Citation Nr: 21030388 Decision Date: 05/18/21 Archive Date: 05/18/21 DOCKET NO. 17-65 139 DATE: May 18, 2021 ORDER 1. Entitlement to service connection for chronic obstructive pulmonary disease (COPD) is denied. 2. Entitlement to service connection for bronchitis, to include asthma, is denied. 3. Entitlement to service connection for gastroesophageal reflux disease (GERD), to include as secondary to COPD, is denied. 4. Entitlement to service connection for obstructive sleep apnea (OSA), to include as secondary to GERD, arrhythmia or other heart disability, COPD, or bronchitis, is denied. 5. Entitlement to service connection for a cervical spine disability, to include as secondary to service-connected thoracolumbar spine disability, is denied. REMANDED 6. Entitlement to service connection for arrhythmia, or any other heart disability, is remanded. FINDINGS OF FACT 1. The preponderance of the evidence is against a finding that COPD had an onset in service or is otherwise related to service. 2. The preponderance of the evidence is against a finding that bronchitis, to include asthma, had an onset in service or is otherwise related to service. 3. The preponderance of the evidence is against finding that GERD is secondary to service-connected COPD or is otherwise related to an in-service injury or disease. 4. The preponderance of the evidence is against finding that OSA is secondary to service-connected GERD, arrhythmia or other heart disability, COPD, or bronchitis or is otherwise related to an in-service injury or disease. 5. The preponderance of the evidence is against finding that the cervical spine disability had an onset in service, manifested within one year of service discharge, is caused or aggravated by a service-connected thoracolumbar spine disability, or is otherwise related to service. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for COPD have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2020). 2. The criteria for entitlement to service connection for bronchitis, to include asthma, have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2020). 3. The criteria for entitlement to service connection for GERD, to include as secondary to COPD, have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.310 (2020). 4. The criteria for entitlement to service connection for OSA, to include as secondary to GERD, arrhythmia or any other heart disability, COPD, or bronchitis, have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.310 (2020). 5. The criteria for entitlement to service connection for a cervical spine disability, to include as secondary to service-connected thoracolumbar spine disability, have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 1970 to November 1971. The Veteran testified at a video conference hearing before the undersigned Veterans Law Judge in December 2020. A transcript of the hearing was prepared and associated with the claims file. The Board acknowledges that additional VA treatment records have been associated with the claims file since the most recent statement of the case (SOC) was issued and the claims being transferred to the Board. However, the Board finds these treatment records are not pertinent to the issues before the Board, and therefore, the Board will proceed with review. Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). 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. Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection is also warranted for a disability which is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Such secondary service connection is warranted for any increase in severity of a nonservice-connected disability that is proximately due to or the result of a service-connected disability. 38 C.F.R. § 3.310(b). 1. 2. Entitlement to service connection for COPD and bronchitis, to include asthma The Veteran testified at the December 2020 hearing that his difficulty breathing got worse after his regular exposure to jet fuel fumes in service. The Veteran testified that he did not have a diagnosed respiratory disability when he entered active service, but he did acknowledge that he had occasional shortness of breath. During his active duty, the Veteran testified that he served as military police in charge of guarding aircraft on the flight line. He testified that these jets had their engines running nearly all of the time as they were on alert during the Vietnam War. The Veteran testified that he was near the running aircraft regularly, including while they were being refueled. The Veteran also testified to one instance, while serving in England, when they were under attack and were sprayed with a substance. He did not know what it was, but he reported going to the hospital at that time because he was having difficulty breathing. The Veteran testified that he believes that his exposure to jet fuel fumes and other environmental hazards on the flight line either caused his current respiratory disabilities or aggravated any disability that preexisted his service. The Veteran testified that he continued to have respiratory symptoms after service, though he did not initially seek treatment because he believed he was just going to have to learn to live with the symptoms. The statements from August 2012 and April 2014 are generally consistent with the hearing testimony. The Board has carefully reviewed the evidence of record and finds that the preponderance of the evidence is against the claim for service connection for COPD and bronchitis, to include asthma. The reasons follow. As to evidence of a current disability, a letter submitted by a private provider, Dr. Michael Nader, noted that the Veteran had a diagnosis of COPD and asthma. Therefore, the facts establish that the first element of a service-connection claim is met. Private records document the Veteran has inconsistently reported date of onset of his COPD, and at various times he has reported being diagnosed in 1990, 1998, or 2004. The September 2014 VA examination documents an onset of COPD in April 2005. At the December 2020 hearing, the Veteran testified that he self-diagnosed himself with bronchitis and that he had not received a formal diagnosis of bronchitis. A review of the claims file shows that the Veteran has been diagnosed with acute episodes of bronchitis at various times in his VA and private treatment records, but as he has not been diagnosed with chronic or unresolved bronchitis, the Board finds the preponderance of the evidence is against a finding of a current disability. However, as noted above, the Veteran has diagnoses of COPD and asthma, and thus, the Board concedes there is evidence of a current respiratory disability. As to evidence of a disease or injury in service, the service treatment records (STRs) show that the Veteran reported a history of shortness of breath on his October 1970 entrance Report of Medical History. Furthermore, the Veteran was noted to have upper respiratory infections (URI) throughout service in November 1970, August 1971, and September 1971. STRs from October 1971 documented that the Veteran still had a cough from the September URI, and in November 1971, the Veteran was noted to have wheezing and chest pain, and he was admitted to the hospital. After two days, the Veteran was discharged, and it was noted that the wheezing had cleared. Thus, the facts establish that the second element of a service-connection claim is met. As to evidence of a nexus between the current disability and service, the Board also finds that this element of a service-connection claim is not met. The multiple in-service URIs and the hospitalization related to respiratory issues all resolved in between infections and resolved prior to the Veteran's discharge from active service. On the November 1971 separation examination, clinical evaluation of the lungs and chest was normal, and the Veteran specifically denied having or having had sinusitis, hay fever, asthma, shortness of breath, or a chronic cough on the corresponding Report of Medical History. The Board finds this to be highly probative evidence that the URI symptoms had resolved prior to his discharge, as the Veteran documented having or having had other medical symptoms at discharge, including feeling tired, pain or pressure in his chest, heart trouble, recurrent back pain, and depression or excessive worry. Thus, the Board finds it likely that had the Veteran experienced significant respiratory symptoms at or prior to discharge, he would have reported it given that he did report other symptoms that he had experienced or currently experienced at discharge. This is evidence against a chronic respiratory disability having its onset in service. The Veteran was provided a VA examination in November 2016. The examiner documented the diagnoses of COPD and asthma and noted the Veteran's history of working on the flight line and his likely exposure to jet fuel and other environmental hazards, as well as his in-service history of URIs. The examiner opined that the instances of diffuse symptoms of coughing, wheezing, and URIs during service were less likely than not related to asthma symptoms. The examiner noted that the Veteran's COPD and asthma were diagnosed many years later and was more likely the result of many years of smoking cigarettes (the examiner noted he had a 44 pack-year smoking history). The examiner added that the development of COPD and asthma caused by smoking is exceedingly common in the general population. The Board finds that the November 2016 VA medical opinion is highly probative, as the examiner reviewed the file, listened to the Veteran's report of history, physically examined the Veteran, understood the Veteran's allegation that he believed he had a respiratory disability due to jet fuel and other environmental hazards, and provided a rationale for the opinion that relied on the specific facts of the case, which facts are accurate and complete. This is evidence against a nexus between the current respiratory disability and service. The Board acknowledges the opinions provided by Dr. Nader in April 2014 and October 2016 in which Dr. Nader opined that the extent of the exposure to jet fuel more than likely contributed to the development of asthma and COPD. However, the Board finds this opinion to be less probative than the opinion of the November 2016 VA examiner, as the opinions were not based on a review of the entirety of the claims file, which Dr. Nader acknowledged in his April 2014 opinion, when he wrote he had completed only a partial review of the records. The two opinions provided by Dr. Nader also do not acknowledge the significant time period between the jet fuel exposure in service and the onset of COPD and asthma, nor do they provide medical literature or any other rationale to support for the opinion that COPD and asthma were likely caused by jet fuel exposure in service. Furthermore, Dr. Nader, in both opinions, noted that the Veteran's significant history of smoking complicated the history and acknowledged that the smoking history also contributed to the development of COPD and asthma, consistent with the November 2016 VA medical opinion. The November 2016 VA examiner had commented on the private opinions submitted by Dr. Nader, noting that the opinions added little to the overall discussion, as the VA examiner found they were nonspecific and did not address the 30 year gap between in-service symptoms and the development of a diagnosis of COPD and asthma. Accordingly, for these reasons, the Board finds that the November 2016 medical opinion outweighs Dr. Nader's opinions. The Board must analyze the credibility and probative value of the evidence, account for the evidence it finds persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the Veteran. Kahana v. Shinseki, 24 Vet. App. 428, 433 (2011). This includes weighing the credibility and probative value of lay evidence against the remaining evidence of record. See King v. Shinseki, 700 F.3d 1339 (Fed. Cir. 2012); Kahana, 24 Vet. App. at 43334. The Board acknowledges the Veteran's belief that his asthma and COPD were caused or aggravated by exposure to jet fuel in service. However, while the Veteran is competent to report symptoms that he has experienced in service and since service, including coughing or wheezing, he is not competent to directly link the current diagnoses of asthma and COPD to service or exposure to jet fuel or other environmental toxins in service. Medical expertise is required to competently provide such an opinion. In this regard, the question of causation involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship. As such, the question of etiology in this case may not be competently addressed by lay evidence, and the Veteran's own opinion is nonprobative evidence. The Board also acknowledges the many articles submitted by the Veteran that support the contention that jet fuel exposure may cause COPD or asthma or irritate the respiratory system. However, the Board notes that these articles do not relate to the specific facts in the Veteran's case. Specifically, these articles do not address circumstances in which the exposure to jet fuel over a less-than-two-year period is combined with an approximately 44-year history of smoking and an approximately 30 year delayed onset diagnosis, circumstances, which facts are addressed by the November 2016 VA examiner, which the Board does find highly probative. In reaching the above conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, that doctrine is not applicable where, as here, there is not an approximate balance of positive and negative evidence. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Thus, the claim for service connection for a COPD and bronchitis, to include asthma, is denied. 3. Entitlement to service connection for GERD, to include as secondary to COPD The Veteran testified at the December 2020 hearing that he had no issues with GERD prior to service and that during service he began to take Alka Seltzer for indigestion, a practice he testified he has maintained since service, including after he was diagnosed with GERD. The Veteran also asserts that his GERD is secondary to his diagnosis of COPD. The Board has carefully reviewed the evidence of record and finds that the preponderance of the evidence is against the claim for service connection for GERD. The reasons follow. As to evidence of a current disability, VA treatment records from July 2009 document a diagnosis of GERD. Therefore, the facts establish that the first element of a service-connection claim is met. As to evidence of a disease or injury in service, the STRs do not show that the Veteran reported or experienced symptoms suggestive of an onset of GERD during service. The Veteran reported symptoms of diarrhea and stomach cramps in November 1971. However, these symptoms involve the lower gastrointestinal system and not the esophagus. On the November 1971 Report of Medical History the Veteran specifically denied having or having had frequent indigestion. Additionally, the separation examination did not document clinical abnormalities suggestive of the onset of GERD. Thus, the facts do not meet the second element of a service-connection claim, as the preponderance of the evidence is against finding that the Veteran had an onset of GERD or symptoms of an onset of GERD in service. The post-service treatment records show that in February 1988, when the Veteran was hospitalized for alcohol dependence, he reported a history of chest pain relieved by Maalox, which description could constitute symptoms of GERD, which is more than 15 years following service discharge. When the Veteran presented to VA in October 2005 as a new patient, he reported that his primary concern was to get a colonoscopy, as he had undergone one in 2001 to evaluate blood in his stool. When addressing his past medical history, the Veteran reported colon polyps, positive blood in stool, and allergy-induced asthma. The examiner performed a review of systems, and the Veteran denied chest symptoms and gastrointestinal symptoms, including dysphagia. At this point, it had been more than 30 years since service discharge. The Board finds that had the Veteran been experiencing chronic symptoms of GERD and/or heartburn for more than 30 years, as he alleges chronic GERD symptoms since service discharge, the Veteran would have reported such fact at that time, since he thought to report blood in his stool from four years prior. In other words, it would seem likely that symptoms that had been ongoing for decades would have been reported since the Veteran thought to report symptoms that had occurred only four year prior. The subsequent VA treatment records support this conclusion, as the Veteran sought treatment for recurrent vertigo in August 2006, which symptom he reported began three months prior, and he was still reporting that symptom in February 2008, March 2008, April 2008, and June 2008. What this shows is that the Veteran sought treatment for medical symptoms he was experiencing, including symptoms that had been ongoing for approximately two years (here, vertigo). The Veteran did not start reporting GERD until approximately July 2009. It is unclear when he filed for Social Security Administration disability benefits, but it was after July 2009, as he reported within the application that he stopped working in July 2009. When he was asked what illnesses, injuries, or conditions limited his ability to work, the Veteran included vertigo, hypertension, neck pain with loss of sleep due to muscle pain. What he did not include was GERD. The various treatment records over the years show the Veteran was capable of identifying, reporting, and seeking treatment for pain and medical problems as necessary, which did not include GERD or symptoms of GERD until approximately July 2009. The Board finds the Veteran's statements endorsing continuous indigestion since service to be less probative than the contemporaneous evidence, which documents: (1) the Veteran's denial of experiencing having chronic indigestion or other upper gastrointestinal trouble at discharge, despite reporting a history of having other medical symptomatology at that time; (2) reporting chest pain with relief of symptoms with Maalox more than 15 years after service; (3) first reporting GERD symptoms more than 35 years after service. For these reasons, the Board finds the preponderance of the evidence is against a nexus between the diagnosis of GERD and service. The Board acknowledges that the Veteran has also asserted that his GERD may be secondary to COPD. However, as noted above, the Veteran is not service connected for COPD. Thus, service-connection on a secondary basis is also denied. VA had not provided the Veteran with a VA examination or medical opinion in connection with this claim, and the Board finds that entitlement to a VA examination or medical opinion is not warranted. VA must provide a medical examination and/or medical opinion when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran's service or with another service-connected disability, but (4) there is insufficient competent medical evidence on file for the Secretary to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79 (2006). Here, the evidence does not establish that an event, injury, or disease occurred in service or an indication that the disability may be associated with the Veteran's service or with another service-connected disability. For a VA examination and/or medical opinion to be warranted, all the McLendon criteria have to be met, and at least one of the criteria is not met. Therefore, entitlement to a VA examination and/or medical opinion is not warranted for this service-connection claim. In reaching the above conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, that doctrine is not applicable where, as here, there is not an approximate balance of positive and negative evidence. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Thus, the claim for service connection for GERD is denied. 4. Entitlement to service connection for OSA, to include as secondary to GERD, arrhythmia or any other heart disability, COPD, or bronchitis The Veteran testified at the December 2020 hearing that he did not recall having sleep disturbance issues prior to service. He testified that in service, he began having difficulty sleeping, and he testified that he was told in service that he was snoring loudly. He also testified that in service he was told that he stopped breathing while he was sleeping and would often wake up not feeling rested. He testified that he increasingly felt fatigued or lacked energy throughout the workday approximately five to six years after his discharge from active service. The Veteran also asserts that his OSA is secondary to GERD, arrhythmia or any other heart disability, COPD, or bronchitis. The Board has carefully reviewed the evidence of record and finds that the preponderance of the evidence is against the claim for service connection for OSA. The reasons follow. As to evidence of a current disability, a private sleep study conducted in April 2014 diagnosed the Veteran with mild to moderate OSA. Therefore, the facts establish that the first element of a service-connection claim is met. As to evidence of a disease or injury in service, the STRs do not show that the Veteran reported symptoms consistent with an onset of OSA during his active service. For example, at a September 1971 psychiatric consultation, the Veteran specifically denied experiencing sleep disturbances. Furthermore, on the Report of Medical History completed just prior to separation in November 1971, the Veteran, while documenting that he felt tired, specifically denied having or having had frequent trouble sleeping. The Board finds that had the Veteran been experiencing symptoms of sleep disturbances or other symptoms of OSA during service as the Veteran testified to at the December 2020 hearing, he would have reported it because the Veteran reported having or having had numerous other medical symptoms. For example, on the November 1971 Report of Medical History, the Veteran specifically reported having or having had pain or pressure in his chest, heart trouble, recurrent back pain, and depression or excessive worry. Additionally, the separation examination shows that clinical evaluation of the mouth and throat were normal. Furthermore, though the Veteran reported some decreased sleep at an April 1990 mental status exam and nighttime symptoms in June 2010 VA treatment records, the Veteran did not consistently report sleep disturbances or symptoms suggestive of an onset of OSA and was not diagnosed with OSA until April 2014, despite the presence of significant VA and private treatment records in the claims file dating back to the 1980s. Given the September 1971 denial of sleep disturbances in service, his specific denial of frequent trouble sleeping on his separation examination, and the general lack of consistent reporting of sleep disturbances until his diagnosis of OSA in April 2014, approximately 43 years after discharge from service, the Board finds the Veteran's testimony that he experienced frequent symptomatology of sleep disturbances in service and since service to be less probative than the contemporaneous medical records contained in the claims file. Thus, the facts do not support the second element of a service-connection claim as the preponderance of the evidence is against finding that the Veteran had an onset of OSA or symptoms of an onset of OSA in service. Thus, the Board finds that the preponderance of the evidence is against both an in-service disease or injury and a nexus between the current disability and service, and service connection on a direct basis is denied. The Board acknowledges that the Veteran has also asserted that his OSA may be secondary to COPD, bronchitis, and/or GERD. However, as noted above, the Board has denied service connection for COPD, bronchitis, and GERD. Thus, service-connection on a secondary basis is also denied. Furthermore, though the Board has remanded the claim for service connection for arrhythmia or any other heart disability, the Veteran has not provided medical literature or any other contentions other than a vague assertion of a relationship between his OSA and his diagnosed heart disabilities. Absent more than a vague assertion of a relationship between the two disabilities, the Board finds that further development is not required. VA has not provided the Veteran with a VA examination or medical opinion in connection with this claim, and the Board finds that the evidence does not establish entitlement to a VA examination or medical opinion for OSA. VA must provide a medical examination and/or medical opinion when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, (2) evidence establishing that an event, injury, or disease occurred in service, or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran's service or with another service-connected disability, but (4) there is insufficient competent medical evidence on file for the Secretary to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79 (2006). In this case, the preponderance of the evidence is against an event, injury, or disease occurred in service or an indication that the disability may be associated with the Veteran's service or with another service-connected disability. For a VA examination and/or medical opinion to be warranted, all the McLendon criteria have to be met, and at least one of the criteria is not met. Therefore, entitlement to a VA examination and/or medical opinion is not warranted for this service-connection claim. In reaching the above conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, that doctrine is not applicable where, as here, there is not an approximate balance of positive and negative evidence. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Thus, the claim for service connection for OSA is denied. 5. Entitlement to service connection for a cervical spine disability, to include as secondary to service-connected thoracolumbar spine disability The Veteran testified at the December 2020 hearing that he did not have any symptoms or pain in his cervical spine prior to service. He testified that while he was on emergency leave in 1971, he got into a motor vehicle accident in which he injured his cervical spine. He testified that he was unsure if he reported the accident when he returned to active duty, but he testified that he had a sling on his arm and a neck brace that he wore at night upon return, noting that he did not want people to see him injured during the day. He reported that in 1989 to 1990 he started having more problems with his cervical spine, and that his symptoms have been getting progressively worse since that time. The Board has carefully reviewed the evidence of record and finds that the preponderance of the evidence is against the claim for service connection for a cervical spine disability. The reasons follow. As to evidence of a current disability, VA treatment records from April 2010 document a lipoma on his neck as well as multilevel degenerative disc disease of the cervical spine. An April 2016 VA examination documents a diagnosis of degenerative joint disease of the cervical spine. Therefore, the facts establish that the first element of a service-connection claim is met. As to evidence of a disease or injury in service, the STRs do not show that the Veteran experienced a disease or injury to the cervical spine during service. For example, the Veteran claims the motor vehicle accident that caused the cervical spine injury occurred in 1971. However, the service treatment records from 1971 show the Veteran seeking treatment for multiple medical symptoms, such as upper respiratory infection, psychiatric symptoms, corneal abrasion, chest pain, thoracic muscle pain, lymphadenopathy, and low back pain. Absent from these treatment records is complaints of a neck or cervical spine disease or injury. Additionally, the November 1971 separation examination shows that clinical evaluations of neck and spine were normal. While the examiner noted a history of a recurrent thoracolumbar spine strain over the last month, the examiner did not document an underlying disease or injury, and the examiner's notation did not document a diagnosis related to the cervical spine. Given the many details provided as to the history of pain in the thoracolumbar spine, the Board finds it highly likely that the examiner would have provided the same attention to detail had the examination revealed abnormalities or a history of abnormalities involving the cervical spine. Furthermore, on the Report of Medical History completed by the Veteran at the time of the separation examination, the Veteran, despite reporting a positive history of recurrent back pain, did not document having or having had any symptoms related to his cervical spine. Additionally, when asked on that document whether he had experienced any illness or injury other than those already noted on the form, the Veteran checked, "No." This does not support the Veteran having been in a motor vehicle accident that totaled the car, which resulted in him being given a sling and a neck brace. There are STRs dated in December 1971, after the Veteran completed this Report of Medical History where he reports low back pain. Thus, the preponderance of the evidence is against a finding of a disease or injury related to the cervical spine during service. The Board acknowledges that the Veteran testified to a motor vehicle accident while on emergency leave in 1971. However, the Board finds this testimony is not credible, and is therefore, not probative. Initially, the Board notes that the Veteran's statements regarding the circumstances of this accident have been inconsistent. The Veteran first reported that he had an accident in the summer of 1971 in an August 2012 statement. He reported that he returned to duty after his emergency leave in 1971 with a neck brace and that his cervical spine never properly healed following that accident. At an April 2016 VA examination, the Veteran again reported the 1971 accident, but, this time, he stated that he did not report the injuries upon return and was not seen for pain in his neck for years after the accident, which the Board notes is the first time the Veteran reported he did not report the injuries or have treatment for the injuries prior to or at the time of his return to active duty following his emergency leave. In an August 2017 statement, the Veteran again changed his story regarding the 1971 motor vehicle accident. Specifically, the Veteran reported that his emergency leave was extended due to his injuries after the accident. At this time, the Veteran submitted a sworn statement from another person in the car at the time of the accident, but the sworn statement noted that the Veteran returned to active duty shortly after the accident and that person did not know the extent of the injuries following the accident. This sworn statement is inconsistent with the Veteran's report that his leave was extended as a result of the accident. At the December 2020 hearing, the Veteran again changed his story, noting that he cannot remember if he reported the accident when he went back to service following his 1971 emergency leave, but he testified that he returned with a sling and neck brace that he wore at night because he did not want people to see him with injuries during the daytime. The Board finds these inconsistencies in the Veteran's story regarding the 1971 motor vehicle accident to weigh against the Veteran's credibility, as the details on which the Veteran is inconsistent are major details regarding his reports to the military regarding the accident, including whether or not he reported the accident at all, and whether or not his leave was extended as a result of the reported injuries related to the accident. Furthermore, while inconsistent with each other, the Veteran's statements regarding his reported 1971 motor vehicle accident are also inconsistent with the STRs. As noted above, the STRs do not document an injury to the cervical spine at any point during active service. Had the Veteran been injured severely enough to require the use of a neck brace, consistent with some of his testimony and statements related to the motor vehicle accident, such significant pain would likely have been noted in his STRs, as his STRs show the Veteran was seen regularly during service for all sorts of medical complaints. Furthermore, if the Veteran's testimony that his emergency leave had been extended as a result of the accident were correct, that would also likely have been noted and his injuries noted in his STRs upon his return. At the very least, the history of injury would have been documented on his separation examination or the associated Report of Medical History, as the Report of Medical History, where he denied "ever had an illness or injury other than those already noted." He reported a positive history of recurrent back pain, and it was documented that this pain was believed to be a "minor strain through there is no history of trauma." The Board finds that it is reasonable to conclude that if the Veteran had sustained a neck injury that required hospitalization, that he would have documented such fact in this record, as he thought to document back pain with a denial of trauma. Contemporaneous evidence is especially probative. These inconsistencies with the contemporaneous medical records also weigh against the Veteran's credibility. Finally, the Board notes that the claims file documents injuries to the cervical spine other than the 1971 motor vehicle. First, in a June 1978 statement, approximately seven years after the Veteran's service discharge, the Veteran reported that he experienced severe whiplash following a June 1978 motor vehicle accident, where he was a passenger in the car and specifically documented experiencing a "cervical strain." In February 1988, the Veteran was diagnosed with a mass in his left neck. The Veteran reported at that time that he had seen a chiropractor from August to December 1987 following an incident in which a box fell on his neck. The Veteran reiterated the incident of the box falling on his cervical spine when treated in April 2010 along with complaints of ongoing pain in his cervical spine. At the time of the February 1988 and April 2010 treatment, the Veteran did not report a history of a cervical spine injury dating back to a 1971 motor vehicle accident. It is not until after filing the claim for service connection for a cervical spine disability in April 2011 that the Veteran first reported a motor vehicle accident in the summer of 1971. For all these reasons, the Board finds the preponderance of the evidence is against an in-service disease or injury involving the cervical spine and a nexus between the cervical spine disability and service. Thus, direct service connection is not warranted. Despite not meeting the criteria for service connection on a direct basis due to the preponderance of the evidence being against a finding that the disability had an onset in service, the Board will still address the claim that his current cervical spine disability is caused or aggravated by his service-connected thoracolumbar spine disability. The Board finds the preponderance of the evidence is against a finding that the cervical spine disability was caused or aggravated by the thoracolumbar spine. An April 2016 VA examiner opined that the current cervical spine disability is less likely than not caused or aggravated by the thoracolumbar spine. The examiner noted that that the thoracolumbar spine did not document T7 wedging or dextroscoliosis and his current lumbar disc protrusion and minimal degenerative joint disease would not cause problems in the cervical spine, as they are separate conditions. The examiner further noted that degenerative disc disease of the cervical spine is normally caused by heredity, frequent, recurring jarring of the cervical spine, or a known neck injury. The Board notes that the claims file documents a history of a cervical spine injury following a 1978 motor vehicle accident, as well as an incident in which a box fell on the cervical spine in 1987, which could constitute a post-service known neck injury. The Board finds that the April 2016 VA opinion is competent and probative regarding secondary service connection, opining that the service-connected thoracolumbar spine disability is not related to the current cervical spine disability. The examiner reviewed the evidence of record and provided a rationale for the conclusion. While the examiner did not specifically address "aggravation," the Board finds that the opinion is distinguishable from the holding in El-Amin v. Shinseki, 26 Vet. App. 136 (2013). In that case, the U.S. Court of Appeals for Veterans Claims (Court) found that the examiner's opinion that it was "more likely than not that the veteran's alcohol abuse was related to factors other than the veteran's post-traumatic stress disorder" did not rule out the possibility that the veteran's service-connected PTSD aggravated his alcohol abuse to some degree. Id. In contrast, here, the April 2016 examiner opined that that the cervical spine disability was more likely due to one of the other causes of a degenerative disc disease, including a pervious injury, which the Board notes is supported by the medical records in the claims file. Furthermore, the examiner noted that the nature of the thoracolumbar spine disability was a separate and distinct injury than degenerative disc disease of the cervical spine. Because the examiner clearly opined that there was no medical relationship between the service-connected thoracolumbar spine and the cervical spine disability, the examiner's statement, unlike that of the examiner in El-Amin, rules out the possibility that the service-connected disability may aggravate to some degree the non-service-connected disability. Thus, the Board finds that the examiner's opinion addressed both causation and aggravation and is, therefore, probative regarding whether the service-connected disability caused or aggravated the cervical spine disability. Furthermore, the Board finds that the April 2016 VA medical opinion is highly probative, as the examiner reviewed the file, listened to the Veteran's report of history, physically examined the Veteran, and provided a rationale for the opinion that relied on the specific facts of the case, which facts are accurate. There is no competent evidence to weigh against this medical opinion. Thus, service connection for the cervical spine on a secondary basis is also denied. Finally, where a veteran served 90 days or more of active service, and certain chronic diseases, such as degenerative joint disease, become manifest within one year after the date of separation from such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.307, 3.309(a). Despite not meeting the requirements for service connection on a direct and secondary basis, the Board notes that degenerative joint disease is a chronic disease under 38 C.F.R. § 3.309, which allows for service connection on a presumptive basis if the chronic disease is manifested to a compensable degree within one year of discharge from service. However, in this case the preponderance of the evidence is against finding that the degenerative joint disease had an onset within one year of service discharge. Rather, degenerative joint disease was not diagnosed until the April 2016 VA examination, approximately 45 years after the Veteran's discharge from service. Thus, service connection on a presumptive basis for a chronic disease is not warranted denied. While the Veteran is competent to report symptoms that he has experienced in service and since service, he is not competent to directly link the current cervical spine disability to service or a service-connected disability, as medical expertise is required. In this regard, the question of causation involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship. As such, the question of etiology in this case may not be competently addressed by lay evidence, and the Veteran's own opinion is nonprobative evidence. In reaching the above conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, that doctrine is not applicable where, as here, there is not an approximate balance of positive and negative evidence. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Thus, the claim for service connection for a cervical spine disability is denied. REASONS FOR REMAND 6. Entitlement to service connection for arrhythmia, or any other heart disability The Veteran was provided a VA examination in March 2015 to assess the nature and etiology of his arrhythmia or any other heart disability. In the December 2015 NOD, the Veteran requested a copy of the CV, list of publications, and list of specialties of the examiner who conducted the March 2015 VA examination pertaining to his heart claim. The Veteran has not yet been provided these materials. The matter is REMANDED for the following action: Provide the Veteran and the representative with the qualifications and credentials of the VA examiner, who performed the March 2015 VA examination involving the heart. See December 10, 2015 NOD submitted by the Veteran. A. P. SIMPSON Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Keninger, 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.