and to follow-up as needed. A follow up examination several days later noted the Veteran still reported continued mid and low back pain and he had increased pain when sitting. Physical examination noted scoliosis to the left. Muscle spasms were noted and a muscle sprain was noted. The Veteran was recommended to continue treatment and return as needed. At separation on the report of medical examination in December 1979 clinical evaluation of the spine and musculoskeletal system was normal. A private opinion from August 2011 has been associated with the claims file. The Veteran's treating neurologist noted that the Veteran has been suffering from moderate to severe low back pain and based on a review of his records from March 1977 in-service it would appear that his lumbar spine problems began in-service. The Board finds that this private opinion is entitled to less probative weight as the Veteran's private treatment provider has failed to apply the appropriate VA standard warranted for service connection, and the opinion has failed to apply, a valid, reliable, medically supported rationale. In addition, a private opinion from September 2011 has been associated with the claims file. The Veteran's treating physician noted that he has had back problems as long as the Dr. has been treating him and based on a review of his records appear to date back to service in March 1977. The private physician noted that the Veteran has a history of findings in-service that were very typical for disc disease and an MRI now confirms herniated discs at T8-9 and T 10-11. The private physician also noted that the Veteran's in-service physical at entrance in September 1976 did not disclose any back issues. The Board finds that this private opinion is entitled to less probative weight as the Veteran's private treatment provider has failed to apply the appropriate VA standard warranted for service connection, and the opinion has failed to apply, a valid, reliable, medically supported rationale. The Veteran was afforded a VA examination in October 2011. The examiner noted a current diagnosis of arthritis, and a prior diagnosis of scoliosis. The Veteran reported in-service in 1977 he experienced low back pain and was seen and treated and that his pain has continued and gotten worsened since service. Range of motion testing was normal, and the Veteran was able to perform repetitive use testing and had no functional loss. Muscle strength testing was normal. No muscle atrophy was noted. A reflex and sensory exam was normal. There were mild symptoms of radiculopathy bilaterality with constant pain and involvement of the sciatic nerve. No intervertebral disc syndrome was noted. Imaging noted arthritis. The examiner noted that the Veteran's low back disability does not impact his ability to work. The examiner found that the Veteran's current low back disability was less likely than not incurred in or caused by the claimed in-service, injury, event or illness. The examiner noted the Veteran reported an incident of traumatic back pain in-service that was diagnosed as a sprain and treated with simple modalities which subsequently resolved as expected. STRs noted no documentation of chronicity and at exit there was no indication of a back problem. The examiner noted that post-service there is no documentation of a back problem until after 2000, which is more than 20 years after the Veteran's initial complaint. As to the in-service diagnosis of scoliosis, the examiner noted that this was diagnosed on a physical examination which is not an acceptable diagnostic modality and unreliable even in the most skilled of observers. The examiner noted that a review of the Veteran's current MRI findings did not support his claim for the reasons discussed above as well as because bulging thoracic discs are just as likely, if not more so completely incidental and not related to his previous complaint or present symptoms. Then, the Veteran was afforded a VA examination in July 2019. The examiner noted degenerative disc disease of the lumbar spine and right sciatic radiculopathy. The Veteran reported flare-ups of the low back and functional loss which limits walking, standing, lifting and bending. Range of motion testing noted forward flexion to 80 degrees, extension to 20 degrees, right and left lateral flexion to 20 degrees and right and left lateral rotation to 20 degrees. The Veteran reported pain on motion and pain with and without weight bearing and pain with active and passive motion. Localized tenderness and pain on palpation was noted. Muscle strength testing was normal and no muscle atrophy was noted. A reflex exam was normal. A sensory exam noted decreased right toe and foot sensation to light touch. Mild right lower extremity radiculopathy was noted. No ankylosis was noted. The Veteran did not have IVDS. Imaging noted arthritis and an April 2019 MRI noted DDD of the lumbar spine and no scoliosis. The examiner noted that the Veteran's low back disability impacts his ability to work in that he is limited in standing, walking, lifting and bending. The examiner noted that the Veteran's current low back disability was less likely than not incurred in or caused by the claimed in-service, injury, event or illness. The examiner noted review of the entirety of the record including the private opinions of record. The VA examiner noted that the Veteran's STRs are silent for chronic or recurrent back problems. The examiner noted while the Veteran reported low back problems in 1980, there was no further medical documentation of any back problems until 2005. Examination and imaging noted no current evidence of current scoliosis. The examiner noted that in-service the Veteran experienced an incident of atraumatic back pain which was diagnosed as a sprain and treated with simple modalities and resolved as would be expected. There was no documentation of chronicity in his STRs and at separation from service there was no mention of a back problem. Then post-service there is no documentation of a back problem until after 2000, which is more than 20 years after the Veteran's initial complaint. The examiner noted that while in service there was documentation of scoliosis this was not an acceptable diagnostic modality and unreliable even in the most skilled of observers. Current MRI findings from April 2019, do not support the Veteran's claim for the reasons noted above but also because bulging thoracic discs are just as likely, if not more completely incidental and not related to his previous complaint or his present low back complaints. As such the examiner found that it was less likely than not that the Veteran's current low back disability was incurred in or caused by the claimed in-service injury. In addition, the Veteran was afforded a VA opinion in January 2021. The examiner noted an extensive review of the Veteran's claims file, lay statements and VA and private opinions. The VA opinion found that it is less likely than not that the Veteran's current low back disability was incurred in or caused by the claimed in-service, injury, event or illness. The examiner noted that a review of the Veteran's STRs noted reported low back pain in March 1977 and he was diagnosed with a back sprain. The Veteran reported no cause of injury and reported that he heard something pop in his back which was followed by an inability to move from side to side or bend forward without pain. The Veteran again sought treatment 2 days later as the low back pain had persisted and was advised bed rest and prescribed Valium for the pain. Then at separation in 1978 the examination did not mention any low back pain or a diagnosis of a low back condition. There was no further medical documentation for any back problems until 2004, when the Veteran had an X-ray taken which revealed degenerative arthritis of the lower spine and mild degenerative changes. An MRI of the thoracic spine in November 2010 noted disc herniation. A recent MRI of the thoracolumbar spine in April 2019 noted degenerative disc disease but no scoliosis. The VA examination in 2019 also revealed the same findings which are degenerative arthritis of the spine. The VA examiner noted that a lumbar strain or sprain is an injury to the low back. This results in damaged tendons and muscles that can spasm and feel sore. Back muscle strains typically heal with time, many within a few days and most within 3 to 4 weeks. Most claimants with a mild or moderate lumbar strain make a full recovery and are free of symptoms within days, weeks or possibly months., In this case the Veteran complained of low back pain and sought treatment in 1977. While he was treated for a back condition, on active duty, his service treatment records do not show continuity and chronicity. At separation in December 1979 clinical examination was silent for any back condition. As such the examiner found that the Veteran's claimed low back condition with degenerative disc disease was less likely than not incurred in or caused by an in-service, illness, event or injury. As to presumptive service connection the examiner found that the Veteran's degenerative disc disease of the lumbar spine less likely than not began during active service, manifested within the applicable presumptive period after discharge from service, or was noted during service with continuity of the same symptomology since service. The examiner noted that the Veteran was diagnosed with a back sprain in 1977 while on active duty. He was treated with a pain relievers and advised bed rest. STRs are silent for further complaints or treatment for a low back and continuity and chronicity is not established. The examiner noted as to the Veteran's reports of ongoing symptoms that began during service and have persisted since the examiner found that the Veteran was treated in-service in 1977 for back pain and was treated with pain relivers and bed rest. He was not treated for a back condition again until 2005, a year after an X-ray taken revealed degenerative arthritis of the lower lumbar spine and mild degenerative changes. Degenerative arthritis symptomology includes a low grade continuous pain around the degenerating disc that occasionally flares up into more severe potentially disabling pain. Although a lumbar sprain and degenerative disc disease may have different etiologies, both have similar presenting symptoms pain in the back. The Veteran may seem to have had symptoms that are persistent, but the back pain in-service was acute in nature. The silence of his STRs as to continuing treatment during active service attests to the acuteness of the condition. Degenerative arthritis pain is persistent, maybe relieved but ultimately does not resolve hence the back pain comes and goes. Although, the Veteran had been experiencing a similarity in the symptoms, these conditions are not one and the same and do not have a direct causal link between them. The VA examiner noted consideration and review of the August 2011 and September 2011 private opinions of record. The examiner noted that the August 2011 opinion indicated that the Veteran had been having back pain since March 1977. While the possibility of a herniated disc was suggested there was no objective evidence or studies done to confirm this possibility. The September 2011 private opinion noted the same possibility, that of a disc disease as the symptoms were opined as typical. However, the diagnosis rendered in-service in March 1977 was a lumbar sprain. After conservative treatment of pain relivers and bed rest, the Veteran's STRs were silent for further complaints. Further, at separation his examination had no declaration of significant findings. The examiner noted that the evidence of record attests to the acute and transitory nature of the Veteran's in-service lumbar strain. Such is not the case for disc diseases which are chronic and do not readily resolved. VA and private treatment records have been associated with the claims file. VA and private treatment records note ongoing complaints of low back pain. A private MRI from November 2010 noted a small central disc herniation at T8-9 with mild ventral effacement of the thecal sac, and moderate sized central disc herniation at T10-11 with moderate ventral effacement of the thecal sac. The Board has considered the Veteran's representative's contentions. In June 2017 correspondence the Veteran's representative contended that service connection is warranted based on the private opinions of record and the Veteran's statements. Further, the Veteran's representative contends that the August 2011 and September 2011 private opinions satisfy the VA standard for service connection. The Board has considered the representative's general contentions. However, the Board finds these contentions are not supported by the probative evidence of record. The representative did not cite any records, communications from the Veteran, or other factors to support that a grant of service connection is warranted based on the private opinions of record. Further, VA benefits may not be granted based on speculative opinions. Lastly, the benefit of the doubt rule is for application when the evidence is in equipoise, which occurs only when there is an approximate balance between the positive and negative evidence. 38 C.F.R. § 3.102 (2019). That evidence must be both competent and credible. Here, there is no such balance of evidence. In addition, the Veteran's representative in July 2019 correspondence requested information regarding the Veteran's July 2019 VA examination and qualifications of the examiner citing Francway v. Wilkie, 940 F.3d 1304 (Fed. Cir. 2019). As to the contention that such is a request for information as to the competency of the examiner, as noted in the January 2021 Board remand neither the Veteran nor his representative has raised a specific challenge to the professional medical competency or qualifications of the VA examiner who provided the medical evidence obtained by the agency of original jurisdiction (AOJ) during the pendency of the appeal. As a result of the January 2021 Board remand the Veteran and his representative were provided written correspondence in February 2021 and given an opportunity to provide rationale for challenging the competency of any prior VA examinations. Neither the Veteran nor his representative has provided adequate rationale challenging the competency of a prior VA examination. The United States Court of Appeals for the Federal Circuit (Federal Circuit) has held that a Veteran is required to raise a specific challenge to the competency of a VA examiner before VA is required to respond with information about the qualifications of the examiner. See Sickels v. Shinseki, 643 F.3d 1362 (Fed. Cir. 2011), and Francway v. Wilkie, 940 F.3d 1304 (Fed. Cir. 2019) (finding that a Veteran is required to challenge a VA examiner's competence in the first instance). Neither the Veteran nor his representative has raised a specific challenge to the professional medical competence or qualifications of the most recent VA examiner, or any VA examiner of record. In other words, the Veteran has not satisfied the requirement of raising a specific challenge to a VA examiner's competence in the first instance. As a result, VA is not required to support its decision in this appeal by presenting information about the examiner's qualifications. Id. It is presumed that VA follows a regular process that ordinarily results in the selection of a competent medical professional. Parks v. Shinseki, 716 F.3d 581, 585 (Fed. Cir. 2013) (citing Sickels v. Shinseki, 643 F.3d 1362, 1366 (Fed. Cir. 2011)). Accordingly, and as the Federal Circuit explained in Francway, if the Veteran does not meet the requirement to challenge a VA examiner's competence in the first instance, then VA is not required to prove any examiner's competence before relying on medical evidence obtained from the examiner in adjudicating this appeal. See Francway, supra. The Veteran's representative has provided no specific challenge to the VA examiner's qualifications, but rather contends that he does not have the necessary information to form a challenge so as to begin to identify potential inadequacies in the examiner's qualifications. The Board disagrees with an obligation to provide any additional information not already of record. The examiner noted that he is a physician with a doctoral degree in medicine with practice area of family medicine. All VA examiners are presumed to be competent - and their medical opinions, in turn, are assumed to be adequate - absent specific evidence to the contrary. See Nohr v. McDonald, 27 Vet. App. 124, 131-32 (2014) (quoting Parks v. Shinseki, 716 F.3d 581, 585 (Fed. Cir.2013) ("It is now well settled that 'VA benefits form a [rebuttable] presumption that it has chosen a person who is qualified to provide a medical opinion in a particular case.'"). The Board disagrees with an obligation to provide any additional information not already of record absent any articulated challenge. The Board finds that the Veteran's representative's general request for documentation including the examiner's curriculum vitae and other documents is insufficient to rebut the presumption of regularity and serves only to delay adjudication. First, the Veteran and/or his representative have not set forth any specific reason why the VA clinician is not qualified to give a competent opinion or capable of providing medical diagnoses. The Veteran has simply demanded that VA provide him publicly available information in order to form a challenge. The Veteran has in fact not yet raised any specific challenge. Instead, the argument focuses on the examiner's opinions, indicating general disagreement with the conclusions, and the Board has thoroughly addressed the adequacy of the opinions herein. Thus, the Veteran's representative's assertion lacks the necessary specificity with respect to the competency of the examiner. Nohr, supra. Secondly, the representative has not submitted any evidence to contradict the conclusions of the examiner and thus call into question his competency. Lastly, the examiner is a medical doctor, has been designated as a Compensation and Pension examiner, and there is no indication that he does not have the requisite medical knowledge to conduct VA examinations, issue medical opinions, and diagnose disabilities. Additionally, the examiner's opinions were based upon consideration of the Veteran's pertinent medical history, his lay assertions and current complaints, and provided detail sufficient to allow the Board to make a fully informed determination. After consideration of all the evidence of record the Board finds that the preponderance of the evidence is against finding that service connection for a low back disability is warranted. The Board concludes that service connection is not warranted as the Veteran's current low back disability is not related to service. The Veteran's lay statements of record note ongoing symptoms of low back pain which he attributes to an in-service injury in March 1977 which he is competent to report. However, the Board finds that the preponderance of the evidence is against the Veteran's claim for service connection for a low back disability. While the Veteran's and the associated lay statements of record contend that his ongoing symptoms of low back pain are related to an in-service injury in March 1977 the Veteran is not competent to provide a nexus opinion in this case. The record does not reflect that he has the requisite training or expertise to offer a medical opinion diagnosing a low back disability and linking his current symptoms to an in-service injury and as such he is not competent to provide an opinion in this case. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The Board notes that the medical evidence is more probative and more credible than the lay opinions of record. Based on the evidence of record, while treatment records note ongoing low back pain, the most probative evidence of record finds that the Veteran's current low back disability is not related to an in-service injury. The Board has considered the extensive medical opinions of record and finds that the July 2019 and January 2021 VA opinions taken in consideration together are entitled to the most probative weight. The Board notes that there is conflicting evidence of record. The private opinions in August 2011 and September 2011 have been considered however the Board finds that these are entitled to less probative weight as the private opinions in August 2011 and September 2011 are entitled to less probative weight as the Veteran's private treatment providers failed to apply the appropriate VA standard warranted for service connection, and theses opinions failed to provide a valid, reliable, medically supported rationale. In the August 2011 private opinion, the Veteran's treating neurologist noted that the Veteran has been suffering from moderate to severe low back pain and based on a review of his records in-service it would appear that his lumbar spine problems began in-service. Service connection is warranted when it is at least as likely as not that a current disability incurred in-service. Such does not rise to the VA standard. Further, the private opinion in September 2011 from the Veteran's treating physician noted that he has had back problems as long as the Dr. has been treating him and based on a review of his records such appears to date back to service in March 1977. The private physician noted that the Veteran has a history of findings in-service that were very typical for disc disease and an MRI now confirms herniated discs at T8-9 and T 10-11. Again, the Board finds that this private opinion is entitled to less probative weight as the Veteran's private treatment provider has failed to apply the appropriate VA standard warranted for service connection, noting that his current symptomology appears to date back to his service in March 1977. Such does not rise to the necessary VA standard of at least as likely as not. Further, while the private physician noted that the Veteran's findings in-service were typical for disc disease there is no supporting rationale to support this conclusion. Herein, the Board finds the July 2019 and January 2021 VA opinions are more probative and credible than the lay and additional medical opinions of record. As to direct service connection, the Board finds that the VA opinion is entitled to significant weight. The VA opinion in September 2019 noted that the Veteran's current low back disability was less likely than not incurred in or caused by the claimed in-service, injury, event or illness. The VA examiner noted the Veteran's STRs are silent for chronic or recurrent back problems. Further, while the Veteran reported low back problems in 1980, there was no further medical documentation of any back problems until 2005. The examiner noted that in-service the Veteran experienced an incident of atraumatic back pain and was diagnosed with a sprain and treated with simple modalities and such resolved as would be expected. A disc injury would not have resolved with rest and anti-inflammatory medication. There was no documentation of chronicity in his STRs and at separation from service there was no mention of a back problem. Then post-service there is no documentation of a back problem until after 2000, which is more than 20 years after the Veteran's initial complaint. The examiner noted that while in service there was documentation of scoliosis however, this was not an acceptable diagnostic modality and unreliable even in the most skilled of observers. Current MRI findings from April 2019, do not support the Veteran's claim for the reasons noted above but also because bulging thoracic discs are just as likely, if not more completely incidental and not related to his previous complaints or his present low back complaints. As such the examiner found that it was less likely than not that the Veteran's current low back disability was incurred in or caused by the claimed in-service injury. In addition, the VA opinion in January 2021 noted that while the Veteran was treated for a back condition, while he was on active duty, his service treatment records do not show continuity and chronicity. At separation in December 1979 clinical examination was silent for any back condition. As such the examiner found that the Veteran's claimed low back condition with degenerative disc disease was less likely than not incurred in or caused by an in-service, illness, event or injury. As to presumptive service connection the examiner found that the Veteran's degenerative disc disease of the lumbar spine less likely than not began during active service, manifested within the applicable presumptive period after discharge from service, or was noted during service with continuity of the same symptomology since service. The examiner noted that the Veteran was diagnosed with a back sprain in 1977 while on active duty. He was treated with a pain relievers and advised bed rest. STRs are silent for further complaints or treatment for a low back condition and continuity and chronicity is not established. As to the Veteran's reports of ongoing symptoms that began during service and have persisted since the examiner found that the Veteran was treated in-service in 1977 for back pain and was treated with pain relivers and bed rest. He was not treated for a back condition again until 2005, a year after an X-ray taken revealed degenerative arthritis of the lower lumbar spine and mild degenerative changes. Degenerative arthritis symptomology includes a low grade continuous pain around the degenerative disc that occasionally flares up into more severe potentially disabling pain. Although a lumbar sprain and degenerative disc disease may have different etiologies, both have similar presenting symptoms pain in the back. The Veteran may seem to have symptoms that are persistent, but the back pain in-service was acute in nature. The silence of his STRs as to continuing treatment during active service attest to the acuteness of the condition. Degenerative arthritis pain is persistent, maybe relieved but ultimately does not resolve hence the back pain comes and goes. Although, the Veteran had been experiencing a similarity in the symptoms, these conditions are not one and the same and do not have a direct causal link between them. Although the Board may not find the Veteran's reports of continuous disability since service based only on the absence of treatment records, the weight of medical assessment is sufficient to assign low credible weight to his reports. The VA examiner noted consideration and review of the August 2011 and September 2011 private opinions of record. The examiner noted that the August 2011 opinion indicated that the Veteran had been having back pain since March 1977. While the possibility of a herniated disc was suggested there was no objective evidence or studies done to confirm this possibility. The September 2011 privation opinion noted the same possibility, of a disc disease as the symptoms were opined as typical. However, the diagnosis rendered in-service in March 1977 was a lumbar sprain. After conservative treatment of pain relievers and bed rest, the Veteran's STRs were silent for further complaints. Further, at separation his examination had no declaration of significant findings. The examiner noted that this attests to the acute and transitory nature of the Veteran's in-service lumbar strain. Such is not the case for disc diseases which are chronic and do not readily resolve. As such the examiner found that it was less likely than not that the Veteran's current low back disability was incurred in or caused by the claimed in-service injury. Further, at separation from service in December 1979 the Veteran's clinical examination of the spine and musculoskeletal system was normal with no identified abnormalities or diagnosis. These normal findings are inconsistent with ongoing manifestations of pathology. As such, after consideration of the entirety of the evidence the Board finds that the VA opinion in September 2019 and January 2021 opinions are entitled to significant probative weight as to direct service connection and the Veteran's statements and less probative opinions of record are outweighed, and the VA opinion weighs against the claim. As such direct service connection is not warranted. In addition, the Board concludes that, while the Veteran has degenerative changes and arthritis, which is a chronic disease under 38 U.S.C. § 1101(3)/38 C.F.R. § 3.309 (a), it was not chronic in service or manifest to a compensable degree in service or within a presumptive period, and continuity of symptomatology is not established. Arthritis was not "noted" during service or within one year of separation. See Walker, 708 F.3d 1331. At separation on the report of medical examination in December 1979 clinical examination of the spine and musculoskeletal system was normal. Service records do not support an onset of the Veteran's low back degenerative changes during active service. Based on the probative evidence of record the Board finds that the Veteran's arthritis did not manifest within the one-year period after service and service connection is not warranted on a presumptive basis. VA treatment records note the Veteran was not diagnosed with low back degenerative changes at the earliest in 2000, which is over 20 years after service. In addition, in weighing the evidence of record the Board finds the competent and credible evidence of record is against finding continuity of symptomatology. As a result, service connection based on continuity of symptomology is not warranted. (continued next page) As such, the Board finds that service connection for a low back disability is not warranted. Since the preponderance of the evidence is against the claim, the benefit of the doubt rule is not applicable. See 38 U.S.C. § 5107(b); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990); 38 C.F.R. § 3.102. For these reasons, the claim is denied. J.W. FRANCIS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K.R. Kardian, 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.