Citation Nr: 21030026 Decision Date: 05/17/21 Archive Date: 05/17/21 DOCKET NO. 11-27 327 DATE: May 17, 2021 ORDER Service connection for bilateral knee disability is denied. Service connection for lumbar spine disability is denied. Service connection for osteoarthritis of bilateral hand is denied. Service connection for carpal tunnel syndrome of bilateral wrist is denied. Service connection for gastroesophageal reflux disease is denied. FINDINGS OF FACT 1. The Veteran's bilateral knee disability was not manifest during active service or within the first post-service year, and is not attributable to service. 2. The Veteran's lumbar spine disability was not manifest during active service or within the first post-service year, and is not attributable to service. 3. The Veteran's osteoarthritis of bilateral hand was not manifest during active service or within the first post-service year, and is not attributable to service. 4. The Veteran's carpal tunnel syndrome of bilateral wrist was not manifest during active service or within the first post-service year, and is not attributable to service. 5. The Veteran's gastroesophageal reflux disease was not manifest during active service, and is not attributable to service. CONCLUSIONS OF LAW 1. Bilateral knee disability, to include arthritis, was not incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1112, 1113, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309. 2. Lumbar spine disability, to include arthritis, was not incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1112, 1113, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309. 3. Osteoarthritis of bilateral hand was not incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1112, 1113, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309. 4. Carpal tunnel syndrome of bilateral wrist was not incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1112, 1113, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309. 5. Gastroesophageal reflux disease was not incurred in or aggravated by service. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Air Force from July 1966 to October 1968, and had a period of unverified service in December 1976. She timely appealed these matters from an October 2010 rating decision. The Veteran failed to appear for a video conference hearing scheduled in October 2016 before a Veterans Law Judge at the RO. Under these circumstances, the Veteran's request for a hearing is considered withdrawn. See 38 C.F.R. § 20.700. In December 2016, the Board of Veterans' Appeals (Board) remanded the matters for further development. In November 2017, the Board requested medical expert opinions from the Veterans Health Administration (VHA) for purposes of addressing medical questions for an equitable disposition of the appeal. See 38 C.F.R. § 20.901. Opinions were obtained in December 2017, and further clarifications of opinions were obtained in June 2018 and associated with the claims file. Pursuant to 38 C.F.R. § 20.903, the Veteran and her representative were provided copies of VHA opinions and clarifications in November 2018; and were provided a period of 60 days to submit any additional evidence or argument. No additional evidence or argument was received. In March 2019, the Board again remanded the matters for further development. Here, substantial compliance with the Board's prior remand orders is demonstrated. See Dyment v. West, 13 Vet. App. 141, 146-47 (1999); Stegall v. West, 11 Vet. App. 268, 271 (1998). In this case, all available records identified by the Veteran as relating to each of the claims was obtained, to the extent possible. Social Security records were no longer available and had been destroyed. In clarifications of VHA opinions, medical experts specifically considered the Veteran's lay statements of injury or event during active service. Examination reports and opinions of record are thorough and adequate for the Board to render decisions in the Veteran's appeal. 38 U.S.C. § 5103A(a)(2). See also Dalton v. Nicholson, 21 Vet. App. 23 (2007). Service Connection Service connection will be granted if it is shown that the Veteran suffers from a disability resulting from personal injury suffered or disease contracted in the line of duty, or for aggravation of a preexisting injury suffered or disease contracted in the line of duty, during active military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. In order to establish service connection on a direct basis, the record must contain competent evidence of: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Lay assertions may serve to support a claim for service connection by establishing the occurrence of observable events or the presence of disability or symptoms of disability that are subject to lay observation. 38 U.S.C. § 1153(a); 38 C.F.R. § 3.303(a); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); see also Buchanan v. Nicholson, 451 F. 3d 1331, 1336 (Fed. Cir. 2006) (addressing lay evidence as potentially competent to support presence of disability even where not corroborated by contemporaneous medical evidence). Some chronic diseases, such as arthritis, may be presumed to have been incurred in service, if they become manifest to a degree of ten percent or more within the applicable presumptive period. 38 U.S.C. §§ 1101(3), 1112(a); 38 C.F.R. §§ 3.307(a), 3.309(a). For those listed chronic conditions, a showing of continuity of symptoms affords an alternative route to service connection. 38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F. 3d 1331 (Fed. Cir. 2013). The applicable presumptive period is one year from separation. 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) proximately caused by or (b) proximately aggravated by a service-connected disability. When service connection is established for a secondary condition, the secondary condition shall be considered a part of the original condition. 38 C.F.R. § 3.310(a). In this case, the Veteran was presumed sound at service entry. Clinical evaluation at entry in April 1966 was normal, and no disability was recorded. Nor is there medical evidence of any disability prior to active service. The Board is within its province to make a determination as to whether the evidence supports a finding of service incurrence. See Barr v. Nicholson, 21 Vet. App. 303, 307 (2007). Bilateral Knee The Veteran seeks service connection for bilateral knee disability. She underwent a right total knee replacement in December 2014, with ongoing pain. X-ray evidence revealed degenerative changes of left knee, with small enthesis from superior pole of patella, in February 2017. Due to the nature of assignments in active duty service, the Veteran had stood in place for prolonged periods; and had bent and used her legs to push heavy objects, such as carts loaded with suppliesplacing undue stress on each knee. She made these same allegations repeatedly and consistently. Where symptoms are capable of lay observation, a lay witness is competent to testify to a lack of symptoms prior to service, continuity of symptoms after in-service injury or disease, and receipt of medical treatment for such symptoms. Layno v. Brown, 6 Vet. App. 465, 469-71 (1994)). Service treatment records do not reflect any findings or complaints of bilateral knee pain. Nor is there evidence of trauma or injury to the Veteran's knees in active service. There is no evidence of treatment in active service for any knee pain. Clinical evaluation of the Veteran's lower extremities was normal at her separation examination in September 1968. Here, the evidence does not show that a bilateral knee disability had its onset in active service, or that arthritis of bilateral knee manifested within one year after the Veteran's separation from active service. As such, she is not entitled to direct or presumptive service connection. Private records reveal that the Veteran took medication for joint pain in August 2009, which helped with joint stiffness in the mornings. Examination of bilateral knee at that time revealed no swelling, no tenderness, and no pain upon active ranges of motion. Posterior and anterior joint signs were negative; there was neither varus nor valgus stress. Tenderness to palpation was noted on bilateral knee joint line. No bilateral knee disability was indicated. Based on reports by the Veteran, a family physician in January 2011 noted that the Veteran had longstanding arthritis, which started in 1968 in active duty service. No bilateral knee disability was indicated. The Veteran reported bilateral knee pain in August 2011 and in February 2012. In September 2015, the Veteran reported having ongoing pain in her right knee following a total knee replacement in December 2014. She had effusion in the knee drained twice and took medication for some minor relief. She had injections in left knee due to pain, and was "holding off" on a left total knee replacement. Examination in September 2015 revealed no synovitis and no joint swelling. During a February 2017 VA examination, the Veteran reported a medical history of bilateral knee hurting for the past twenty years (right greater than left). She denied any injury or trauma. She reported bilateral knee pain when "walking a lot" and denied any "lockup episodes." She worked a night shift twice weekly at an assisted living facility and made rounds every hour for 15 minutes, resting most of the hour. Diagnostic testing revealed degenerative arthritis of left knee, with small enthesis from superior pole of patella and minimal effusion. Following examination in February 2017, the examiner opined that the Veteran's bilateral knee disability was less likely than not incurred in or caused by active service. In support of the opinion, the examiner reasoned that service treatment records had no documentation of any bilateral knee condition to substantiate the Veteran's reported history. No significant injury was noted during service. The degenerative arthritis was a natural aging effect. It was unlikely the Veteran would have worked for many decades after service if any significant disability was incurred in or otherwise related to active service. Her employment history revealed that the Veteran retired in 2010 from steel processing. She also worked in pharmacy as a manager and technician for approximately forty years. The Veteran was on her feet all the time, lifting and doing physical labor. In 2017, she worked in a resident home and assisted residents with activities of daily living. In December 2017 and October 2018 clarifications, the examiner opined that the Veteran's bilateral knee disability was not likely due to in-service injury or overuse; and more likely was due to normal process of aging, for a Veteran in her sixties. The examiner explained that it was unlikely that arthritis of bilateral knee began in active service because the Veteran had no complaints of pain or injury in either knee in service; and it was unlikely that she had joint damage consistent with early osteoarthritis, without expressing pain. Osteoarthritic changes on X-rays were unlikely in a 20-year-old. The examiner reasoned that it was not common for one to have years of joint "wear and tear" at age 20 to develop osteoarthritis. It is likely for a 60-year-old to have had years of "wear and tear" on joints necessary for development of osteoarthritis. The status-post right total knee replacement and degenerative arthritis of left knee with small enthesis from superior pole of patella more likely were due to normal process of aging for a Veteran in her sixties. In December 2019, a VA nurse practitioner noted that the Veteran worked part-time as a home health aide; and that her bilateral knee disability was less likely than not incurred in or caused by active duty service. Rather, current symptoms were a new and separate condition, and not related to active service. Again, the nurse practitioner reasoned that service treatment records were silent for chronic progressive complaints; and there was neither diagnosis nor treatment of bilateral knee condition in service or within the first year after service. While the Veteran is competent to describe her symptoms, here, the evidence does not reveal any bilateral knee problems or injury in active service. Further, the Board finds that the Veteran is not credible in this regard. Her current accounts of arthritis beginning in 1968 in active service are contradicted by service treatment records. The Veteran specifically denied arthritis or rheumatism on a report of medical history completed contemporaneously in September 1968 at her separation examination. She also denied arthritis or rheumatism or bursitis on a report of medical history completed several years later in December 1976. There was no evidence of chronicity of care since service. Accordingly, the underlying premise of the family physician's notation in January 2011 is lacking in foundation. Hence, that notation is afforded no probative value. Here, the competent medical opinions of record regarding the etiology of bilateral knee disability are against the claim. The December 2017 examiner and October 2018 clarification considered the Veteran's service treatment records and contemporaneous records, as well as the Veteran's lay statements of bending and standing for prolonged periods in service as the cause of her knee problems. The clarification explained that these activities neither should contribute nor lead to degenerative joint disease in a 20-year-old, as there was no identified injury due to such activity in service. The opinion is consistent with the evidence of record, well-reasoned, and uncontradicted. In short, the preponderance of the evidence is against granting service connection for bilateral knee disability. On this matter, the benefit-of-the-doubt rule does not apply, and the claim must be denied. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). Lumbar Spine The Veteran seeks service connection for lumbar spine disability. Recent records show a diagnosis of degenerative arthritis of lumbar spine. Due to the nature of assignments in active duty service, the Veteran stood in place for prolonged periods; and bent and pushed and lifted heavy objects and packs, placing undue stress on her spine. Poor ergonomics also played a role in her chronic low back pain. She has made these same allegations repeatedly and consistently. As noted above, the Veteran is competent to testify to a lack of symptoms prior to service, continuity of symptoms after in-service injury or disease, and receipt of medical treatment for such symptoms. Layno, 6 Vet. App. at 469-71. Service treatment records do not reflect any findings or complaints of low back pain. Nor is there evidence of trauma or injury to the Veteran's spine in active service. There is no evidence of treatment in active service for any lumbar pain. Clinical evaluation of the Veteran's spine was normal at her separation examination in September 1968. Here, the evidence does not show that a lumbar spine disability had its onset in active service, or that degenerative arthritis of lumbar spine manifested within one year after the Veteran's separation from active service. As such, she is not entitled to direct or presumptive service connection. Private records reveal that the Veteran was treated for back spasms in December 2008 and took medication. She had similar spasms in the past. The Veteran described a sharp stabbing pain on left side of her upper back that hurt constantly and was worse with any movement. She denied recent falls or history of heavy lifting. Examination at that time revealed tenderness to palpation over left paraspinous muscles with reproduction of pain. The assessment in December 2008 was muscle spasm, and medication was prescribed. The Veteran was again treated for low back pain and muscle spasms in July 2010. Based on reports by the Veteran, a family physician in December 2009 noted that the Veteran had some arthritis. The assessment at that time was arthritis, and the Veteran was prescribed medication for her back pain. The Veteran reported chronic low back pain in April 2011. In September 2015, she reported having lumbar injections with cortisone, which had not helped. Her muscle spasms occurred infrequently. During a February 2017 VA examination, the Veteran reported a medical history of lower back stiffness for most of her life; and that pain and stiffness came and went. She reported difficulty getting up and reported doing lots of standing and bending all her life. She denied any injury or trauma. She used to have muscle spasms at mid-back, and took muscle relaxers approximately once a month. Her low back pain was sharp and non-radiating. X-rays taken ten years ago revealed arthritis. Current X-rays revealed minimal anterior spondylolisthesis at L4, as well as degenerative changes in facet joints of lower lumbar spine. Following examination in February 2017, the examiner opined that the Veteran's degenerative arthritis of thoracic and lumbar spine was less likely than not incurred in or caused by active service. In support of the opinion, the examiner reasoned that service treatment records had no documentation of any lumbar disability to substantiate the Veteran's reported history. No significant injury was noted during service. The degenerative arthritis was a natural aging effect. It was unlikely the Veteran would have worked for many decades after service if any significant disability was incurred in or otherwise related to active service. The examiner noted the Veteran's employment history, as shown above. In December 2017 and June 2018 clarifications, the examiner opined that the Veteran's degenerative arthritis of thoracic and lumbar spine was not likely due to in-service injury or overuse; and was more likely due to normal process of aging for a Veteran in her sixties. The examiner explained that it was unlikely that degenerative arthritis of thoracic and lumbar spine began in active service because the Veteran had no complaints of pain or injury in the spine in service; and it was unlikely that she had joint damage consistent with early osteoarthritis without expressing pain. Osteoarthritic changes on X-rays were unlikely in a 20-year-old. The examiner reasoned that it was not common for one to have years of joint "wear and tear" at age 20 to develop osteoarthritis. It was likely for a 60-year-old to have had years of "wear and tear" on joints necessary for development of osteoarthritis. The degenerative arthritis of thoracic and lumbar spine more likely was due to normal process of aging for a Veteran in her sixties. The Veteran again was treated for muscle spasms in her middle back in December 2018. In December 2019, a VA nurse practitioner noted that the Veteran had difficulties with prolonged sitting, standing, and walking; and that her degenerative arthritis of the spine was less likely than not incurred in or caused by active duty service. Rather, current symptoms were a new and separate condition, and not related to active service. Again, the nurse practitioner reasoned that service treatment records were silent for chronic progressive complaints; and there was neither diagnosis nor treatment of lumbar spine condition in service or within the first year after service. While the Veteran is competent to describe her symptoms, here, the evidence does not reveal any lumbar spine problems or injury in active service. Further, the Board finds that the Veteran is not credible in this regard. As noted above, her current accounts of arthritis beginning in 1968 in active service are contradicted by service treatment records. Moreover, the Veteran specifically denied recurrent back pain on a report of medical history completed contemporaneously with her separation examination in September 1968. She also denied recurrent back pain on a report of medical history completed several years later in December 1976. There was no evidence of chronicity of care since service. Degenerative changes of lumbar spine first were noted decades after service. In this regard, a continuity of symptomatology of degenerative arthritis of lumbar spine is not established. Walker, 703 F.3d at 1338-39. Here, the competent medical opinions of record regarding the etiology of lumbar spine disability are against the claim. The December 2017 examiner and June 2018 clarification considered the Veteran's service treatment records and contemporaneous records, as well as the Veteran's lay statements of bending and pushing and lifting heavy objects and packs as the cause of her lumbar disability. The clarification explained that it is not common to have the years of joint "wear and tear" to develop osteoarthritis at age 20. The opinion is consistent with the evidence of record, well-reasoned, and uncontradicted. In short, the preponderance of the evidence is against granting service connection for degenerative arthritis of lumbar spine. On this matter, the benefit-of-the-doubt rule does not apply, and the claim must be denied. 38 U.S.C. § 5107(b); Gilbert, 1 Vet. App. at 53-56. Bilateral Hand The Veteran seeks service connection for osteoarthritis of bilateral hand. Due to the nature of assignments in active duty service, the Veteran performed repetitive movements of both hands in preparing surgical supplies (assembly and wrapping) for sterilization. She performed these repetitive movements with both hands daily for 18 months, which she contends resulted in arthritis. She made these same allegations repeatedly and consistently. Where symptoms are capable of lay observation, a lay witness is competent to testify to a lack of symptoms prior to service, continuity of symptoms after in-service injury or disease, and receipt of medical treatment for such symptoms. Layno, 6 Vet. App. at 469-71. Service treatment records do not reflect any findings or complaints of bilateral hand pain. Nor is there evidence of trauma or injury to the Veteran's hands in active service. There is no evidence of treatment in active service for any hand pain. Clinical evaluation of the Veteran's upper extremities was normal at her separation examination in September 1968. Here, the evidence does not show that a bilateral hand disability had its onset in active service, or that osteoarthritis of bilateral hand manifested within one year after the Veteran's separation from active service. As such, she is not entitled to direct or presumptive service connection. Private records reveal a history of arthritis of right hand in July 2009. Examination of left hand in June 2010 was similar to examination of right hand, with exception of actually worse evidence of degenerative changes at thumb carpometacarpal joint with much less motion. In March 2011, the Veteran complained of joint pain in hands that improved with medication. Examination then revealed that left thumb did not spread out fully, and there were several nodes noted on right digits. The examiner opined that the Veteran's joint pain in hands most likely was due to osteoarthritis. In July 2010, the Veteran reported a lot of pain in her hands. She wore some splints on her hands and thumb. Her main pain was at the base of her thumb. Based on reports by the Veteran, a family physician in January 2011 noted that the Veteran had longstanding arthritis, which started in 1968 in active duty service; the assessment then was osteoarthritis. The Veteran reported bilateral hand pain in April 2011, in August 2011, and in February 2014. During a February 2017 VA examination, the Veteran reported a medical history of bilateral hand pain, including thumbs, for the past twenty years (left greater than right). She denied any fracture or surgery. She did break the fingertip of left middle finger in September 2016 on a dog leash. She reported having aching hands and stiffness in the mornings, and took medication for relief. She used hand splints when necessary for worsening pain. Diagnostic testing revealed degenerative or traumatic arthritis of both hands. The impression was advanced osteoarthritis. Following examination in February 2017, the examiner opined that the Veteran's bilateral hand disability was less likely than not incurred in or caused by active service. In support of the opinion, the examiner reasoned that service treatment records had no documentation of any bilateral hand condition to substantiate the Veteran's reported history. No significant injury was noted during service. The degenerative arthritis was a natural aging effect. It was unlikely the Veteran would have worked for many decades after service if any significant disability was incurred in or otherwise related to active service. The examiner noted the Veteran's employment history, as shown above. In December 2017 and October 2018 clarifications, the examiner opined that the Veteran's osteoarthritis of bilateral had was not likely due to in-service injury or overuse; and more likely was due to normal process of aging, for a Veteran in her sixties. The examiner explained that it was unlikely that osteoarthritis of bilateral hand began in active service because the Veteran had no complaints of pain or injury in either hand in service; and it was unlikely that she had joint damage consistent with early osteoarthritis, without expressing pain. Osteoarthritic changes on X-rays were unlikely in a 20-year-old. The examiner reasoned that it was not common for one to have years of joint "wear and tear" at age 20 to develop osteoarthritis. It is likely for a 60-year-old to have had years of "wear and tear" on joints necessary for development of osteoarthritis. Osteoarthritis of bilateral hand more likely was due to normal process of aging for a Veteran in her sixties. In December 2019, a VA nurse practitioner noted that the Veteran reported having bilateral hand pain since active service when she wrapped instrument trays, and currently reported difficulty with prolonged gripping and squeezing and loss of grip strength. Following a review of the record, the nurse practitioner opined that the Veteran's osteoarthritis of bilateral hand was less likely than not incurred in or caused by active duty service. Rather, current symptoms were a new and separate condition, and not related to active service. Again, the nurse practitioner reasoned that service treatment records were silent for chronic progressive complaints; and there was neither diagnosis nor treatment of osteoarthritis of bilateral hand in service or within the first year after service. While the Veteran is competent to describe her symptoms, here, the evidence does not reveal any bilateral hand problems or injury in active service. Further, the Board finds that the Veteran is not credible in this regard. As noted above, her current accounts of arthritis beginning in 1968 in active service are contradicted by service treatment records. Moreover, the Veteran specifically denied swollen or painful joints on a report of medical history completed contemporaneously with her separation examination in September 1968. She also denied swollen or painful joints on a report of medical history completed several years later in December 1976. There was no evidence of chronicity of care since service. Thus, the fact that the Veteran specifically denied symptoms of painful joints both in-service and post-service is what the Board finds probative. Osteoarthritis of bilateral hand first was noted decades after service. In this regard, a continuity of symptomatology of osteoarthritis of bilateral hand is not established. Walker, 703 F.3d at 1338-39. As noted above, the underlying premise of the family physician's notation in January 2011 is lacking in foundation. Hence, that notation is afforded no probative value. Here, the competent medical opinions of record regarding the etiology of osteoarthritis of bilateral hand are against the claim. The December 2017 examiner and June 2018 clarification considered the Veteran's service treatment records and contemporaneous records, as well as the Veteran's lay statements of wrapping objects repeatedly with her hands and pushing and lifting objects in service as the cause of her bilateral hand problems. The clarification explained that these activities neither should contribute nor lead to degenerative joint disease in a 20-year-old, as there was no identified injury due to such activity in service. The opinion is consistent with the evidence of record, well-reasoned, and uncontradicted. In short, the preponderance of the evidence is against granting service connection for osteoarthritis of bilateral hand. On this matter, the benefit-of-the-doubt rule does not apply, and the claim must be denied. 38 U.S.C. § 5107(b); Gilbert, 1 Vet. App. at 53-56. Carpal Tunnel Syndrome The Veteran seeks service connection for carpal tunnel syndrome of bilateral wrist. As noted above, the Veteran performed repetitive movements of both hands in preparing surgical supplies (assembly and wrapping) for sterilization. She performed these repetitive movements with both hands daily for 18 months, which she contends resulted in carpal tunnel syndrome. She made these same allegations repeatedly and consistently. Where symptoms are capable of lay observation, a lay witness is competent to testify to a lack of symptoms prior to service, continuity of symptoms after in-service injury or disease, and receipt of medical treatment for such symptoms. Layno, 6 Vet. App. at 469-71. Service treatment records do not reflect any findings or complaints of carpal tunnel syndrome of bilateral wrist. Nor is there evidence of trauma or injury to the Veteran's wrists in active service. There is no evidence of treatment in active service for any wrist pain. As noted above, clinical evaluation of the Veteran's upper extremities was normal at her separation examination in September 1968. Here, the evidence does not show that carpal tunnel syndrome of bilateral wrist had its onset in active service, or that a chronic disease (to include organic diseases of the nervous system) manifested within one year after the Veteran's separation from active service. As such, she is not entitled to direct or presumptive service connection. Private records reveal that carpal tunnel provocative maneuvers were positive in June 2010. Wrist ranges of motion were mildly diminished, and grip strength was mildly diminished. Diagnoses at that time included carpal tunnel syndrome. In July 2010, the Veteran complained of hand pain and numbness. She wore wrist splints for another three weeks. The Veteran was treated for carpal tunnel syndrome due to failed braces in April 2011 and in June 2012. During a February 2017 VA examination, the Veteran reported being told she had carpal tunnel syndrome ten years ago and that splints did not help. She reported no history of surgery for carpal tunnel syndrome. Bilateral hand grip was 5/5; there was no muscle atrophy of hands and fingers. Following examination in February 2017, the examiner did not diagnose carpal tunnel syndrome. No significant injury was noted during service. The examiner opined that it was unlikely the Veteran would have worked for many decades after service if any significant disability was incurred in or otherwise related to active service. VA records, dated in September 2019, show a medical history of carpal tunnel syndrome. The Veteran underwent a VA peripheral nerves condition examination in December 2019. The examiner noted a diagnosis of carpal tunnel syndrome, and the date of diagnosis was 2010. The Veteran reported a medical history of bilateral tingling, numbness, and weakness of first three digits bilaterally; and reported that symptoms of carpal tunnel began after prolonged repetitive use of hands and wrists during service, and that symptoms were ongoing. The Veteran reported difficulty with prolonged gripping and squeezing. Following examination in December 2019, the examiner opined that the Veteran's diagnosed peripheral neuropathy was less likely than not incurred in or caused by active duty service. Rather, current symptoms were a new and separate condition, and not related to active service. The examiner reasoned that service treatment records were silent for chronic progressive complaints; and there was neither diagnosis nor treatment of peripheral neuropathy in service or within the first year after service. Post-service records first diagnosed carpal tunnel syndrome of bilateral wrist in 2010. While the Veteran is competent to describe her symptoms, here, the evidence does not reveal any symptoms of carpal tunnel syndrome of bilateral wrist in active service. The Veteran specifically denied neuritis on a report of medical history completed contemporaneously with her separation examination in September 1968. She also denied neuritis on a report of medical history completed several years later in December 1976. There was no evidence of chronicity of care since service. Thus, the fact that the Veteran specifically denied symptoms of neuritis both in-service and post-service is what the Board finds probative. Carpal tunnel syndrome of bilateral wrist first was noted decades after service. In this regard, a continuity of symptomatology of a chronic disease (to include organic diseases of the nervous system) is not established. Walker, 703 F.3d at 1338-39. Here, the competent medical opinion of record regarding the etiology of carpal tunnel syndrome of bilateral wrist is against the claim. The December 2019 examiner considered the Veteran's service treatment records and contemporaneous records, as well as the Veteran's lay statements of prolonged repetitive use of hands and wrists during service as the cause of her carpal tunnel syndrome. The evidence does not show that carpal tunnel syndrome of bilateral wrist had its onset in active service. The first credible showing of pertinent disability is many years after service with no competent evidence that the disability is in any way related to active service. The December 2019 opinion is consistent with the evidence of record, well-reasoned, and uncontradicted. In short, the preponderance of the evidence is against granting service connection for carpal tunnel syndrome of bilateral wrist. On this matter, the benefit-of-the-doubt rule does not apply, and the claim must be denied. 38 U.S.C. § 5107(b); Gilbert, 1 Vet. App. at 53-56. Gastroesophageal Reflux Disease The Veteran seeks service connection for gastroesophageal reflux disease. She contended that all through active duty service, she was required to eat the types of food presented (even those types she was not accustomed to); and was pressured to eat at a speed not conducive to proper digestion. The many months of this type of eating caused digestive problems, which are recurring. She made these same allegations repeatedly and consistently. Where symptoms are capable of lay observation, a lay witness is competent to testify to a lack of symptoms prior to service, continuity of symptoms after in-service injury or disease, and receipt of medical treatment for such symptoms. Layno, 6 Vet. App. at 469-71. Service treatment records do not reflect any findings or complaints of gastroesophageal reflux disease. Nor is there evidence of trauma or injury to the Veteran's abdomen or gastrointestinal tract in active service. There is no evidence of treatment in active service for any digestive problems. Clinical evaluation of the Veteran's abdomen and viscera was normal at her separation examination in September 1968. Here, the evidence does not show that gastroesophageal reflux disease had its onset in active service. As such, she is not entitled to direct service connection; no presumptive provisions apply. Private records reveal that an esophagogastroduodenoscopy was negative in 2003; a history of gastroesophageal reflux disease, currently under good control, was noted in July 2010 and in January 2011. The Veteran again was treated for gastroesophageal reflux disease in September 2015 and in February 2017. The Veteran underwent a VA esophageal conditions examination in December 2019. The examiner noted a diagnosis of gastroesophageal reflux disease, and the date of diagnosis was 2008. The Veteran reported difficulty with heartburn that began years ago. She reported eating very fast like she did in active service, and reported taking medication. Following examination in December 2019, the examiner opined that the Veteran's diagnosed gastroesophageal reflux disease was less likely than not incurred in or caused by active duty service. Rather, current symptoms were a new and separate condition, and not related to active service. The examiner reasoned that service treatment records were silent for chronic progressive complaints; and there was neither diagnosis nor treatment of gastroesophageal reflux disease in active service. Post-service records first diagnosed gastroesophageal reflux disease in 2008. While the Veteran is competent to describe her symptoms, here, the evidence does not reveal any symptoms of gastroesophageal reflux disease in active service. The Veteran specifically denied frequent indigestion and denied stomach or liver or intestinal trouble on a report of medical history completed contemporaneously with her separation examination in September 1968. She also denied frequent indigestion and denied stomach or liver or intestinal trouble on a report of medical history completed several years later in December 1976. Thus, the fact that the Veteran specifically denied such symptoms both in-service and post-service is what the Board finds probative. Gastroesophageal reflux disease first was noted decades after service. It is not listed as a chronic disability in 38 C.F.R. § 3.309 (a); hence, reports of continuity of symptomatology do not assist the Veteran in this case. Walker, 708 F.3d at 1338-39. Here, the competent medical opinion of record regarding the etiology of gastroesophageal reflux disease is against the claim. The December 2019 examiner considered the Veteran's service treatment records and contemporaneous records, as well as the Veteran's lay statements of eating very fast as she did during service as the cause of her gastroesophageal reflux disease. The evidence does not show that gastroesophageal reflux disease had its onset in active service. The first credible showing of pertinent disability is many years after service with no competent evidence that the disability is in any way related to active service. The December 2019 opinion is consistent with the evidence of record, well-reasoned, and uncontradicted. In short, the preponderance of the evidence is against granting service connection for gastroesophageal reflux disease. On this matter, the benefit-of-the-doubt rule does not apply, and the claim must be denied. 38 U.S.C. § 5107(b); Gilbert, 1 Vet. App. at 53-56. WILLIAM H. DONNELLY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Mary C. Suffoletta 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.