Citation Nr: 22016118 Decision Date: 03/21/22 Archive Date: 03/21/22 DOCKET NO. 16-61 624 DATE: March 21, 2022 ORDER Entitlement to service connection for a cervical spine disability is denied. FINDINGS OF FACT 1. A cervical spine disability was not manifest during active service, or until many years after service, and is not shown to be causally or etiologically related to an in-service event, injury, or disease. 2. Any preexisting cervical spine disorder was clearly and unmistakably not aggravated by service. CONCLUSION OF LAW The criteria for entitlement to service connection for a cervical spine disability have not been met or approximated. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. §§ 3.303, 3.304 (2021). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty from June 1969 to June 1971. This matter comes before the Board of Veterans' Appeals (Board) on appeal of a May 2013 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Lincoln, Nebraska. Jurisdiction is now with the Milwaukee, Wisconsin RO. The Board remanded the issues on appeal for additional development in November 2020 and April 2021. The directives having been substantially complied with, the matter again is before the Board. D'Aries v. Peake, 22 Vet. App. 97, 105 (2008); Stegall v. West, 11 Vet. App. 268 (1998). The Veteran and his spouse testified before the undersigned Veterans Law Judge (VLJ) in a videoconference hearing in September 2019. A transcript of that hearing is of record. The Board notes the presence of a separate appeal by this Veteran before the Board and already docketed for a different issue that is under the new procedures of the Appeals Modernization Act (AMA) that took effect for claims that received their initial decision after February 2019. Because there are different legal procedures for legacy appeals versus AMA appeals, the two appeals cannot be combined, and this Board decision will address only the issue above. The Veteran will receive a separate Board decision for his AMA appeal in the near future. The Veteran made a Privacy Act request pertinent to this appeal on July 15, 2021. VA responded with records to satisfy the Veteran's request, and that particular Privacy Act request is now considered satisfied. The Board notes the presence of a separate Privacy Act request related to his AMA appeal, but considers it to be unrelated to this legacy appeal for a different issue. As such, the Board will proceed with the adjudication of this appeal. Veterans Claims Assistance Act of 2000 (VCAA) The Veterans Claims Assistance Act of 2000 (VCAA) and implementing regulations impose obligations on VA to provide claimants with notice and assistance. 38 U.S.C. §§ 5100, 5102, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2021). The Veteran in this case has not referred to any deficiencies in either the duties to notify or assist; therefore, the Board may proceed to the merits of the claim. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015, cert. denied, U.S.C. Oct. 3, 2016) (holding that "the Board's obligation to read filings in a liberal manner does not require the Board....to search the record and address procedural arguments when the [appellant] fails to raise them before the Board"); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to an appellant's failure to raise a duty to assist argument before the Board). The Board has reviewed all of the evidence in the Veteran's claims file. Although the Board has an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that the evidence submitted by the Veteran or obtained on his behalf be discussed in detail. Rather, the Board's analysis below will focus specifically on what evidence is needed to substantiate the claim and what the evidence in the claims file shows, or fails to show, with respect to the claim. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) and Timberlake v. Gober, 14 Vet. App. 122, 128-130 (2000). Service Connection for Cervical Spine Disability Legal Criteria for Service Connection - General Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). To establish entitlement to service-connected compensation benefits, a Veteran must show: "(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service-the so-called "nexus" requirement." Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Service connection may also be granted for disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303(d). Service connection may also be established for a current disability on the basis of a presumption that certain chronic diseases, to include arthritis, manifesting themselves to a certain degree within a certain time after service must have had their onset in service. 38 U.S.C. §§ 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309(a). For arthritis, the disease must have manifested to a degree of 10 percent or more within one year of service. 38 C.F.R. § 3.307(a)(3). Service connection can also be established through continuity of symptomatology. Walker v. Shinseki, 708 F.3d 1331 (2013); 38 C.F.R. §§ 3.303(b), 3.309. For chronic diseases shown as such in service or within the applicable presumptive period, subsequent manifestations of the same chronic disease at any later date are service-connected unless attributable to an intercurrent cause. 38 C.F.R. § 3.303(b). For a chronic disease to be considered to have been "shown in service," there must be a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings. Id. When the condition noted in service or within the presumptive period is not a chronic disease, a showing of continuity of symptomatology after discharge is required. Id. A veteran will be considered to have been in sound condition when examined, accepted and enrolled for service, except as to defects, infirmities, or disorders noted at entrance into service, or where clear and unmistakable (obvious or manifest) evidence demonstrates that an injury or disease existed prior thereto. Only such conditions as are recorded in examination reports are to be considered as noted. 38 U.S.C. § 1111; 38 C.F.R. § 3.304(b). However, the Court has held that the presumption of soundness does not apply to congenital defects because such defects are not considered diseases or injuries within the meaning of 38 U.S.C. §§ 1110 and 1111. See Quirin v. Shinseki, 22 Vet. App. 390, 396-97 (2009); see also Terry v. Principi, 340 F.3d 1378, 1385-86 (Fed. Cir. 2003); Winn v. Brown, 8 Vet. App. 510, 516 (1996). When no preexisting condition is noted upon entry into service, the burden falls on the government to rebut the presumption of soundness by clear and unmistakable evidence that the disability was both preexisting and not aggravated by service. Wagner v. Principi, 370 F.3d 1089 (Fed. Cir. 2004). The government may show a lack of aggravation by establishing that there was no increase in disability during service or that any increase was due to the natural progress of the preexisting condition. Id. at 1096. A claimant is not required to show that the disease or injury increased in severity during service before VA meets both of these burdens. See VAOPGCPREC 3-2003. VA is required to give due consideration to all pertinent medical and lay evidence in evaluating a claim for disability benefits. 38 U.S.C. § 1154(a). Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Lay evidence cannot be determined to be not credible merely because it is unaccompanied by contemporaneous medical evidence. Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006). However, the lack of contemporaneous medical evidence can be considered and weighed against a Veteran's lay statements. Id. Further, a negative inference may be drawn from the absence of complaints or treatment for an extended period. Maxson v. West, 12 Vet. App. 453, 459 (1999), aff'd sub nom. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). Proof of a current disability is a threshold to establishing service-connection for any claimed disability. In the absence of proof of a present disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). To be a present as a current disability, there must be evidence of the condition at some time during the appeals period. Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998). After the evidence is assembled, it is the Board's responsibility to evaluate the entire record. See 38 U.S.C. § 7104(a) (2012). When there is an approximate balance of evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each issue shall be given to the claimant. See 38 U.S.C. § 5107 (2012); 38 C.F.R. §§ 3.102, 4.3. In Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990), the United States Court of Appeals for Veterans Claims (Court) stated that "a veteran need only demonstrate that there is an 'approximate balance of positive and negative evidence'' in order to prevail." A claim will be denied only if the approximate balance of the evidence is against the claim. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021). Evidence and Analysis The Veteran contends that he has a cervical spine disability which is related to service. In his September 2019 Board hearing before the undersigned VLJ, the Veteran asserted that while in service he carried "hundreds of pounds of equipment" on his back and that he was treated for a neck injury while in service. Service treatment records confirm that the Veteran was treated for a "stiff neck" in May 1971. The Veteran received another military physical examination in January 1973 for entrance into the National Guard, which was silent for any cervical spine conditions or complaints. A private treatment record from Kaiser Permanente in October 1980 notes that the Veteran had "stiff neck for the last 2 days woke up with it." A U.S. Department of Labor physicians report from Mare Island Naval Shipyard in August 1981 notes "sudden back pain after arising from reclining chair." A Kaiser Permanente treatment note from December 1981 notes a "stiff neck [for] 3 days," and a later Kaiser Permanente note from November 1982 notes "recurring episodes of sharp pain in mid back." A Kaiser Permanente treatment note from May 1983 also notes a "stiff neck 2 days." Private medical records from January 1985 contain complaints of neck pain. The Veteran also reported neck pain in April 1985 and a medical note reads "possible carpal tunnel." Private medical records also reveal complaints of neck pain in June, September, and October of 1985, and October and December of 1987. Another private treatment record from January 1988 reveals stiffness in the shoulders and upper back and notes that the Veteran worked as an electrician in a shipyard and did a lot of lifting, reaching, and overhead work. The Veteran also complained of neck pain in July 1989, and an August 1989 medical record describes "cervical nerve-root irritation." A May 2006 private chiropractor record noted complaints of left neck pain for 7 days but does not note a precipitating event. Thereafter, private chiropractor records contain additional notes of treatment for a neck strain and cervical spondylosis. Private treatment records dated September 2011 from a chiropractor revealed "congenital spinal stenosis made worse by multi-level degenerative spondylosis." The Veteran submitted a letter from a private chiropractor dated October 2011. The chiropractor did not indicate that he had reviewed the Veteran's service treatment records or claims file, and noted that the Veteran sustained injuries in service, but did not note a specific incident. This chiropractor opined that the Veteran's cervical spine condition were related to his military service, due to the fact the Veteran was forced to carry a heavy backpack, ammunition, and weapons for miles at a time. He also noted that the Veteran had to carry heavy tool bags while going up and down ladders while working at Mare Island Naval Shipyard from 1980 to 1992: The Veteran was provided a VA examination in March 2013. This VA examiner confirmed a diagnosis of a neck strain and cervical spondylitic myelopathy. The examiner noted the Veteran's treatment for a stiff neck in May 1971, after which muscle relaxers and bed rest without a pillow were prescribed. The VA examiner noted that the Veteran's May 1971 separation examination and subsequent May 1973 entrance examination for the Army National Guard were normal without any mention of a cervical spine condition. The Veteran reported that after his military career he worked as an electrician from 1980 to 1992 and that he had to go up and down ladders carrying heavy tools on his shoulders and that he worked in tight confined spaces. The Veteran also reported to the VA examiner that he was employed as a security guard and police officer since then. The VA examiner wrote that the record indicated possible carpal tunnel syndrome in September 1999, but found no evidence of cervical myelopathy in that September 1999 record. The Veteran reported intermittent symptoms of pain in the neck radiating into his arms. The VA examiner noted the October 2011 letter from the private chiropractor. The Veteran reported to the VA examiner that as a police officer, he wore a 5 lbs. vest and carried a gun, and that his symptoms prevented him from completing his work duties from 3 to 4 days a month. This March 2013 VA examiner opined that the Veteran's current cervical spine disability was less likely than not incurred in or caused by the claimed in-service injury, event or illness. The VA examiner reasoned that there was only one report during service for a stiff neck and no mention of any neck condition at the Veteran's second enlistment examination for the Army National Guard in May 1973. The examiner noted that there was no evidence of cervical spine myelopathy in September 1999. The VA examiner concluded by writing that all the evidence "support[s] a diagnosis of right cervical myelopathy at this time. It is therefore not likely that [the] Veteran's current cervical spondylitic myelopathy was caused by neck condition of strain noted in service [in May 1971], and it is not the same condition as that noted [in May 1971]." After a Board remand, VA provided an addendum opinion in November 2020. This examiner noted, based a review of the records, that the Veteran's neck condition was cervical spinal stenosis and spondylosis. The examiner also provided a negative opinion for service connection, saying the Veteran's cervical spine conditions are less likely than not due to his active-duty service. The examiner's rationale was extensive, and started by noting a review of STRs document one episode of acute and transitory neck pain, no trauma, no sequela. The military separation exam negative. There was no medical evidence of a chronic or disabling neck condition during service or shortly after separation. There was no evidence to refute the 2013 VA medical opinion, which noted the current conditions were diagnosed in 2006 (moderate cervical spondylosis) and in 2011 (spinal canal stenosis and multilevel spondylosis). The November 2020 VA examiner noted there was an MRI finding of possibly congenital spinal stenosis in 2011. There are no medical records prior to service documenting a congenital cervical spine condition. There are no medical records during service documenting a disability due to or an aggravation of a congenital cervical spine condition. There is no evidence of additional disability due to aggravation during service of a congenital defect by any superimposed disease or injury. No evidence congenital spinal stenosis underwent any worsening during service or was worsened beyond natural progression by military service. The military entrance and separation exams were negative. The Veteran's medical records were silent 36 years before diagnosis of cervical spondylosis, and 40 years before diagnosis of spinal stenosis. The November 2020 examiner continued by noting the earliest document cervical or neck complaint, a muscle spasm in 1985, with negative x-rays. Medical records indicate Veteran sustained neck and back injury from a motor vehicle accident in 1988, and he had persistent pain and numbness in right arm, though the x-ray was normal. The Veteran was treated for 9 months with physical therapy. The examiner noted that the Veteran had not mentioned that 1988 motor vehicle accident in previous VA treatment and examinations, and declined to mention it to the VLJ during the September 2019 hearing. VA provided another examination and opinion in July 2021 to address the Veteran's cervical spine disability. The Veteran was examined in person, and the examiner found one diagnosis, that of cervical spinal stenosis and spondylosis. The examiner noted the Veteran's claimed history, that he had to carry heavy things during his active service. The Veteran could not recall the exact date of the motor vehicle accident from his records, which was in 1988, and that he worked as an electrician, again without being able to recall the dates, and then as a police officer, retiring in 2016. This July 2021 VA examiner provided a negative opinion for service connection, saying it was less likely than not that the Veteran's cervical spine condition was incurred in, causally related to, or aggravated by his military service. The examiner's rationale was that the service treatment records document one acute and transitory neck muscle spasm with no sequela. There is no stated or documented neck trauma. The military entrance and separation examinations were negative for any cervical spine issues. There was no evidence of a congenital, chronic, or disabling neck condition during service or shortly after separation. The examiner examined the possibility of a preexisting condition, and noted the evidence of record does not clearly and unmistakably show that the Veteran had a cervical spine disability or condition which pre-existed service. No objective medical evidence of a congenital neck condition prior to or during service. Military entrance and separation exams negative. Cervical spine x-ray in 1985 was normal-no evidence of arthritic or congenital condition. The Veteran's current cervical spine condition is not due to or the result of minor, self-limited neck muscle strain or spasm that occurred during military service, nor is there evidence of a congenital condition during or shortly after military service. The Veteran's current cervical spine condition more likely than not due to neck trauma with significant sequelae from the 1988 MVA, physical occupations, natural degeneration and genetics. There is no evidence from any source that refutes the March 2013 and November 2020 VA opinions. Pre-existing Condition Analysis Pursuant to 38 C.F.R. § 3.304 The Veteran served on active duty June 1969 to June 1971, and no service treatment record or examination notes any pre-existing cervical condition. The Veteran himself has never stated that he had any kind of preexisting cervical or neck condition. Pursuant to 38 U.S.C. § 1111 and 38 C.F.R. § 3.304, if a pre-existing condition is not noted at service entrance, then the initial evidentiary burden is upon VA, using a clear and unmistakable evidence standard, to show 1) the asserted condition pre-existed service, and 2) the pre-existing condition was not aggravated during service. See Wagner v. Principi, 370 F.3d 1089 (Fed. Cir. 2004) (emphasis added). Clear and unmistakable evidence means that the evidence "cannot be misinterpreted and misunderstood, i.e., it is undebatable." Vanerson v. West, 12 Vet. App. 254, 258 (1999) (citing definition of "clear and unmistakable error" in Russell v. Principi, 3 Vet. App. 310, 31314 (1992)). The clear and unmistakable evidence standard is an "onerous" one. Laposky v. Brown, 4 Vet. App. 331, 334 (1993) (citing Akins v. Derwinski, 1 Vet. App. 228, 232 (1991)). Here, as previously discussed, the Veteran had no conditions noted at service entrance. In consequence, the initial evidentiary burden is upon VA, using a clear and unmistakable evidence standard, to show 1) the asserted condition pre-existed service, and 2) the pre-existing condition was not aggravated during service. See Wagner v. Principi, 370 F.3d 1089 (Fed. Cir. 2004) (emphasis added). The evidence of record does not clearly and unmistakable show that the veteran had a cervical spine disability or condition which pre-existed service. No objective medical evidence of a congenital neck condition prior to or during service. Military entrance and separation exams were negative. Cervical spine x-ray in 1985 was normal with no evidence of arthritis or congenital condition. The July 2021 VA examination notes that any cervical spine stenosis was clearly and unmistakably present prior to service, based on later diagnoses, and that it was clearly and unmistakably not aggravated during service, in that no medical record from any source, VA or private, notes any aggravation of a cervical spine condition of any source. Here, the Veteran's service treatment records are silent for any pre-existing cervical spine disorder. The Board thus considers that the two conditions regarding a pre-existing condition have been satisfied by VA. The Veteran is thus presumed sound at service entrance, and the analysis for aggravation for a pre-existing condition not documented at service entrance fails. 38 U.S.C. § 1111; 38 C.F.R. § 3.304; Wagner v. Principi, 370 F.3d 1089 (Fed. Cir. 2004); see also Quirin v. Shinseki, 22 Vet. App. 390, 397 (2009); Horn v. Shinseki, 25 Vet. App. 231 (2012). Direct Service Connection Analysis Even though analysis pursuant 38 U.S.C. § 1111 and 38 C.F.R. § 3.304 for the Veteran's claim for service connection for cervical spine condition fails, the Veteran can still possibly establish such entitlement via direct service connection analysis. See Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). The Board finds the March 2013, November 2020, and July 2021 VA examination reports and opinions to be the most probative evidence of record. The Board notes the examination was performed by a VA clinician based on extensive and detailed discussion with conclusions based on a review of the Veteran's complete history and evaluation of current symptoms. The Board notes with emphasis that these three VA examiners were the only opinion writers in the claims file who addressed all of the Veteran's symptoms and statements over his life, along with consideration of statements from the Veteran and family members. A medical opinion is most probative if it is factually accurate, fully articulated, and based on sound reasoning. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). These examiners reviewed the claims file and provided opinions that were extremely comprehensive, sufficiently clear, and had well-reasoned rationales. See Bloom v. West, 12 Vet. App. 185, 187 (1999); Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998); see also Claiborne v. Nicholson, 19 Vet. App. 181, 186 (2005). The Board also finds the multiple medical records from Kaiser Permanente from 1981 through to 1995 to be highly probative as to the current state of any cervical spine disability in the Veteran, though no Kaiser medical examiner ever provided a nexus opinion regarding those cervical spine conditions. The Board finds the private chiropractor records to be of low probative value in that those diagnoses did not correlate to the cervical spine diagnoses from VA or Kaiser Permanente, and that the nexus opinion provided was conclusory and without any foundation as to its stated conclusion. Furthermore, there is no evidence that this examiner had access to the Veteran's claims file. Therefore, this opinion is of no probative value. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (the probative value of a medical opinion is derived from a factually accurate, fully articulated, and soundly reasoned opinion). A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). 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. 18, 22 (2007). The Board must be able to conclude that a medical expert has applied valid medical analysis to the significant facts of the particular case. See Stefl, supra. A medical opinion is inadequate when it is unsupported by clinical evidence. Black v. Brown, 5 Vet. App. 177, 180 (1995); see also LeShore v. Brown, 8 Vet. App. 406, 409 (1995) (a bare transcription of lay history, unenhanced by additional comment by the transcriber, does not become competent medical evidence merely because the transcriber is a health care professional). While the Veteran is competent to report what he has experienced, he is not competent to ascertain the etiology of any current condition, as the causative factors for such are not readily subject to lay observation. See Young v. McDonald, 766 F.3d 1348, 1353 (Fed. Cir. 2014) (holding that "PTSD is not the type of medical condition that lay evidence... is competent and sufficient to identify"); Charles v. Principi, 16 Vet. App. 370, 374-75 (2002); Layno v. Brown, 6 Vet. App. 465 (1994); see also Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Furthermore, and critical for this case and decision, the Veteran's inconsistencies in reporting undermines the credibility of his statements and their usefulness in evaluating the Veteran's claim for service connection. See Caluza v. Brown, 7 Vet. App. 498 (1995). In addition, the Board finds that the gap in time between the Veteran's last date of active service, in June 1971, to his initial evaluation of possible cervical disorders in October 1980, after he had started his electrician position at the Mare Island Naval Shipyard, to be probative of a lack of nexus between the diagnosed current disability and active service. The Board notes multiple intervening events that are pertinent to a nexus analysis regarding the Veteran's cervical spine claims, to include his employment at the naval shipyard, his motor vehicle accident in 1988, and his work as a law enforcement officer until his retirement in 2016, but that the Veteran omits discussion of those events. A negative inference may be drawn from the absence of complaints or treatment for an extended period. See Maxson v. West, 12 Vet. App. 453, 459 (1999), aff'd sub nom. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). The Board notes there are no other statements besides the previously mentioned chiropractor by any medical provider, VA or private, that are in favor of a possible nexus to service for the Veteran's claimed cervical spine disability. Upon review of the record, the Board concludes that entitlement to service connection for a cervical spine disability is not warranted. The Board notes a current diagnosis of a cervical spine disability, and thus the requirement for a current disability is shown for the cervical spine claim. The Board acknowledges the Veteran's contentions, and the Veteran's post-service statements are noted. However, the Veteran's service medical records, to include all examinations, are silent for any existing cervical spine condition at the time of separation, and there is no competent evidence to tie the current assertion to any in-service disease or injury. Multiple VA examiners have discussed all of the Veteran's cervical spine disabilities and all possible risk factors raised by the record, and opined that the current cervical spine disability is not related back to active service. The Board also notes multiple intervening events, in the 1988 motor vehicle accident, the Veteran's work record at the Mare Island Naval Shipyard from 1980 to 1992, and the law enforcement work afterwards up until retirement in 2016. The Board thus finds the Veteran fails the third prong of the test for entitlement to direct service connection. See Davidson v. Shinseki, 581 F.3d 1313, 1315-16 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); 38 C.F.R. § 3.303. With regard to possible presumptive service connection for degenerative arthritis, the weight of evidence shows no formal diagnosis of any cervical spine arthritis on any examination, private or VA, beyond that noted and discussed above. As such, presumptive service connection is not warranted. 38 C.F.R. §§ 3.303, 3.309. (CONTINUED ON NEXT PAGE) Based on the above, the Board finds that the evidence of record persuasively weighs against the Veteran's claimed cervical spine disability. For these reasons, the Board finds that an approximate balance of the evidence is against the claim of service connection for a cervical spine disability, and the claim must be denied. Because the approximate balance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not for application. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021). MICHAEL A. PAPPAS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Setter, 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.