Citation Nr: 21040463 Decision Date: 07/03/21 Archive Date: 07/03/21 DOCKET NO. 17-08 624 DATE: July 3, 2021 ORDER Service connection for bilateral hearing loss disability is denied. Service connection for posttraumatic stress disorder (PTSD) is denied. Service connection for lumbar spine disability is denied. Service connection for cervical spine disability is denied. Service connection for right lower extremity (RLE) radiculopathy is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against finding right ear hearing loss disability during the pendency of the claim. 2. The preponderance of the evidence is against finding left ear hearing loss disability manifested during or is otherwise related to ACDUTRA or active service. 3. The preponderance of the evidence is against finding PTSD manifested during or is otherwise related to ACDUTRA or active service. 4. The preponderance of the evidence is against finding lumbar spine disability manifested during or is otherwise related to ACDUTRA or active service. 5. The preponderance of the evidence is against finding cervical spine disability manifested during or is otherwise related to ACDUTRA or active service. 6. The preponderance of the evidence is against finding RLE radiculopathy manifested during or is otherwise related to ACDUTRA or active service. CONCLUSIONS OF LAW 1. The criteria for service connection for bilateral hearing loss disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for PTSD are not met. 38 U.S.C. §§ 1101, 1131, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304. 3. The criteria for service connection for lumbar spine disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 4. The criteria for service connection for cervical spine disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 5. The criteria for service connection for RLE radiculopathy are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served a period of active duty for training (ACDUTRA) from February 1982 to May 1982 and a period of active duty from January 1991 to March 1991. The Veteran testified at a hearing before the undersigned Veterans Law Judge in November 2018. A transcript of the hearing is associated with the record. The Board notes some of the Veteran's STRs are missing. A March 2021 formal finding of unavailability noted that STRs were unavailable for the Veteran's period of service from January 1991 to March 1991. It was stated that all procedures to obtain STRs were exhausted and further attempts would be futile. The Veteran was informed of the STR unavailability by a March 2021 letter. When service records are missing through no fault of the claimant, VA has a heightened obligation to consider the applicability of the benefit of the doubt rule, to assist the claimant in developing his claim, and to explain its decision. O'Hare v. Derwinski, 1 Vet. App. 365 (1991). The Board's analysis has been undertaken with this heightened duty in mind. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). For periods of ACDUTRA, service connection may only be granted for a disability resulting from disease or injury incurred or aggravated while on ACDUTRA. 38 U.S.C. §§ 101 (24), 106; 38 C.F.R. § 3.6. Certain chronic diseases will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). The presumption of service connection applies to anyone who served on active duty for 90 days of active, continuous service. 38 C.F.R. § 3.307(a)(1); Biggins v. Derwinski, 1 Vet. App. 474, 478 (1991). The chronic disease presumption does not apply to claims based on a period of ACDUTRA. Smith v. Shinseki, 24 Vet. App. 40, 47 (2010). Accordingly, the chronic disease presumption is not applicable in this claim. 1. Service connection for bilateral hearing loss disability The Veteran contends entitlement to service connection for hearing loss disability. Specifically, he reported noticing diminished hearing after loud bursts of noise during firing squads around 1991. See November 2019 hearing testimony. Hearing loss disability is defined by regulation. For the purpose of applying the laws administered by VA, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. The preponderance of the evidence is against finding the Veteran's right ear hearing impairment meets the criteria for hearing loss disability under 38 C.F.R. § 3.385. See June 2015 VA treatment visit, July 2016 VA examination, and February 2017 VA treatment visit. The Board recognizes the Veteran has left ear hearing loss disability under 38 C.F.R. § 3.385. The Board recognizes the Veteran experienced noise exposure during ACDUTRA and active service. See January 2021 Board decision. Therefore, the question is whether his left ear hearing loss disability manifested during or is otherwise related to ACDUTRA or active service. STR do not show evidence of hearing loss during ACDUTRA or active service. See Hensley v. Brown, 5 Vet. App. 155, 157 (1993) (indicating that thresholds above 20 decibels are indicative of at least some degree of hearing loss). Even if no hearing loss or auditory shifts are noted in STRs, the Court has held that 38 C.F.R. § 3.385 does not preclude an award of service connection for a hearing disability established by post-service audiometric and speech-recognition scores, even when hearing was found to be within normal limits on audiometric and speech-recognition testing at the time of separation from service. Id. at 159; see also Ledford v. Derwinski, 3 Vet. App. 87, 89 (1992). Following separation from active service, an April 2010 VA treatment visit reported left side hearing loss. The Veteran reported that three years prior he came out of a concert and noticed loss of hearing in both ears. He reported his right ear hearing recovered and his left ear hearing did not recover. The clinician assessed marked left nonsyndromic hearing loss (NSHL). A June 2015 VA audiology consultation reported hearing loss for at least 20 years. He reported serving 12 years in the Army Reserves with noise exposure from grenades and rifles during training exercises. A July 2016 VA examination audiogram showed left ear hearing loss disability under 38 C.F.R. § 3.385. The clinician opined the Veteran's left ear hearing loss disability was less likely as not caused by or a result of military service. The clinician noted the Veteran's total time of active military service was five months. He noted the Veteran reported sudden hearing loss in the left ear in 1993 upon waking up one morning. The clinician stated his hearing evaluation revealed low frequency sensorineural hearing loss in the left ear with poor speech discrimination, which is consistent with a sudden hearing loss. He stated sudden sensorineural hearing loss may have several causes, including reduced blood flow to the inner ear, viruses, or other medical pathology. He stated this type of hearing loss does not occur from noise exposure. At a November 2019 Board hearing, the Veteran reported noticing diminished hearing after noise exposure during firing squads around 1991. He reported he wore foam hearing protection, but it did not work well. He stated he did not have his hearing checked during service because he did not think it was serious at the time. He reported first seeking treatment for his hearing loss in early 2000, once he started noticing he could not hear out of his left ear. He reported audiologists have not been able to pinpoint the etiology of his hearing loss. The Board finds the preponderance of the evidence is against finding the Veteran's left ear hearing loss disability manifested during or is otherwise related to ACDUTRA or active service. Regarding the onset of the Veteran's left ear hearing loss, the Board gives probative weight to statements made at the first treatment visit for hearing loss in the claims file. At the April 2010 VA treatment visit, the Veteran reported sudden hearing loss three years prior. See Rucker v. Brown, 10 Vet. App. 67, 73 (1997) (statements made to physicians for purposes of diagnosis and treatment are exceptionally trustworthy because the declarant has a strong motive to tell the truth in order to receive proper care). The Board considered later statements made by the Veteran about the onset of his hearing loss, to include a June 2015 report of hearing loss for at least 20 years, a July 2016 report of sudden hearing loss in the left ear in 1993, and a November 2019 report of diminished hearing around 1991. The Board gives greater probative weight to the initial treatment visit statement made by the Veteran regarding the onset of his hearing loss than to later statements made by the Veteran during the pendency of the claim or recent to the filing of the claim. See Pond v. West, 12 Vet. App. 341, 345 (1999) (interest may affect the credibility of testimony). Regarding whether the Veteran's left ear hearing loss disability is etiologically related to his ACDUTRA or active service, the Board gives probative weight to the July 2016 VA examination opinion. The opinion was based on an accurate medical history and provided a clear conclusion and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The clinician found the characteristics of the Veteran's audiological testing were not reflective of hearing loss related to noise exposure. The Board considered the Veteran's contention that his hearing loss is related to noise exposure during firing squads around 1991. The Veteran is not competent to opine on the etiology of his left ear hearing loss disability, as that requires medical testing and expertise that is outside the realm of common knowledge of a layperson. Kahana v. Shinseki, 24 Vet. App. 428 (2011); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Accordingly, as the preponderance of the evidence is against the claim, service connection for bilateral hearing loss disability is denied. 2. Service connection for PTSD The Veteran contends entitlement to service connection for PTSD. Specifically, he identified two stressors, a military sexual assault (MST) and witnessing a fellow soldier collapse unconscious during a training. Service connection for PTSD requires: (1) a medical diagnosis of PTSD in accordance with 38 C.F.R. § 4.125(a); (2) credible supporting evidence that the claimed in-service stressor actually occurred; and (3) medical evidence of a causal nexus between current symptomatology and the specific claimed in-service stressor. 38 C.F.R. § 3.304 (f); Cohen v. Brown, 10 Vet. App. 128, 139 (1997). The Board recognizes the Veteran has a medical diagnosis of PTSD in accordance with 38 C.F.R. § 4.125(a). Therefore, the question is whether there is credible supporting evidence the claimed in-service stressor occurred; and whether there is medical evidence of a causal nexus between his current symptomatology and the specific claimed in-service stressor. When a PTSD claim is based on in-service personal assault, evidence from sources other than service records may corroborate the account of the stressor incident. 38 C.F.R. § 3.304(f)(5). Examples of such evidence include, but are not limited to: records from law enforcement, rape crisis centers, mental health counseling centers, hospitals, or physicians; pregnancy tests or tests for sexually transmitted diseases; and statements from family members, roommates, fellow service members, or clergy. Id. Evidence of behavior changes following the claimed assault is a type of relevant evidence that may be found in these sources. Id. In the context of a PTSD claim based on personal assault, medical opinion evidence may be submitted for use in determining whether the occurrence of a stressor is corroborated. Menegassi v. Shinseki, 638 F.3d 1379, 1382 (Fed. Cir. 2011). However, VA is not required to accept a doctor's diagnosis of PTSD due to personal assault as proof that the stressor occurred, as doctors typically rely on unverified stressor information provided by the patient. See Menegassi, 638 F.3d at 1382 n.1. Favorable medical evidence diagnosing PTSD based on the Veteran's account of in-service assault must be weighed against all other evidence of record when determining whether the claim in-service personal assault has been corroborated. Id. STR do not show evidence of diagnosis or treatment of psychiatric disability. The Veteran has not contended he received treatment for psychiatric disability during service. Post-service, the first treatment visit for psychiatric disability is a November 2008 private treatment record noting a history of anxiety and continued Ativan prescription. Treatment records show continued treatment for anxiety. At an August 2015 VA psychiatric consultation, the Veteran reported nightmares twice a week about people attacking him, including being attacked by patients, which happened when he was a guard at a psychiatry hospital. He stated at this job, he experienced constant threat of physical assault, was assaulted on several occasion, and witnessed severe assaults on co-workers that led to the co-workers no longer being able to work. He reported it was a maximum-security facility and he was not allowed to carry a weapon. He stated he worked there 25 years and the last ten years were more stressful due to changes in policy that gave staff less control over patient management. The Veteran also reported serving in the Army Reserves. He noted he was deployed to Fort Benning, Georgia to prepare for Desert Storm, but did not end up going overseas. He stated it was worrisome thinking you could be called to the front line at any time. A December 2015 PTSD initial evaluation reported over the prior four to five years feeling depressed mood, loss of interest in activities, social isolation, and anxiety in public places. The clinician noted at the outset of the interview, the Veteran could not identify any life events, changes, or stressors that precipitated the onset of these symptoms, but during the interview it appeared the symptoms began after an assault at his work. The Veteran stated he retired from his job at a psychiatric facility in February 2014 because he could not take being around people anymore. He reported in the 25 years that he served as a corrections officer, he experienced and witnessed numerous assaults by patients on staff. First, four years prior, while working at the psychiatric facility, he was sent into a seclusion room of a patient who needed to be moved to restraints. He stated the patient punched him in the head hard enough to knock him against the wall and cause a concussion. He stated he was on medical leave from work for five to six months. He noted his immediate emotional response was anger toward the supervisor, whom he felt handled the situation poorly. Second, 11 to 12 years prior, he witnessed an officer knocked down and a patient stomped on his head. He saw the officer medically airlifted from the facility. He reported feeling helpless and horrified. Third, ten years prior, he wrestled a guy to the ground during work and sustained a contusion to his hand that resulted in medical leave from work for two to three months. A January 2016 VA Form 21-0781, Statement in Support of Claim for PTSD, reported two in-service stressors. First, the Veteran reported a MST around February 1991. He stated a sergeant isolated him and grabbed him inappropriately. The Veteran pushed him away and reported it to a superior. The superior told him he would handle it, but nothing was done. He reported nightmares about the incident. Second, he reported witnessing a solider collapse during a training exercise around March 1991. He reported feeling worry about how it could have been him. A July 2016 VA examination diagnosed PTSD with panic disorder. The clinician described four stressors reported by the Veteran. First, a sergeant approached the Veteran during a break and attempted to touch him inappropriately. The Veteran rebuked his advances and reported the event. He never heard follow-up about his complaint. The clinician noted the primary available marker was the Veteran's poor attendance following the reported event, but noted the Veteran had trouble with attendance prior to the reported event as well. Second, the Veteran witnessed a private collapse during a drill. He remembered realizing the task was dangerous and worrying about being able to return home to his wife and kids. Third, while working at an inpatient psychiatry forensic unit, the Veteran witnessed a co-worker kicked in the head and was never able to return to work. Fourth, the Veteran was assaulted by a patient at his job. He reported being punched in the face with enough force to hit his head against a wall and cause a concussion. The clinician opined the Veteran's PTSD was less likely than not incurred as a result of his military service. He noted the Veteran had stressors that meet the diagnostic criteria for PTSD during military service, namely the reported sexual assault, but the onset of his symptoms were not consistent with this being a primary stressor, as symptoms appear to have occurred primarily since the Veteran's retirement from his civilian job and he maintained a successful career in a high pressure setting for many years after his MST. The clinician opined it was more likely that his symptoms were caused by the reported events while he was on the job as a security guard, including the initiation of symptoms following his observation of a co-worker getting attacked and an assault on himself. The clinician stated this was consistent with the Veteran's description of his emotional response following each of these events. A May 2017 private treatment opinion found the Veteran presented with classic symptomology related to service-connected MST. The clinician noted a sergeant grabbed the Veteran inappropriately in 1991. The Veteran reported it to a superior, but nothing was done about it. The clinician noted that since the incident, the Veteran had intimacy problems and drank heavily. He reported despite medication and treatment, his symptoms persisted. The clinician opined this incident more likely than not was the nexus of his current symptoms. The clinician noted that although the Veteran experienced other traumatic experiences at work and in his personal life, his thoughts return to this incident in the military. At the November 2019 Board hearing, the Veteran reported being touched inappropriately by a sergeant while training in Fort Benning. He reported nightmares from the incident. He stated he reported the incident to a superior during service, his ex-wife (who is deceased), and more recently his treating therapist and psychiatrist. The preponderance of the evidence is against finding a nexus between the Veteran's PTSD and reported in-service stressors. The Board gives probative weight to the July 2016 VA examination opinion that the Veteran's PTSD was less likely than not incurred as a result of his military service. The clinician discussed in detail the Veteran's reported in-service and post-service stressors. With regard to the Veteran's reported in-service stressors, the clinician discussed potential markers in personnel records or other sources. The clinician noted the primary available marker was the Veteran's poor attendance following the reported event, but noted the Veteran had trouble with attendance prior to the reported event as well. Despite this consideration, the clinician opined the Veteran's PTSD was more likely caused by the reported events during his job as a guard on a forensic unit, including his initiation of symptoms following his observation of a co-worker getting attacked and an assault on himself. The clinician stated this was consistent with the onset and description of his emotional response following each of these events. This finding is consistent with the Veteran's statements during treatment visits describing being under constant threat of physical assault working as a guard at a psychiatry hospital, being assaulted on several occasion, and witnessing severe assaults on co-workers. He reported working this job for 25 years and the last 10 years were more stressful. He described two instances when he was on medical leave from work due to injuries incurred during assaults at his workplace. The Board gives less probative weight to the May 2017 private treatment opinion that the Veteran's MST more likely than not was the nexus of his current PTSD symptoms. The clinician generally noted the Veteran experienced other traumatic experiences at work and in his personal life, but did not discuss any details of the nature, severity, and frequency of his post-service stressors. This is significant because treatment records indicate the Veteran worked in a highly stressful environment for 25 years, to include being assaulted and witnessing assaults on co-workers. The clinician did not discuss potential markers in personnel records or other sources to support her conclusion. Accordingly, as the preponderance of the evidence is against the claim, service connection for PTSD is denied. 3. Service connection for lumbar spine disability 4. Service connection for cervical spine disability The Veteran contends his lumbar spine and cervical spine disabilities are related to infantry training, to include carrying a heavy rucksack during training. See November 2019 hearing testimony and May 2021 brief. The Board recognizes the Veteran has current lumbar spine disability and cervical spine disability. Therefore, the question is whether these disabilities manifested during or are otherwise related to ACDUTRA or active service. STR show no evidence of back or neck disability during ACDUTRA or active service. The Veteran has not contended he sought treatment for back or neck symptoms during ACDUTRA or active service. Post-service, the first treatment visit mentioning back pain was a November 2008 private treatment visit that prescribed pain medication for back pain. The first treatment visit for neck pain was a January 2009 cervical x-ray showing mild spondylosis between C4-6. Subsequent treatment records show continued treatment for back and neck symptoms. An April 2009 private treatment visit reported injuring his back during exercise. The clinician gave an impression of acute pain post trauma. A lumbar x-ray showed an essentially normal study with mild narrowing of the lumbosacral disc space. A June 2009 private treatment visit reported acute low back pain after moving furniture the day prior. The clinician noted no change from the previous x-ray. An October 2009 private treatment visit reported doing heavy lifting at home and hearing a pop in his back, which took him to the floor. The clinician noted the lumbar x-ray showed degenerative disc disease. The clinician gave a working diagnosis of acute trauma to the lower back with severe spasm. At an August 2010 private treatment visit, the Veteran reported working in a place with convicts, which required walking every 15 minutes, wresting, and fighting. He reported doing something to his back resulting in terrible pain and being unable to bend or stand straight. The clinician gave a working diagnosis of acute pain to lower back status post trauma. An August 2012 private treatment visit noted his work was strenuous and caused more back and neck pain. A March 2013 private treatment visit reported walking at work caused persistent pain to the ankle, knee, and back. A March 2014 private treatment visit reported falling playing basketball with pain to the back. The clinician noted his lumbar x-ray looked normal with chronic arthritic changes. A February 2015 private treatment visit stated that he felt something pop during work and almost fell down. The clinician noted x-rays were consistent with disc disease and sciatica. A July 2015 private treatment visit reported increasing low back pain, worse at the end of the day. He stated his job required a lot of bending, lifting, and walking. An October 2015 private treatment visit reported pain to his back and legs. The clinician noted the lumbar MRI showed spondylotic changes combined with facet hypertrophy resulting in neural foraminal stenosis, moderate spondylosis, and discogenic disc disease. An August 2016 private treatment visit reported after moving furniture with his brother, feeling a sharp popping to his back, resulting in pain stabbing down his leg. At a November 2019 Board hearing, the Veteran reported wearing a rucksack that weighed 50 to 60 pounds during infantry training that caused his back and neck pain. He stated the pain was minor at first, but later intensified. He reported he initially got pain medication from his primary care doctor, starting around the mid-1990s. He reported VA later sent him to a chiropractor for his back. The preponderance of the evidence is against finding the Veteran's lumbar or cervical disabilities manifested during or are otherwise related to ACDUTRA or active service. The Board gives probative weight to the Veteran's post-service treatment records for his back and neck. The first imaging in the claims file, in 2009, noted mild cervical spondylosis and an essentially normal lumbar study with mild narrowing of the lumbosacral disc space. Treatment visits in 2009 mentioned back pain related to exercise, moving furniture, and heavy lifting. Throughout his treatment records, the Veteran reported the strenuous nature of his job, which he worked from 1989 to 2014. There is not competent evidence of a nexus between the Veteran's back and neck disability and his periods of ACDUTRA or active duty. The Board considered the Veteran's contention that his back and neck pain are related to infantry training in 1991, to include carrying a heavy rucksack. The Veteran is not competent to opine on the etiology of his current back or neck disability, as that requires medical testing and expertise that is outside the realm of common knowledge of a layperson. Kahana v. Shinseki, 24 Vet. App. 428 (2011); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). A VA examination was not provided in conjunction with the Veteran's claim for back disability or neck disability. VA has a duty to provide an examination when the record lacks evidence to decide the Veteran's claim and there is evidence of (1) a current disability; (2) an in-service event, injury, or disease; and (3) some indication that the claimed disability may be associated with the established event, injury, or disease. 38 C.F.R. § 3.159(c)(4); see also McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). The Board does not find sufficient indication his back disability or neck disability may be associated with service to trigger the duty to provide an examination. See Waters v. Shinseki, 601 F.3d 1274, 1278-79 (Fed. Cir. 2010) (explaining that something more than a veteran's conclusory, generalized statement is needed to trigger VA's duty to assist by providing a medical nexus examination). Here, as the preponderance of the evidence is against the claims, service connection for back disability and service connection for cervical disability are denied. 5. Service connection for RLE radiculopathy The Veteran contends entitlement to service connection RLE radiculopathy. Specifically, he reports experiencing mild pain shooting down his right leg during service. He stated his RLE symptoms were related to his flat feet. See November 2019 hearing testimony. The Board recognizes the Veteran has RLE radiculopathy. Therefore, the question is whether his RLE radiculopathy manifested during or is otherwise related to ACDUTRA or active service. STR show no evidence of RLE disability during ACDUTRA or active service. The Veteran stated he was not treated for RLE symptoms during service. See November 2019 hearing testimony. Post-service, an October 2014 EMG study noted the Veteran presented with significant numbness, tingling, and discomfort around the lateral aspect of the right leg on and off for several months. The EMG impression was right leg radiculopathy. Subsequent treatment records show continued treatment for RLE symptoms. The preponderance of the evidence is against finding RLE radiculopathy manifested during or is otherwise related to ACDUTRA or active service. The Board gives probative weight to the October 2014 treatment visit reporting RLE pain on and off for several months. See Rucker v. Brown, 10 Vet. App. 67, 73 (1997) (statements made to physicians for purposes of diagnosis and treatment are exceptionally trustworthy because the declarant has a strong motive to tell the truth in order to receive proper care). This statement is consistent with numerous visits with the Veteran's primary care physician prior to October 2014 that are silent for RLE complaints. The Board finds RLE pain is type of symptom that would ordinarily be reported and noted during treatment visits where the Veteran is describing his body pain. (Continued on the next page) A VA examination was not provided in conjunction with the Veteran's claim for RLE radiculopathy. 38 C.F.R. § 3.159(c)(4); see also McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). The Board does not find sufficient indication his RLE radiculopathy may be associated with service to trigger the duty to provide an examination. See Waters v. Shinseki, 601 F.3d 1274, 1278-79 (Fed. Cir. 2010) (explaining that something more than a veteran's conclusory, generalized statement is needed to trigger VA's duty to assist by providing a medical nexus examination). Accordingly, as the preponderance of the evidence is against the claim, service connection for RLE radiculopathy is denied. KELLI A. KORDICH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Winkler, 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.