Citation Nr: 22017982 Decision Date: 03/27/22 Archive Date: 03/27/22 DOCKET NO. 16-61 155 DATE: March 27, 2022 ORDER 1. Entitlement to service connection for traumatic brain injury (TBI) is denied. 2. Entitlement to service connection for a cervical spine disability is denied. FINDINGS OF FACT 1. The evidence is persuasively against a finding that the Veteran has a current diagnosis of TBI, to include symptoms that caused functional impairment that affects earning capacity or had a TBI during service at the time of the January 1992 motor vehicle accident. 2. The evidence is persuasively against a finding that the Veteran's cervical spine disability had its onset in service, was manifested within one year following service discharge, or is otherwise related to service. CONCLUSIONS OF LAW 1. The criteria for service connection for a TBI have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for entitlement to service connection for a cervical spine disability have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from September 1985 to February 1993. The Veteran testified before the undersigned Veterans Law Judge (VLJ) at a July 2019 Travel Board hearing held at the Boise VA Regional Office (RO). In March 2020, the Board of Veterans' Appeals (Board) remanded the claims for further development. Specifically, the Board remanded the claims in order to give the Veteran an opportunity to complete a VA Form 21-4142, Authorization to Disclose Information to the Department of Veterans Affairs, to authorize VA to obtain any outstanding and relevant private treatment records, including medical treatment while the Veteran was incarcerated with the Idaho Department of Corrections from approximately 1998 to 2007. The matter was remanded by the Board again in July 2020 in order to provide the Veteran additional time to return the VA Form 21-4142 and identify any outstanding and relevant private treatment records. The Veteran returned the VA Form 21-4142 in August 2020, but did not identify any treatment providers or missing records. Additionally, in October 2020, the Idaho Department of Correction provided a negative response to VA's records inquiry, indicating that no records were found pertaining to the Veteran. The Veteran has also been provided opportunity to provide any outstanding records that may be in his possession, pursuant to the July 2020 remand order. The Board finds there has been substantial compliance with the remand directives and the matter is again before the Board. See Stegall v. West, 11 Vet. App. 268 (1998). Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). To establish a right to compensation for a present disability, a veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Disorders diagnosed after discharge will still be service connected if all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Additionally, where a veteran served 90 days or more of active service, and certain chronic diseases, such as arthritis, which is also known as degenerative joint disease and degenerative changes, become manifest to a degree of 10 percent or more within one year after the date of separation from such service, including arthritis, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1110, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309(a). 1. TBI The Veteran has alleged that he suffered a TBI resulting from a January 1992 motor vehicle accident that occurred when the Veteran reportedly fell asleep while driving during his period of active duty. Despite evidence establishing that the Veteran was in a January 1992 motor vehicle accident, the evidence is persuasively against a finding that the Veteran incurred a TBI at that time or has a present diagnosis of TBI, which is explained below. As to evidence of a disease or injury in service, the record shows no diagnosis of TBI during the Veteran's military service, or reports of associated symptoms. A January 1992 hospital record shows that the Veteran was treated for injuries sustained in a motor vehicle accident. The Veteran was found to have lacerations and a fracture in the upper and lower extremities, which required surgery. Some tender nasal cartilage was noted on a physical examination of the head, eyes, ears, nose, and throat, but there was no bone damage or other indication of a head injury, and the Veteran's head was described as "AT/NC," meaning atraumatic, normocephalic. The Veteran was noted to be alert and oriented and there was no mention of a traumatic brain injury. An August 1993 Accident Report relating to the January 1992 incident included a statement from the police officer who responded to the Veteran's motor vehicle accident. The officer's statement included a description of lacerations to the right leg, a broken bone in the left foot, a crushed muscle of the left arm, and a broken ligament on the left hand. There was no documentation of a head injury. The officer also indicated that the Veteran was unable to speak with the officer following the accident when the officer arrived on the scene. At the Veteran's Board hearing, the representative suggested that this statement indicated that the Veteran was entirely unable to speak, which would be indicative of a head injury. However, the officer's statement refutes this notion and makes clear that the Veteran was able to speak, but did not speak to the officer, potentially due to receiving medical treatment for the severe injuries incurred to his extremities, as noted above. The responding officer wrote that, although the Veteran did not speak with the officer, the Veteran "repeatedly" told a separate individual on the scene "that he must've fallen asleep." This shows that the Veteran was able to speak after the accident and was able to discuss the circumstances preceding his motor vehicle accident. As such, the representative's contention that the Veteran was unable to speak, as evidence that a head injury occurred, is not supported by the evidence of record. In the Report of Medical History during the Veteran's separation examination in February 1993, he specifically denied a history of a head injury and periods of unconsciousness. The Veteran reported that his health was good, except for leg and ankle issues, and he was noted to not use any medication. A concurrent Report of Medical Examination showed that the Veteran received a normal clinical evaluation of both the head and neurological functioning. At the Veteran's July 2019 Board hearing, the Veteran indicated that he did not complain about medical problems other than his lower extremity injuries because he wanted to downplay any disabilities in order to remain in active duty service. This sentiment was also reflected in a statement submitted by the Veteran's ex-wife in June 2018. However, the February 1993 Report of Medical History and Report of Medical Examination were prepared explicitly in association with the Veteran's separation from active duty, at which point, there was no incentive to downplay medical conditions in order to remain on active duty. Additionally, the Veteran reported a number of positive medical histories in the February 1993 Report of Medical History, unrelated to his lower extremity disabilities, including a history of hay fever, skin diseases, and ear, nose, or throat trouble. This shows that the Veteran did not have a concern with reporting positive medical histories at service discharge. As such, the Veteran's contention is not persuasive and not credible. The Board finds as fact that the denial of a history of head injury and loss of consciousness in the February 1993 Report of Medical History is affirmative evidence against an in-service head injury at the time of the motor vehicle accident. Attached to the Report of Medical History is a Standard Form 507 that listed multiple injuries that were incurred at the time of the 1992 motor vehicle accident, which did not include a head injury. Thus, the Board finds that the evidence persuasively weighs against an in-service disease or injury involving a TBI, and the Veteran's allegation of an in-service disease or injury involving a TBI is not credible. Accordingly, the second element of a service-connection claim is not met. Additionally, following the Veteran's discharge from active duty, medical treatment records from 1993 to 1994 do not show complaints attributable to, or the assessment of, a TBI, which further supports the finding that the Veteran did not experience a TBI at the time of the 1992 motor vehicle accident. For example, in 1993, the Veteran sought VA disability benefits relating to the left foot and right knee injuries incurred during his 1992 motor vehicle accident, but he made no mention of incurring a TBI at this time. The Veteran underwent a VA examination in November 1993, during which time, the Veteran reported that during the motor vehicle accident, he had injured his left foot, sustained aa laceration of the dorsum of his left hand, and right ankle. He made no mention of a head injury. A physical examination of the head and neck revealed that the Veteran's eyes were reactive to light and accommodation. A neurological examination was also normal, and there were no findings suggestive of TBI. In 1994, the Veteran was documented to be alert and oriented, and an examination of the Veteran's head, ears, eyes, nose, and throat continued to describe the Veteran's condition as atraumatic and normocephalic. Given that the Veteran was seeking treatment for separate disabilities associated with the motor vehicle accident and pursuing claims for disability benefits, the Board finds that, if the Veteran was suffering symptoms related to a TBI sustained in service, he would have reported or sought treatment for such symptoms. To the extent that the Veteran has indicated that he was not entirely truthful in reporting his disabilities and symptomology, this negatively impacts the Veteran's overall credibility. Inadvertent or otherwise, inconsistencies in the Veteran's recitation of facts decreases the probative value of his lay statements. For example, as discussed below, a 2016 VA examiner stated that the Veteran's concurrent report of the 1992 accident was not consistent with the 1993 Accident Report. A separate examination report from 2016, relating to the Veteran's service-connection claim for a cervical spine disability described a lack of recollection of various events and medical care, as well as a demonstrated propensity to have recollections that contradict the medical record. The Veteran began to report some concentration and/or memory deficits in 2013; however, the Veteran's cognitive functioning remained generally intact and no diagnosis of TBI was made. It is noted that the Veteran's psychiatric symptoms have been associated with separate, diagnosed conditions, including antisocial personality disorder, and stimulant use disorder, for which the Veteran has separately been denied service connection, and which disabilities are not presently before the Board. The reporting of such symptoms do not confer the diagnosis of a TBI. Some more recent VA treatment records mention a history of TBI, but these records indicate that the TBI was self-reported without a formal diagnosis. The Veteran underwent a VA examination for assessment of a TBI in January 2016. The examiner noted that the Veteran's report of the 1992 accident was not consistent with the Accident Report, including the Veteran's statement that he hit a tractor trailer "head on and my car flew 1,280 feet from impact." The examiner found the Veteran did not have a current or past TBI. The examiner opined that, with a reasonable degree of medical certainty, the Veteran does not have a history of TBI incurred during his active duty service. On examination, the Veteran was found to have no complaints of impairment of memory, attention, concentration, or executive functions, with normal judgment, routinely appropriate social interaction, full orientation, normal consciousness, normal motor activity, normal visual spatial orientation, intact ability to communicate no neurobehavioral effects, and no subjective symptoms. The examiner stated that the motor vehicle accident that occurred resulted in a left talus fracture that was surgically repaired while on active duty shortly after the incident, and there was no evidence in the record that the Veteran had any loss of consciousness or head injury of any sort resulting from the accident. At the Veteran's Board hearing, the Veteran's representative stated that the VA examiner did not take into consideration the severity of the Veteran's 1992 accident. The representative referred to the Accident Report's indication that the Veteran was unable to speak to the responding officer, which is not supported, as discussed above. To the extent the representative was arguing this January 2016 VA examination to be inadequate, the Board finds this contention to be unpersuasive. Rather, the examination report reflects that the examiner reviewed the evidence of record, and the examiner provided a reasoned rationale, supported by the evidence of record, which includes specific citations to the relevant Accident Report, subsequent medical examination, relevant service treatment records, and the Veteran's contentions. The examiner also did not believe that the Veteran had experienced as TBI at the time of the motor vehicle accident, which is a finding of fact that the Board has made based on its own review of the evidence. Thus, the examiner's opinion is based on an accurate factual premise. For these reasons, the Board finds the January 2016 examination report to be probative evidence against a finding that the Veteran has residuals from a TBI. The Veteran submitted multiple third party statements from 2018 to 2021, including multiple family members, the Veteran's ex-wife, and a supply specialist who worked with the Veteran during service. These statements reported witnessing changes in the Veteran after his 1992 motor vehicle accident, including reduced self-esteem, interpersonal difficulties, impulsive actions, anger issues, changes in behavior and personality, depression, and anxiety. However, these statements do not confer a current diagnosis of a TBI and these parties have not been shown to be medical professionals who are competent to make such a diagnosis. To the extent that individuals implied that the Veteran had sustained a TBI at the time of the motor vehicle accident, the Board finds that what is documented in the service treatment records is more probative than these statements submitted more than 25 years after the accident. The Veteran affirmatively denied history of a head injury at service discharge, which refutes allegations by these individuals of a head injury. The Veteran completed that form at service discharge, where he certified the truth of his statements within that form. The Board finds no reason to question the accuracy of what the Veteran documented at that time, and the statements he made within that document are found credible. While the Veteran is competent to report his observed symptoms, lay assertions do not constitute a competent clinical diagnosis of TBI. See 38 C.F.R. § 3.159(a)(1). The Veteran's lay assertions cannot constitute competent medical evidence in support of a current diagnosis because he has not demonstrated the requisite medical training or expertise. The Veteran does not proffer competent evidence establishing a current diagnosis of a TBI or a disability during or in close proximity to the appeal period. The Board is mindful of the holding in Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018), in which the U.S. Court of Appeals for the Federal Circuit explained that where pain alone results in functional impairment that affects earning capacity, even if there is no identified underlying diagnosis, it can constitute a disability. However, the evidence of record does not show that the Veteran has had functional impairment affecting his earning capacity related to symptoms of TBI. Rather, the Veteran's symptoms may be attributed to disabilities for which the Veteran already has diagnoses, including a psychological disorder and/or a cervical spine disability. Additionally, on examination for assessment of TBI, the Veteran was found to have no complaints of impairment of memory, attention, concentration, or executive functions, with normal judgment, routinely appropriate social interaction, full orientation, normal consciousness, normal motor activity, normal visual spatial orientation, intact ability to communicate no neurobehavioral effects, and no subjective symptoms. Thus, the record does not reflect a diagnosis of TBI or impairment of earning capacity related to symptoms of a TBI. In the absence of evidence of an in-service disease or injury related to a TBI and a showing of functional impairment of earning capacity resulting from TBI or a currently diagnosed TBI, service connection cannot be established. As the evidence is persuasively against the claim of service connection for a TBI, the benefit-of-the-doubt doctrine is not for application, and the claim is denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 2. Degenerative joint disease of the cervical spine The above discussion of the Veteran's service-connection claim for TBI is incorporated herein, to the extent that the Veteran alleges that the onset of both a TBI and cervical spine disability occurred simultaneously. The Veteran contends that he has a cervical spine disability attributable to his 1992 motor vehicle accident described above. The Veteran has been diagnosed with degenerative joint disease of the cervical spine with radiculopathy. Accordingly, the facts establish that the first criteria for establishing service connection is met. However, despite the present disability and the Veteran's 1992 motor vehicle accident, the totality of the evidence is persuasively against a finding that the Veteran incurred an injury or disease of the cervical spine in this accident, and finding a causal relationship between the Veteran's current disability and his 1992 accident. For example, the record does not show that the Veteran complained of or was treated for a cervical spine disease or injury during his time in service. During hospital treatment following the 1992 accident, physical examination was reported relating to the Veteran's head, ears, eyes, nose, throat, cardiovascular system, and musculoskeletal system. Fracture, abrasion, contusion, lacerations, pain, and swelling of the Veteran's extremities were recorded; however, there was no documentation of a cervical spine or neck disease or injury recorded. The Veteran's head was described as normocephalic and atraumatic. The August 1993 Accident Report documented injuries to the Veteran's right leg, left foot, left arm, and left hand; however, there was no mention of a cervical spine, neck, or head disease or injury. As discussed above, the Veteran's representative suggested that the Veteran's car accident was more severe than indicated, supporting that a head/neck injury was incurred, based on the responding officer's statement that that the Veteran was unable to speak to the officer at the scene of the accident. However, the officer's statement refutes this notion and makes clear that the Veteran was able to speak, but did not speak to the officer, potentially due to receiving medical treatment for the severe injuries incurred to his extremities. The responding officer stated that, although the Veteran did not speak with the officer, the Veteran "repeatedly" told a separate individual on the scene "that he must've fallen asleep." This shows that the Veteran was able to speak after the accident and was able to discuss the circumstances preceding his motor vehicle accident. As such, the representative's contention that the Veteran was unable to speak, indicative of a cervical spine or neck injury, is not supported by the evidence of record. In the Report of Medical History during the Veteran's separation examination in February 1993, the Veteran specifically denied a history of arthritis, recurrent back pain, head injury, and periods of unconsciousness. The Veteran reported a positive history of swollen or painful joints, broken bones, bone, joint, or other deformity, and foot trouble. In this regard, the Veteran then documented musculoskeletal symptoms, which involved wearing a knee and ankle brace on both legs since the 1992 motor vehicle accident and having a fractured talus of the left foot. Thus, when addressing musculoskeletal symptoms, the Veteran did not include his neck or cervical spine, while discussing other musculoskeletal symptoms he had experienced from the motor vehicle accident. A concurrent Report of Medical Examination showed that the Veteran received a normal clinical evaluation of the head, neck and spine. At the Veteran's Board hearing, the Veteran indicated that he did not complain about medical problems other than his lower extremity injuries because he wanted to downplay any disabilities in order to remain in active duty service, as discussed above. This sentiment was also reflected in a statement submitted by the Veteran's ex-wife in June 2018. However, as stated above when discussing the TBI claim, the Board notes the February 1993 Report of Medical History and Report of Medical Examination were prepared explicitly in association with the Veteran's separation from active duty, at which point there was no incentive to downplay medical conditions in order to remain on active duty. Additionally, the Veteran did report a number of medical problems in February 1993, unrelated to his lower extremity disabilities, including a history of hay fever, skin diseases, and ear, nose, or throat trouble. As such, the Veteran's contention is not persuasive and not credible. The Board finds as fact that had the Veteran experienced a cervical spine injury at the time of the motor vehicle accident, he would have reported such injury, as he reported other injuries sustained from that accident, which consistently involved his lower extremities, including his left foot, and his left hand. His reports of lower extremity and left hand injuries are consistent with the contemporaneous evidence surrounding the motor vehicle accident and in the months following the accident. The Board finds that the service treatment records are complete, and that the silence in the records of a cervical spine injury is indicative of the Veteran not having sustained an in-service injury to his cervical spine at the time of the January 1992 motor vehicle accident. Thus, the Board finds that the evidence persuasively weighs against an in-service disease or injury involving the cervical spine, and the Veteran's allegation of a cervical spine disease or injury at the time of the January 1992 motor vehicle accident is not credible. Accordingly, the second element of a service-connection claim is not met. A November 1993 VA examination report shows that the examiner wrote, "Exam of head and neck reveals the eyes react to light and accomodation." It appears that the examiner did not document the neck findings, but the lack of findings would indicate that the examiner did not find a positive finding related to the Veteran's neck, which is evidence against ongoing neck symptoms following service discharge. Within the examination report, the examiner wrote that the Veteran had injured his left foot in a car accident and had undergone surgery. The examiner also wrote, "At the same accident[,] he sustained laceration of the dorsum of the left hand and the right ankle," and that these were also treated with surgery. Thus, while the Veteran reported three, different injuries from the motor vehicle accident, he did not include an injury involving his neck or cervical spine, which further supports the finding that there was no cervical spine disease or injury during service. A 2002 CT scan showed that the Veteran had arthritis in his vertebrae. In February 2004, the Veteran was treated for a flare of neck pain and was assessed with degenerative joint disease with cervical radiculopathy. He stated that he was involved in an accident in service at which time he broke his ankle and the Veteran thought he may "have injured his neck or shoulder." The Veteran underwent spinal fusion surgery in 2007. The Veteran underwent a VA examination for assessment of a cervical spine disability in January 2016. The examiner noted the Veteran's diagnosis of degenerative joint disease with radiculopathy. The Veteran recalled the 1992 motor vehicle accident, but stated that he did not recall when he first noted neck issues as he recalled putting up with it a long while and suffering a lot before he could finally get treatment. The examiner noted that the service treatment records differ from the Veteran's recollection of the motor vehicle accident, as the Veteran self-reported that he was transported for medical care by a police car, and not an ambulance, as indicate by service treatment records. As discussed above, the record reflects recurrent inconsistencies regarding material facts that have negatively impacted the Veteran's overall credibility. The examiner found it less likely than not that the Veteran's cervical spine disability was caused by his in-service motor vehicle accident. The examiner stated that an opinion was complicated by the Veteran's reported lack of recollection of various events and medical care, as well as demonstrated propensity to have recollections that contradict the medical record. However, the examiner stated that cervical trauma of significant severity to cause multi-level post-traumatic degenerative changes would most likely be associated with symptoms within weeks to months following the acute trauma. The examiner stated that, while it is plausible that these symptoms could be overlooked initially while dealing with an acute ankle fracture, they would most likely be demonstrable and problematic during the recuperation phase and no evidence is found of this either at emergency trauma evaluation, follow-up medical visits, or on separation one year later. The examiner noted that the Veteran has reported a very active lifestyle, including intentionally picking fights and even engaging in fights for money in mental health examinations, and that he has had some legal difficulties apparently in that regard. The examiner concluded that based on the absence of evidence of cervical injury in service, in the available records, and the Veteran's own lack of recollection when cervical symptoms started on examination, the examiner found it less likely than not that the Veteran's neck condition was incurred or caused by the motor vehicle accident during service. At the Veteran's Board hearing, the Veteran's representative implied that the VA examiner's opinion may not be adequate because the examiner did not take into consideration the severity of the Veteran's 1992 accident and because the examiner stated that the opinion was complicated by inconsistencies in the Veteran's reporting when compared to the evidence of record. However, the Board finds that the examiner adequately considered the evidence of record at the time, with specific references to the examinations of the Veteran directly following the accident and one year thereafter, as well as the 1993 Accident Report. While the examiner commented on issues that impacted the Veteran's credibility, the examiner's opinion is well supported by the concurrent medical record. The examiner indicated that the Veteran's cervical spine condition would most likely have been identified in the year following the Veteran's motor vehicle accident, but the Veteran did not report any associated symptoms and received a normal clinical evaluation of the neck and spine. Additionally, the examiner cited to potential intercurrent causes for the Veteran's condition, supported by the longitudinal evidence of record. As stated above, the Board finds that the Veteran's allegation of an in-service cervical spine disease or injury is not credible. Therefore, the examiner's opinion is based on the facts that the Board finds are accurate, which is that there was no in-service disease or injury involving the cervical spine at the time of the 1992 motor vehicle accident. Thus, the Board finds the January 2016 VA examiner's opinion to be probative. The Veteran submitted multiple third-party statements between 2018 and 2021, including from multiple family members, the Veteran's ex-wife, and a supply specialist who worked with the Veteran during service. These statements indicated that the Veteran experienced neck pain after suffering whiplash from his 1992 accident. However, these individuals are not competent to provide a diagnosis of a cervical spine disability in this instance. Additionally, these statements generally reflect the Veteran's past lay statements, which are found to be not credible and are contradicted by the clinical evaluation at the Veteran's discharge from service, and his reporting of symptoms at the relevant time period. For example, the supply specialist stated that the Veteran experienced constant headaches following his motor vehicle accident. The Veteran's ex-wife also reported that the Veteran had headaches, and the Veteran's mother stated that the Veteran seemed disoriented. However, approximately one year after the Veteran's accident, in February 1993, the Veteran specifically denied a history of frequent or severe headaches, and he received normal clinical evaluations of the neck, spine, and neurological functioning. He reported that his health was good except for leg and ankle issues. As discussed above, given that the Veteran reported a wide range of medical issues and symptoms relating to other disabilities at service discharge, the record supports that the Veteran was honest relating to his functioning at the time, and if the Veteran was experiencing symptoms associated with a neck injury, he would have reported them at the time. Thus, the statements alleging headaches after the motor vehicle accident are refuted by the Veteran's own statements. To the extent that individuals implied that the Veteran had sustained a neck injury at the time of the motor vehicle accident, the Board finds that what is documented in the service treatment records is more probative than these statements submitted more than 25 years after the accident. The Board has explained why it finds that had the Veteran sustained a neck or cervical spine injury at that time of the accident, it would have been documented in the service treatment records or even within the records soon after service discharge. But there is no report of a neck injury during service or when he was evaluated both by private and VA medical professionals in 1993, at which times, he reported other injuries he had sustained in the 1992 motor vehicle accident, which did not include a cervical spine injury. Thus, to the extent that these individuals allege a neck/cervical spine injury in service, the Board finds such allegations are not credible. The weight of the evidence is persuasively against the Veteran's current cervical spine disability being related to his 1992 motor vehicle accident. The Veteran reported no head or neck symptoms during treatment following the accident or on separation examination. The contemporaneous treatment records following the accident do not document a cervical spine disease or injury. A 1993 Accident Report made no mention of a neck injury. On separation examination in February 1993, the Veteran received normal clinical evaluations of the neck and spine. Furthermore, the record does not establish the presence of the Veteran's degenerative joint disease within one year of the Veteran's separation from service to warrant an award of service connection on a presumptive basis for a chronic disease. As stated, service treatment records show that the Veteran received normal clinical evaluations of the neck and spine on separate examination in February 1993. The Veteran's current disability was not evidenced until 2002, which is nine years following his discharge from active duty. As such, service connection for a cervical spine disability is not warranted on a presumptive basis. For the above reasons, the evidence is neither evenly balanced nor approximately so with regard to whether service connection for a cervical spine disability is warranted. Rather, the evidence persuasively weighs against the award of service connection. The benefit of the doubt doctrine, see 38 U.S.C. § 5107(b), is therefore not for application. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc) (only when the evidence persuasively favors one side or another is the benefit of the doubt doctrine not for application). A. P. SIMPSON Veterans Law Judge Board of Veterans' Appeals Attorney for the Board G. Wonderling, 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.