Citation Nr: 21032838 Decision Date: 05/28/21 Archive Date: 05/28/21 DOCKET NO. 17-62 587 DATE: May 28, 2021 ORDER New and material evidence having been submitted, a claim of service connection for a lumbosacral strain disability is reopened. Entitlement to service connection for a lumbosacral strain disability is granted. New and material evidence having been submitted, a claim of service connection for a right knee disability is reopened. Entitlement to service connection for a right knee disability is granted. New and material evidence having been submitted, a claim of service connection for a left knee disability is reopened. Entitlement to service connection for a left knee disability is granted. New and material evidence having been submitted, a claim of service connection for a OSA disability is reopened. Entitlement to service connection for an obstructive sleep apnea (OSA) disability is granted. Whether new and material evidence has been received to reopen the previously denied claim for service connection for a pulmonary disability is denied. New and material evidence having been submitted, a claim of service connection for a right wrist disability is reopened. Entitlement to service connection for a right wrist disability is denied. New and material evidence having been submitted, a claim of service connection for a left wrist disability is reopened. Entitlement to service connection for a left wrist disability is denied. FINDINGS OF FACT 1. The claim for service connection for a lumbosacral strain disability was previously denied in a September 2015 rating decision and the Veteran did not appeal the decision. 2. Evidence associated with the claims file subsequent to the final September 2015 rating decision for service connection for a lumbosacral strain disability relates to an unestablished fact, is not cumulative or redundant of the evidence previously of record, and is sufficient to raise a reasonable possibility of substantiating the claim. 3. The evidence of record is in relative equipoise as to whether the Veteran's back disability is related to service. 4. The claim for service connection for a right knee disability was previously denied in a September 2015 rating decision and the Veteran did not appeal the decision. 5. Evidence associated with the claims file subsequent to a final September 2015 rating decision for service connection for a right knee disability relates to an unestablished fact, is not cumulative or redundant of the evidence previously of record, and is sufficient to raise a reasonable possibility of substantiating the claim. 6. The Veteran's right knee disability is related to service. 7. The claim for service connection for a left knee disability was previously denied in a September 2015 rating decision and the Veteran did not appeal the decision. 8. Evidence associated with the claims file subsequent to a final September 2015 rating decision for service connection for a left knee disability relates to an unestablished fact, is not cumulative or redundant of the evidence previously of record, and is sufficient to raise a reasonable possibility of substantiating the claim. 9. The Veteran's left knee disability is related to service. 10. The claim for service connection for an OSA disability was previously denied in a September 2015 rating decision and the Veteran did not appeal the decision. 11. Evidence associated with the claims file subsequent to a final September 2015 rating decision for service connection for an OSA disability relates to an unestablished fact, is not cumulative or redundant of the evidence previously of record, and is sufficient to raise a reasonable possibility of substantiating the claim. 12. The Veteran's OSA is related to service. 13. The claim for service connection for a pulmonary disability was previously denied in a September 2015 rating decision and the Veteran did not appeal the decision. 14. Evidence associated with the claims file subsequent to a final September 2015 rating decision for service connection for a pulmonary disability does not relate to an unestablished fact, is cumulative or redundant of the evidence previously of record, and is insufficient to raise a reasonable possibility of substantiating the claim. 15. The claim for service connection for a right wrist disability was previously denied in a September 2015 rating decision and the Veteran did not appeal the decision. 16. Evidence associated with the claims file subsequent to a final September 2015 rating decision for service connection for a right wrist disability relates to an unestablished fact, is not cumulative or redundant of the evidence previously of record, and is sufficient to raise a reasonable possibility of substantiating the claim. 17. The Veteran does not have a right wrist disability. 18. The claim for service connection for a left wrist disability was previously denied in a September 2015 rating decision and the Veteran did not appeal the decision. 19. Evidence associated with the claims file subsequent to a final September 2015 rating decision for service connection for a left wrist disability relates to an unestablished fact, is not cumulative or redundant of the evidence previously of record, and is sufficient to raise a reasonable possibility of substantiating the claim. 20. The Veteran does not have a left wrist disability. CONCLUSIONS OF LAW 1. The September 2015 rating decision denying a claim to service connection for a lumbosacral strain disability is final. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. 2. The criteria for reopening or reconsideration of the claim of entitlement to service connection for lumbosacral strain are met. 38 U.S.C. §§ 5108, 7105(c); 38 C.F.R. §§ 3.156(a), 20.1103. 3. The criteria for entitlement to service connection for a lumbosacral strain (back) disability are met. 38 U.S.C. §§ 1101, 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 4. The September 2015 rating decision denying a claim to service connection for a right knee disability is final. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. 5. The criteria for reopening or reconsideration of the claim of entitlement to service connection for a right knee are met. 38 U.S.C. §§ 5108, 7105(c); 38 C.F.R. §§ 3.156(a), 20.1103. 6. The criteria for entitlement to service connection for a right knee disability are met. 38 U.S.C. §§ 1101, 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 7. The September 2015 rating decision denying a claim to service connection for a left knee disability is final. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. 8. The criteria for reopening or reconsideration of the claim of entitlement to service connection for a left knee disability are met. 38 U.S.C. §§ 5108, 7105(c); 38 C.F.R. §§ 3.156(a), 20.1103. 9. The criteria for entitlement to service connection for a left knee disability are met. 38 U.S.C. §§ 1101, 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 10. The September 2015 rating decision denying a claim to service connection for an OSA disability is final. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. 11. The criteria for reopening or reconsideration of the claim of entitlement to service connection for an OSA disability are met. 38 U.S.C. §§ 5108, 7105(c); 38 C.F.R. §§ 3.156(a), 20.1103. 12. The criteria for entitlement to service connection for OSA are met. 38 U.S.C. §§ 1101, 1110, 1117, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.317. 13. The September 2015 rating decision denying a claim to service connection for a pulmonary disability is final. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. 14. The criteria for reopening or reconsideration of the claim of entitlement to service connection for a pulmonary disability are not met. 38 U.S.C. §§ 5108, 7105(c); 38 C.F.R. §§ 3.156(a), 20.1103. 15. The September 2015 rating decision denying a claim to service connection for a right wrist disability is final. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. 16. The criteria for reopening or reconsideration of the claim of entitlement to service connection for a right wrist disability are met. 38 U.S.C. §§ 5108, 7105(c); 38 C.F.R. §§ 3.156(a), 20.1103. 17. The criteria for entitlement to service connection for a right wrist disability are not met. 38 U.S.C. §§ 1101, 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 18. The September 2015 rating decision denying a claim to service connection for a left wrist disability is final. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. 19. The criteria for reopening or reconsideration of the claim of entitlement to service connection for a left wrist disability are met. 38 U.S.C. §§ 5108, 7105(c); 38 C.F.R. §§ 3.156(a), 20.1103. 20. The criteria for entitlement to service connection for a left wrist disability are not met. 38 U.S.C. §§ 1101, 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from July 1993 to July 1999, January 2003 to March 2004, June 2007 to January 2008, and November 2009 to September 2010. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2017 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran provided testimony at a July 2020 virtual hearing before the undersigned Veterans Law Judge at the RO. A transcript of the hearing is associated with the claims folder. New and Material Evidence VA may reopen a claim that has been previously denied if new and material evidence is submitted by or on behalf of a veteran. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). Effective March 24, 2015, VA adopted a standardized claims system. 79 Fed. Reg. 57,660, 57,698 (Sept. 25, 2014). VA deleted 38 C.F.R. § 3.157, which allowed for reports of examination or hospitalization to be treated as claims in certain circumstances, and completely rewrote 38 C.F.R. § 3.155, removing the provisions which allowed for the filing of informal claims. For claims to reopen decided prior to February 19, 2019, new evidence is defined as evidence not previously submitted to agency decision makers and material evidence is evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last final denial of the claim(s) sought to be reopened, and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). Where new and material evidence is received prior to the expiration of the appeal period, or prior to the appellate decision if a timely appeal has been filed, it will be considered as having been filed in connection with the claim which was pending at the beginning of the appeal period. 38 C.F.R. § 3.156 (b). To reopen a claim, it is not required that new and material evidence be received as to each previously unproven element of a claim. Where a prior denial was based on lack of current disability and nexus, newly submitted evidence of a current disability was, in concert with evidence already of record establishing an injury in service, new and material and sufficient to reopen the claim and obtain an examination. See Shade v. Shinseki, 24 Vet. App. 110, 117 (2010). For purposes of the "new and material" analysis, the credibility of the evidence is presumed. Justus v. Principi, 3 Vet. App. 510, 512-513 (1992). The term "service connection" applies to disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a). Entitlement to service connection requires (1) medical evidence of current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of disease or injury; and (3) medical evidence of a nexus between the in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). 1. Whether new and material evidence has been received to reopen the previously denied claim for lumbosacral strain (back pain) disability 2. Whether new and material evidence has been received to reopen the previously denied claim for a right knee disability 3. Whether new and material evidence has been received to reopen the previously denied claim for a left knee disability 4. Whether new and material evidence has been received to reopen the previously denied claim for an obstructive sleep apnea (OSA) disability 5. Whether new and material evidence has been received to reopen the previously denied claim for a pulmonary disability 6. Whether new and material evidence has been received to reopen the previously denied claim for a right wrist disability 7. Whether new and material evidence has been received to reopen the previously denied claim for a left wrist disability A September 2015 rating decision denied all of the aforementioned claims on appeal. The denial for the back, pulmonary, and OSA were based on a lack of nexus, i.e. the evidence failed to show the current disabilities were related to service. The denial for the right wrist, left wrist, right knee, and left knee were based on a lack of diagnosis. The evidence of record at the time of the September 2015 rating decision included the service treatment records; military personnel records; and VA examinations for the back and OSA claims. The Veteran did not timely appeal the claims, nor did he submit new and material evidence. Therefore, the September 2015 rating decision became final. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. The relevant evidence receive since the final September 2015 rating decision is detailed below. An August 2016 private examination addressing the etiology for the back, OSA, right knee, right wrist, and left knee claims; VA treatment records for the OSA, back, and pulmonary claim; December 2016 VA examinations addressing the diagnosis and etiology for the back, OSA, bilateral knee, and bilateral wrist claims; and an August 2020 statement from the Veteran's son addressing the OSA claim. As the above described evidence includes VA and private examinations addressing the question of diagnosis and nexus to service, evidence submitted since the previous rating decision addresses an unestablished fact related to an unproven element of the Veteran's claim for service connection for the back, OSA, right wrist, left wrist, right knee, and left knee disabilities. See Justus v. Principi, 3 Vet. App. 510, 512-13 (1992); see also Hodge v. West, 155 F.3d 1356, 1363 (Fed. Cir. 1998); Shade v. Shinseki, 24 Vet. App. 110 (2010). Thus, this evidence is both "new," as it has not been previously considered by the VA, and "material," as it raises a reasonable possibility of substantiating the Veteran's service connection claim. Therefore, the claim for the back, OSA, right wrist, left wrist, right knee, and left knee are all reopened. However, the Board finds that reopening the entitlement to service connection for a pulmonary disability claim is not warranted. The treatment records submitted since the decision further confirms the Veteran has a current disability. As this evidence was already before VA at the time of the prior final decision, the evidence submitted is not "material," as it does not relate to an unestablished fact, is cumulative or redundant of evidence previously submitted, nor raise a reasonable possibility of substantiating the Veteran's service connection claim of entitlement to a pulmonary disability.. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection requires: (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); see also Caluza v. Brown, 7 Vet. App. 498 (1995). Service connection may also be granted for any disease diagnosed after discharge when the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). In addition, for certain chronic diseases, a presumption of service connection arises if the disease is manifested to a degree of 10 percent within one year following discharge from service. 38 C.F.R. §§ 3.307, 3.309(a). When a chronic disease is not shown within one year after service, under 38 C.F.R. § 3.303(b) 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. When the fact of chronicity in service is not adequately supported, a showing of continuity after discharge is required to support a claim for such diseases; however, such continuity of symptomatology may only support a claim for those chronic diseases listed under 38 C.F.R. §§ 3.303(b), 3.309(a); see Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). A Persian Gulf veteran is defined as a veteran who served on active duty in the Armed Forces in the Southwest Asia Theater of operations during the Persian Gulf War. See 38 U.S.C. § 1117; 38 C.F.R. § 3.317 (d)(1). The Southwest Asia Theater of operations includes Iraq, Kuwait, Saudi Arabia, the neutral zone between Iraq and Saudi Arabia, Bahrain, Qatar, the United Arab Emirates, Oman, the Gulf of Aden, the Gulf of Oman, the Persian Gulf, the Arabian Sea, the Red Sea, and the airspace above these locations. See 38 U.S.C. § 1117; 38 C.F.R. § 3.317 (d)(2). Under 38 U.S.C. § 1117 (a)(1), compensation is warranted for a Persian Gulf veteran who exhibits objective indications of a "qualifying chronic disability" that became manifest during service on active duty in the Armed Forces in the Southwest Asia theater of operations during the Persian Gulf War, or to a degree of 10 percent during the presumptive period prescribed by the Secretary. To constitute a "qualifying" chronic disability, the chronic disability must not be attributed to any known clinical disease by history, physical examination, or laboratory tests. See 38 U.S.C. § 1117; 38 C.F.R. § 3.317 (a)(1). The term "objective indications of chronic disability" includes both "signs," in the medical sense of objective evidence perceptible to an examining physician, and other, non-medical indicators that are capable of independent verification. See 38 U.S.C. § 1117; 38 C.F.R. § 3.317 (a)(3). Signs or symptoms which may be manifestations of undiagnosed illness or medically unexplained chronic multi-symptom illness include, but are not limited to: Fatigue, signs or symptoms involving skin, headache, muscle pain, joint pain, neurologic signs and symptoms, neuropsychological signs or symptoms, signs or symptoms involving the respiratory system (upper or lower), sleep disturbances, gastrointestinal signs or symptoms, cardiovascular signs or symptoms, abnormal weight loss, menstrual disorders. See 38 U.S.C. § 1117; 38 C.F.R. § 3.317 (b). A qualifying chronic disability means a chronic disability resulting from any of the following (or any combination of the following): An undiagnosed illness; the following medically unexplained chronic multi-symptom illnesses that are defined by a cluster of signs or symptoms: Chronic fatigue syndrome; Fibromyalgia; Irritable bowel syndrome; Any diagnosed illness that the Secretary determines warrants a presumption of service-connection; or Any other illness that the Secretary determines meets the following criteria for a medically unexplained chronic multi-symptom illness. See 38 U.S.C. § 1117; 38 C.F.R. § 3.317 (a)(2). The term medically unexplained chronic multi-symptom illness means a diagnosed illness without conclusive pathophysiology or etiology, that is characterized by overlapping symptoms and signs and has features such as fatigue, pain, disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities. Chronic multi-symptom illnesses of partially understood etiology and pathophysiology will not be considered medically unexplained. See 38 U.S.C. § 1117; 38 C.F.R. § 3.317(a)(2). Disabilities that have existed for 6 months or more and disabilities that exhibit intermittent episodes of improvement and worsening over a 6-month period will be considered chronic. The 6-month period of chronicity will be measured from the earliest date on which the pertinent evidence establishes that the signs or symptoms of the disability first became manifest. A chronic disability resulting from an undiagnosed illness shall be rated using evaluation criteria from part 4 of this chapter for a disease or injury in which the functions affected, anatomical localization, or symptomatology are similar. A disability shall be considered service connected for purposes of all laws of the United States. 38 U.S.C. § 1117 38 C.F.R. § 3.317(a)(4). The applicable presumptive period specified in 38 C.F.R. § 3.317(a)(1)(i) has been extended several times and it currently ends December 31, 2021. Compensation shall not be paid if there is affirmative evidence that an undiagnosed illness was not incurred during active military, naval, or air service in the Southwest Asia theater of operations during the Persian Gulf War; or if there is affirmative evidence that an undiagnosed illness was caused by a supervening condition or event that occurred between the veteran's most recent departure from active duty in the Southwest Asia theater of operations during the Persian Gulf War and the onset of the illness; or if there is affirmative evidence that the illness is the result of the veteran's own willful misconduct or the abuse of alcohol or drugs. See 38 U.S.C. § 1117; 38 C.F.R. § 3.317(c). VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded the claimant. 8. Entitlement to service connection for a back disability The Veteran claims his back is related to service. Specifically, he alleges he injured his back in 2008. For the reasons discussed below, the Board finds the evidence is in relative equipoise and service connection is warranted. The service treatment records (STRs) reveal that the Veteran's back problems began in September 2008, while in the reserves, which reflects a back-muscle spasms diagnosis. He reported recurrent episodic back pain for several years, including during active duty. In August 2010, toward the end of his final active duty tour, back-muscle spasm was noted, and the Veteran was prescribed medication. Post active-day, bask-muscle spasm was noted again in November 2010. In January 2011 military records, the commanding officer recommended the Veteran receive a fit for duty examination due to severe back muscle spasms. He was subsequently disqualified for service due to the back condition. Post service, an August 2015 VA examination report indicated review of the Veteran's claims file, recounted the Veteran's history, and recited his complaints. He indicated there is no specific back injury/illness event; however, the current back condition is a cumulative effect of having to be in numerous positions for airplane repairs. He currently works as an aircraft mechanic. The examiner opined the condition claimed was less likely than not incurred in or caused by the claimed in-service injury, event or illness. It was reasoned, "in review of STR Veteran had an isolated occurrence of back complaints that does not constitute a chronic disability pattern." The examiner noted the STR medical examinations which were negative for back complaints and results indicated the Veteran's spine was normal. Further, the examiner noted the August 2015 X-ray were negative for a back condition. It was noted there was no diagnosis rendered and no current pathology. An August 2016 private examination report indicated review of the Veteran's claims file, recounted the Veteran's history, and recited his complaints. He was diagnosed with lumbosacral sprain, degenerative disc disease (DDD), and radiculopathy. The doctor opined the lumbago is more likely as not incurred in or caused by the claimed in-service injury, event, or illness. It was also opined the bilateral radiculopathy is more likely as not incurred in or caused by the claimed in-service injury, event, or illness. It was reasoned "the Veteran developed low back pain in 2008. This condition has progressively worsened to the present date." Additionally, the doctor reasoned, there are numerous STRs concerning low back pain beginning in 2008 through 2010. Once a person injures the spine, the condition becomes chronic. The doctor found, "the nexus is formed due to the fact that unlike other injuries of the body, once the spine is injured (chronically,) the disc cannot repair itself and the condition continues to worsen and spirals into a degenerative state as demonstrated by the Veteran's most recent MRI." A December 2016 VA examination report indicated review of the Veteran's claims file, recounted the Veteran's history, and recited his complaints. The examiner opined the condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. It was reasoned that the STRs do not document chronic on-going treatment for a back condition. "He was seen briefly for back spasm which was a temporary condition." The examiner noted the private provider gave positive opinions that do not accurately reflect the service records and the current medical examination is not an accurate medical interpretation. The Board has reviewed all of the lay and medical evidence of record in conjunction with the applicable laws and regulations and finds the evidence is at least in equipoise as to whether the Veteran's back disability is related to service. The Board acknowledges there is an equal balance of positive and negative medical evidence in the claims file. Both the August 2016 private doctor and December 2016 VA examiner provided medical opinions supported by rationales relying on evidence. As such, considering the equal balance of positive and negative evidence, the Board finds the evidence of record is in relative equipoise as to whether the Veteran's back disability is related to active duty service. When cases such as this contain an approximate balance of positive and negative evidence regarding the matter at issue, the Board must resolve reasonable doubt in the Veteran's favor. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. 49. Accordingly, the credible supporting statements coupled with the private opinions support a grant of service connection. Upon resolution of all reasonable doubt in favor of the Veteran, the Board determines that the evidence of record is in relative equipoise as to whether his current back disability is related to active duty service. As such, the benefit of the doubt rule applies. Id. at 58. Therefore, the Veteran's claim of service connection for a back disability is granted. 9. Entitlement to service connection for a right knee disability 10. Entitlement to service connection for a left knee disability The Veteran claims the bilateral knee disability is related to 1994 in-service shin splints. For the reasons discussed below, the Board finds service connection is warranted. In November 1994 STRs the Veteran complained of bilateral shin splints with radiating pain for 3 weeks. In the May 1999 report of medical history, the Veteran denied swollen or painful joints. The concurrent medical examination reflected normal clinical findings for the lower extremities. In the September 2006 report of medical history, the Veteran denied knee troubles and swollen or painful joints. On the concurrent medical examination normal clinical findings were noted for the lower extremities. Post service, in July 2016 private treatment records, the Veteran was seen for bilateral shin pain. It was noted the pain was the result of direct trauma, overuse of joint, or repeated injury. An August 2016 private examination report indicated review of the Veteran's claims file, recounted the Veteran's history, and recited his complaints. He was diagnosed with left knee strain, left knee tendonitis, left knee meniscal tear, left knee joint osteoarthritis and bilateral knee shin splints. The doctor opined the shin splints are more likely as not incurred in or caused by the claimed in-service injury, event, or illness. Also, it was opined the claimed bilateral knee pain is more likely as not incurred in or caused by the claimed in-service injury, event, or illness. It was reasoned, as degenerative conditions are more likely than not to worsen with time. Shin splints, also known as medial tibial stress syndrome (MTSS), are caused by repeated trauma to the connective muscle tissue surrounding the tibial. Once the connective tissue separates the patient will feel pain that can radiate from the ankle to the knee. As illustrated below, an individual who suffers from a shin splint injury will normally begin to place uneven body weight on the affected lower extremity. This uneven stress, due to, overcompensation will result in abnormal pressure on the knee. Since it is well documented that the Veteran experienced these injuries while on active service, this is more likely than not the catalyst/nexus of the Veteran's degenerative right knee condition. A December 2016 VA examination report indicated review of the Veteran's claims file, recounted the Veteran's history, and recited his complaints. He was diagnosed with bilateral degenerative arthritis. The examiner opined the condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. It was reasoned, STR's are silent for complaint, diagnosis, or treatment of [the] right or left knee. Review of available records in VBMS and Vista Web, first documented complaint of bilateral knees [on] 5/6/2016, which is six years after his most recent activation with National Guard. It is less likely than not, [the] Veteran's [degenerative joint disease] of bilateral knees is due to or caused by shin splints, and is more likely than not due to natural progression of aging and history [as an] avid runner. The Board has reviewed all of the lay and medical evidence of record in conjunction with the applicable laws and regulations and finds the current disabilities are related to service. In this regard the Board finds the August 2016 private examination report probative. The doctor reviewed the record, examined the Veteran, and provided a clear rationale consistent with the existing medical record. To the contrary the December 2016 VA examiner incorrectly found STR's are silent for complaint, diagnosis, or treatment of either knee. STR's reflected November 1994 shin splint complaints. The weight of a medical opinion is diminished where that opinion is ambivalent, based on an inaccurate factual premise, based on an examination of limited scope, or where the basis for the opinion is not stated. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993); Sklar v. Brown, 5 Vet. App. 140 (1993). Accordingly, service connection for a right and left knee disability is granted. 11. Entitlement to service connection for OSA The Veteran claims his OSA is related to service. Specifically, during the July 2020 Board hearing he indicated his PTSD affects his sleep. Also, he alleged his wife told him he snored and gasped for breath while in service. Resolving all reasonable doubt in the Veteran's favor, the Board finds that service connection is warranted as directly related to service. STRs do not reflect any symptoms, diagnosis, or treatment for a sleep disability. In the September 2006 report of medical history, the Veteran denied trouble sleeping. The concurrent medical examination did not note any sleep related abnormality. Post service, an August 2015 VA examination report indicated review of the Veteran's claims file, recounted the Veteran's history, and recited his complaints. He was diagnosed with obstructive sleep apnea. He reported an initial onset of symptoms in 2007 while deployed to Kuwait. He alleged his sleep/wake cycle was disrupted due to him being required to remain awake at night and sleep during the day. It was opined it is less likely as not that the Veteran's sleep apnea is related to a specific exposure during service in Southwest Asia. It was reasoned, "the Veteran's disability pattern, obstructive sleep apnea, is a disease with a clear and specific etiology and diagnosis. Obstructive sleep apnea is due to obstruction of airway during sleep. There are several risk factors to include obesity, narrow airway, and genetic predisposition." A September 2015 sleep study reflected a mild OSA diagnosis, mostly positional, associated with mild oxygen. The physician recommended the Veteran lose weight, avoid sleeping in a supine position, and avoid alcohol and/or sedating medications. An August 2016 private examination report indicated review of the Veteran's claims file, recounted the Veteran's history, and recited his complaints. He was diagnosed with obstructive sleep apnea. He reported experiencing heavy snoring and persistent daytime sleepiness after exposure to burn pits while deployed. The doctor opined the Veteran's claimed OSA is as likely as not service related. It was reasoned, "this condition occurred after the Veteran was discharged from service. There is a causal connection between the exposure to environmental pollution, such as burn pits, and OSA." A December 2016 VA examination report indicated review of the Veteran's claims file, recounted the Veteran's history, and recited his complaints. The examiner opined the condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. It was reasoned, STRs do not document chronic on-going treatment for sleep apnea. "He was seen for insomnia which is a distinct and separate diagnosis." The examiner noted the private provider gave positive opinions that do not accurately reflect the service records and the current medical examination is not an accurate medical interpretation. In August 2020 the Veteran's son, A.G. provided a statement. He indicated after his father returned from Iraq in 2007, he observed the Veteran snore softly which worsened over time. The Veteran experiences heavy loud snoring and gasping for air twice a week. The Board has reviewed all of the lay and medical evidence of record in conjunction with the applicable laws and regulations and finds the current disability is related to service. In this regard the Board finds the negative December 2016 VA opinion inadequate. In opining the OSA was not directly related to service, the examiner reasoned STRs do not document chronic on-going treatment for sleep apnea. However, the lack of documented treatment in service cannot by itself constitute an adequate basis for a negative opinion. Dalton v. Peake, 21 Vet. App. 23 (2007). Rather the examiner is required to address whether the current OSA is related to an in-service illness or event. Likewise, the Board finds the August 2016 private examination report is inadequate. For the rationale, the doctor noted "there is a causal connection between the exposure to environmental pollution, such as burn pits, and OSA." However, there was no rationale for this finding. The Court has held that a bare conclusion, even one reached by a health care professional, is not probative without a factual predicate in the record. Miller v. West, 11 Vet. App. 345, 348 (1998). Therefore, the etiology opinion is not probative. In view of the extended time this claim has been on appeal and considering VA's failure to provide adequate medical development, rather than remand for a VA addendum opinion on direct service connection for OSA, the Board will resolve doubt in the Veteran's favor and grant service connection as directly related to his in-service snoring. Notably, the Veteran and family members have provided a competent statements indicating he observed the Veteran snoring and gasping for air after returning from Iraq. There is no evidence to contradict these statements or indicate they are otherwise non-credible. Accordingly, the Board finds that the criteria for service connection for OSA have been approximated and the claim will be granted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 12. Entitlement to service connection for a right wrist disability 13. Entitlement to service connection for a left wrist disability The Veteran claims his left and right wrist are related to service. Specifically, during the July 2020 Board hearing he alleged the bilateral wrist disability was due to repetitive motion injuries from being an aircraft mechanic pushing and pulling heavy objects while working on an aircraft. For the reasons discussed below, the Board finds the evidence weighs against a finding that the Veteran's has a current right or left wrist disability. Therefore, service connection is not warranted. In September 1993 STRs the Veteran complained of a bump on his right wrist resulting in numbness. The assessment/ diagnosis indicated it was an insect bite. Post service, an August 2016 private examination report indicated review of the Veteran's claims file, recounted the Veteran's history, and recited his complaints. He was diagnosed with chronic right wrist sprain and right wrist ostearthritis. The examination did not reflect testing for the left wrist. The doctor opined it is as likely as not that the Veteran's claimed wrist pain is a result of military service. The doctor noted the STR's are positive for wrist pain in 1993, the indication of a lump on the right wrist is a cause for concern and the military did not follow up or diagnose the problem, as the lump could have been a cyst or the start of a degenerative condition. No functional impact was noted, and no imaging studies of the wrist were completed. A December 2016 VA examination report indicated review of the Veteran's claims file, recounted the Veteran's history, and recited his complaints. There was no diagnosis noted. The examiner found there is insufficient evidence to warrant or confirm an acute or chronic right wrist disorder. An examination for both wrists were normal. No functional impact was noted. It was opined the condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. It was reasoned, STR's reviewed: Clinic note 9/20/1993 patient noted small nodule volar aspect left wrist one year ago. Diagnosis: Insect bite. It is noted that on the top of the 9/20/1993 note, wrist involved is identified as right wrist. The medical provider note identifies the left wrist as the source of complaint. Regardless, no further documentation of right or left wrist complaint, diagnosis, or treatment found in review of STR's and medical records in VBMS and Vista Web. Normal physical examination and normal x-ray [were noted for the] right wrist. There is insufficient evidence to warrant or confirm an acute or chronic left or right wrist disorder. The Board has reviewed all of the lay and medical evidence of record in conjunction with the applicable laws and regulations and finds the Veteran does not have a current right or left wrist disability. The threshold requirement for the granting of service connection is evidence of a current disability. In the absence of evidence of a current disability, in this matter a diagnosis of a cervical spine disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The requirement in a claim of service connection of current disability "is satisfied when a claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim and that a claimant may be granted service connection even though the disability resolves prior to the Secretary's adjudication of the claim." See McClain v. Nicholson, 21 Vet. App. 319 (2007). Additionally, for the purposes of service connection, pain alone, without any underlying pathology or disease process, can constitute a current disability if there is objective evidence that the pain causes functional impairment resulting in a decrease of earning capacity. Saunders v. Wilkie, 886 F.3d 1356, 1363 (Fed. Cir. 2018). Here, the totality of the competent evidence does not reflect that the Veteran has or has had a left wrist disability during the relevant period on appeal. In fact, the August 2016 private and December 2016 VA examination failed to note a left wrist disability. There were no post service treatment records identifying a left wrist condition. Notably both the private and VA report indicated there was no functional impact. Thus, there is no objective evidence that the Veteran's left wrist causes functional impairment, which results in a decrease of earning capacity. See Saunders, 886 F.3d at 1363. Although the August 2016 private doctor found the Veteran has a chronic right wrist sprain and right wrist ostearthritis, the Board finds the weight of the evidence is against this finding. The December 2016 VA examiner found there was insufficient evidence to warrant or confirm an acute or chronic right wrist disorder. There are no post service treatment records identifying a right wrist condition. Notably, the August 2016 private examination reflects a right wrist ostearthritis diagnosis, however, the report confirms there were no imaging studies of the right wrist completed. The disability benefits questionnaire used to submit the private opinion explicitly states, the diagnosis of osteoarthritis or traumatic arthritis must be confirmed by imaging studies. In this case that private doctor did not conduct or provide imaging studies of the wrist. As such the Board finds the evidence does not demonstrate the Veteran has a right wrist disability. Likewise, as there is no right wrist disability, there is no objective evidence that the Veteran's right wrist causes functional impairment, which results in a decrease of earning capacity. See Saunders, 886 F.3d at 1363. Accordingly, service connection for a right and left wrist disability is denied. As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not applicable. See 38 U.S.C.§5107(b); 38 C.F.R.§ 3.102; see also Gilbert, 1 Vet. App.at 53-56. JONATHAN B. KRAMER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. Jackman, Associate 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.