Citation Nr: A25032016 Decision Date: 04/08/25 Archive Date: 04/08/25 DOCKET NO. 231129-397614 DATE: April 8, 2025 ORDER 1. Entitlement to service connection for a left knee disability, to include status post residual arthroscopy for meniscal tear, is denied. 2. Entitlement to service connection for a right knee disability, to include status post residual arthroscopy for meniscal tear, is denied. 3. Entitlement to service connection for bilateral plantar fasciitis is denied. 4. Entitlement to service connection for a lumbar spine disability is denied. 5. Entitlement to service connection for a right shoulder disability is denied. 6. Entitlement to service connection for a right wrist disability is denied. FINDINGS OF FACT 1. The evidence persuasively weighs against finding that the Veteran's left knee disability, to include status post residual arthroscopy for meniscal tear, was incurred in or otherwise related to service. 2. The evidence persuasively weighs against finding that the Veteran's right knee disability, to include status post residual arthroscopy for meniscal tear, was incurred in or otherwise related to service. 3. The evidence persuasively weighs against finding that the Veteran's bilateral plantar fasciitis was incurred in or otherwise related to service. 4. The evidence of record persuasively weighs against finding that the Veteran has had a lumbar spine disability at any time during or approximate to the pendency of the claim. The evidence persuasively weighs against finding that a lumbar spine disability was incurred in or otherwise related to service. 5. The evidence of record persuasively weighs against finding that the Veteran has had a right shoulder disability at any time during or approximate to the pendency of the claim. 6. The evidence of record persuasively weighs against finding that the Veteran has had a right wrist disability at any time during or approximate to the pendency of the claim. CONCLUSIONS OF LAW 1. The criteria for service connection for a left knee disability, to include status post residual arthroscopy for meniscal tear, have not been met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 2. The criteria for service connection for a right knee disability, to include status post residual arthroscopy for meniscal tear, have not been met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 3. The criteria for service connection for bilateral plantar fasciitis have not been met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 4. The criteria for service connection for a lumbar spine disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 5. The criteria for service connection for a right shoulder disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 6. The criteria for service connection for a right wrist disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from June 9, 1995 to October 5, 1999, from May 1, 2004 to September 4, 2005, from May 31, 2007 to July 22, 2008 and from June 19, 2011 to May 29, 2012, with additional periods of Reserve duty. This appeal comes to the Board of Veterans' Appeals (Board) from a June 2023 rating decision by the agency of original jurisdiction (AOJ), which denied service connection for bilateral plantar fasciitis, a lumbar spine disability, a right shoulder disability, and a right wrist disability and a July 2023 rating decision in which service connection was denied for a left knee disability and a right knee disability. The Veteran appealed the decision to the Board by submitting a November 2023 VA Form 10182, Notice of Disagreement, and elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the June 2023 and July 2023 AOJ decisions on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801. If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim[s], considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. The Board notes that in the above-mentioned June 2023 rating decision, the AOJ denied service connection for both a left elbow disability and a right elbow disability. Subsequently, the Veteran submitted a November 27, 2023 VA Form 20-0995, Supplemental Claim Application, then filed a claim for both issues, citing the June 2023 rating decision. The above-mentioned November 29, 2023 VA Form 10182 was filed two days later. An April 2024 rating decision adjudicated the claims for service connection for a bilateral elbow disability. As the Veteran submitted a supplemental claim prior to the time of his submission of a notice of disagreement and did not withdraw the supplemental claim, and, in fact, such supplemental claims were already adjudicated, these claims cannot be considered in the current appeal. 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). 1. Entitlement to service connection for a left knee disability, to include status post residual arthroscopy for meniscal tear 2. Entitlement to service connection for a right knee disability, to include status post residual arthroscopy for meniscal tear The Board has carefully reviewed the evidence of record and finds that the evidence persuasively weighs against the award of service connection for a bilateral knee disability. The reasons follow. The Veteran has been diagnosed with a bilateral knee disability, and thus there is evidence of a current disability. For example, in a June 2023 VA examination report, the examiner diagnosed the Veteran with bilateral status post residual arthroscopy for meniscal tear. In the July 2023 rating decision, the AOJ found that there is evidence of a current disability of a bilateral knee disability based on the June 2023 VA examination report. The Board is bound by this favorable finding. See 38 C.F.R. § 3.104(c). Thus, the facts establish that the first element of a service-connection claim is met. However, as to an in-service disease or injury, the evidence does not support a finding of a disease or injury in service indicative of a bilateral knee disability. The service treatment records (STRs) show that the Veteran was found to have clinically normal evaluations of his lower extremities in Reports of Medical Examination from October 1996, September 1999, and April 2003. In a Report of Medical History from September 1999 at separation from that period of active service, the Veteran denied a history of trick or locked knee, which shows that he was not experiencing knee symptoms during this period of active duty. In a March 2003 Medical Prescreen of Medical History Report, the Veteran denied a history of dislocated joint, including the knee; a history of swollen, painful, or dislocated joint or fluid in the joint (including the knee); limited range of motion of any joint (including the knee); shoulder, knee or elbow; locking other knee or other joint; and giving away of knee or other joint. In an April 2003 Report of Medical History from the Veteran's National Guard duty, he denied a history of knee trouble. During the Veteran's National Guard Reserve duty, several records show complaints related to the knees, however, the evidence does not support that the knee symptoms occurred during a period of active duty, active duty for training, or inactive duty training. For example, a September 2012 VA treatment record shows the examiner performed a physical examination of the Veteran and documented that it was difficult to elicit deep tendon reflexes in the knees. A September 2013 VA treatment record shows that the Veteran underwent surgery involving an arthroscopic repair of torn meniscus on the left knee on June 17, 2013. An August 2018 Reserve STR shows that the Veteran had a complex tear of the right knee and in a subsequent encounter was found to have right chondromalacia. Shortly thereafter, in August 2018 the Veteran was placed on a Physical Profile for his right knee pain/injury. The profile documented that the Veteran was not on duty status at the time of the injury or his profile. In a June 2023 VA examination report, the Veteran reported that his bilateral knee disability was caused by wear and tear during service, from rucking, jumping, bending, and squatting. However, the evidence does not persuasively show that he was on a period of active duty, active duty for training, or inactive duty training during the time periods where his bilateral knee disabilities were documented. Accordingly, for all these reasons, the Board finds the evidence persuasively weighs against a finding of disease or injury related to a bilateral knee disability during service, and the in-service disease or injury element is not met. Additionally, the evidence persuasively weighs against a nexus between a bilateral knee disability and service. For example, in the above mentioned 2013 and 2018 records, the, the Veteran was diagnosed with each respective knee disability, which dates are more than one year and approximately six years after active service, and does not lend to a finding that a bilateral knee disability had its onset in active service. In the June 2023 VA examination report, the Veteran reported experiencing daily knee pain. However, the record also does not support that the Veteran's bilateral knee disability symptoms were continuous from service. For example, in the same examination report, the Veteran reported that he has not had any medical management and did not have any upcoming treatment for his knees. As the Veteran has regularly attended VA treatment facilities between 2010 and 2023, and sought medical treatment for a variety of other medical issues, the Board finds that the Veteran's contention of continuity of symptoms is not credible. In the context of the Veteran's ongoing treatment at VA treatment facilities, it is logical to assume that the Veteran would report medical concerns he was having or experiencing, since he reported other medical concerns. If the Veteran had been experiencing knee symptoms since service, the Board finds he would have reported such symptom, as he expressly seeking medical treatment. The June 2023 VA examiner opined that the Veteran's bilateral knee disability was not incurred in or otherwise related to service. The examiner explained even with consideration of the Veteran's service records that showed left knee surgery in 2013 and right knee issues in 2018, the evidence does not support recurrent management and treatment during service. The examiner opined that without chronicity during or after service, a post-service event, illness, an injury is considered to the likely etiology. The examiner concluded that the lack of supportive objective medical evidence from the Veteran's STRS mean that his bilateral knee disability is not related to service. In a July 2023 VA addendum opinion, the same examiner opined that the Veteran's bilateral knee disability was not incurred in or otherwise related to service. After reiterating the June 2023 VA medical opinion, the examiner noted that there was no recurrent medical management or treatment after the original surgery based on the provided medical records. The examiner stated that this suggests that the surgery was successful, and the original left knee disability improved. The examiner stated that there is no supportive evidence that warrants direct service connection based on the provided medical records at this time, because there is no chronicity during or after service, a post service event, illness. The examiner again opined that a separate injury is the more likely etiology for the Veteran's bilateral knee disability. The examiner reviewed the evidence and provided an opinion with a rationale that was based on the specific facts of the case and medical principles. In light of the VA examiner's consideration of the chronicity of the Veteran's symptoms during and after service, the Board affords this opinion probative value and finds that it is evidence against a finding that a bilateral knee disability had its onset in service and is otherwise related to service. The facts upon which the examiner based the opinion are the same facts that the Board finds are the most accurate facts, which is that the Veteran did not have ongoing treatment for the bilateral knee disability during service. Thus, the examiner's opinion is based on an accurate set of facts. At the present time, there is no competent and probative evidence of a nexus between the bilateral knee disability and service to weigh against the June 2023 and July 2023 VA opinions, and the nexus element of a service-connection claim is not met. Additionally, the Board notes that that VA has conceded that the Veteran participated in a toxic exposure risk activity (TERA). Under 38 U.S.C. § 1168(a)(1), it provides that the Secretary of VA shall provide a veteran with a medical examination and obtain a medical opinion "if a veteran submits to the Secretary a claim for compensation for a service-connected disability [] with evidence of a disability and evidence of participation in a toxic exposure risk activity during" service. This requirement does not apply if the Secretary determines there is no indication of an association between the disability claimed by the veteran and the toxic exposure risk activity for which the veteran submitted evidence. 38 U.S.C. § 1168(c). The Secretary has determined that physical traumas have no positive association with participation in a TERA. Thus, a TERA examination and medical opinion is not required in connection with the Veteran's claim for service connection for a bilateral knee disability. A TERA examination is separate from the June 2023 VA examination that was provided by VA during the appeal period. For the above reasons, the evidence is neither evenly balanced nor approximately so with regard to whether entitlement to service connection for a bilateral knee disability is warranted. Rather, the evidence persuasively weighs against 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). 3. Entitlement to service connection for bilateral plantar fasciitis The Board has carefully reviewed the evidence of record and finds that the evidence persuasively weighs against the award of service connection for bilateral plantar fasciitis. The reasons follow. The Veteran has been diagnosed with bilateral plantar fasciitis, and thus there is evidence of a current disability. For example, in a June 2023 VA examination report the Veteran was diagnosed with bilateral plantar fasciitis. In the June 2023 rating decision, the AOJ found that there is evidence of a current disability of bilateral plantar fasciitis. The Board is bound by this favorable finding. See 38 C.F.R. § 3.104(c). Thus, the facts establish that the first element of a service-connection claim is met. However, as to an in-service disease or injury, the evidence does not support a finding of a disease or injury in service indicative of bilateral plantar fasciitis. The STRs show the Veteran was found to have clinically normal evaluations of his feet in Reports of Medical Examination from October 1996, September 1999, and April 2003. In Reports of Medical History from October 1996, September 1999, and April 2003, the Veteran denied a history of foot trouble, which shows that he was not experiencing foot symptoms in service. Accordingly, for these reasons, the Board finds the evidence persuasively weighs against a finding of disease or injury related to bilateral plantar fasciitis during service, and the in-service disease or injury element is not met. Additionally, the evidence persuasively weighs against a nexus between bilateral plantar fasciitis and service. For example, in a June 2023 VA examination report, the examiner first diagnosed the Veteran with bilateral plantar fasciitis, which is more than 10 years after his last period of active service and does not lend to a finding that bilateral plantar fasciitis had its onset in service. Prior to this time, in a September 2012 VA treatment record, the Veteran underwent a physical examination and was found to have no motor weakness or foot drop in the lower extremities, and his toes were found to be unremarkable. However, in a June 2023 VA examination, the Veteran reported that he had experienced bilateral foot pain during service because of his military boots, prolonged standing, jumping, rucking, and weight bearing on his feet. The Veteran reported that since service, he continues to have bilateral foot pain with prolonged standing and walking. He stated that although he has complaints of foot pain, he had no past or current medical management for his foot. The Board finds that the Veteran's contentions of symptoms since service are not credible. As previously noted, the Veteran has been regularly attending VA treatment facilities for a variety of medical symptoms since 2010, and, as discussed above, was affirmatively found to have no symptoms in 2012. The Board finds that it is logical to assume that the fact that the Veteran did not report foot symptoms during this time period is indicative of him not experiencing such symptoms. The June 2023 VA examiner opined that the Veteran's bilateral plantar fasciitis is not incurred in or otherwise related to service. The examiner explained that based on review of the available evidence, it is less likely than not that the claimed condition is due to service as there is a lack of substantiating evidence supporting a nexus between the current diagnosis of plantar fasciitis and military service. The examiner stated that there is no past diagnosis during or after service that is reported in in the Veteran's STRS or other medical records. The examiner concluded that without chronicity during service or after service, a post-service event, illness, or injury is considered to be a more likely etiology. The examiner reviewed the evidence and provided an opinion with a rationale that was based on the specific facts of the case and medical principles. In light of the VA examiner's consideration of the likely etiology of the Veteran's bilateral plantar fasciitis, the Board affords this opinion probative value and finds that it is evidence against a finding that bilateral plantar fasciitis had its onset in service and is otherwise related to service. The facts upon which the examiner based the opinion are the same facts that the Board finds are the most accurate facts, which is that the Veteran's STRs and other medical records do not support a diagnosis of bilateral plantar fasciitis prior to the time of the June 2023 VA examination. Thus, the examiner's opinion is based on an accurate set of facts. At the present time, there is no competent and probative evidence of a nexus between the bilateral plantar fasciitis and service to weigh against the June 2023 VA opinion, and the nexus element of a service-connection claim is not met. As stated above, the Board notes that the Secretary has determined that physical traumas have no positive association with participation in a TERA. Thus, a TERA examination and medical opinion is not required in connection with the Veteran's claim for service connection for bilateral plantar fasciitis. A TERA examination is separate from the June 2023 VA examination that was provided by VA during the appeal period. For the above reasons, the evidence is neither evenly balanced nor approximately so with regard to whether entitlement to service connection for bilateral plantar fasciitis is warranted. Rather, the evidence persuasively weighs against service connection. The benefit of the doubt doctrine, see 38?U.S.C. §?5107(b), is therefore not for application. Lynch, 21 F.4th 776. 4. Entitlement to service connection for a lumbar spine disability The Board has carefully reviewed the evidence of record and finds that the evidence persuasively weighs against the award of service connection for a lumbar spine disability. The reasons follow. The first question before the Board in this case is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease or is caused or aggravated by a service-connected disability. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.310. In order for service connection to be established, there needs to be competent evidence of a current disability. However, here the Board finds that the evidence persuasively weighs against a finding that the Veteran has a current a lumbar spine disability and has not had one at any time during the pendency of the claim or recent to the filing of the claim. In a June 2023 VA examination report, the examiner found that the Veteran does not have a current lumbar spine disability. The examiner stated that the Veteran's symptoms of back pain were subjective, but that upon physical examination, the Veteran was with normal functional limits. Prior to this time, the only notations of the Veteran complaining about back symptoms were in a September 2012 VA treatment record, where he reported two years of back pain with no specific injury and a September 2013 VA treatment record in which he reported taking pain medication for his back. The Board concludes that the evidence persuasively weighs against a finding that the Veteran has current a lumbar spine disability, to include symptoms that cause functional impairment that affects earning capacity and has not had one at any time during the pendency of the claim or recent to the filing of the claim. 38 U.S.C. §§ 1110, 1131, 5107(b), 38 C.F.R. § 3.303(a), (d). For example, of record are medical records from 2010 to 2024, and the evidence during this time period does not support a current a lumbar spine disability, to include symptoms that cause functional impairment that affects earning capacity. These records cover a 14-year period, and the lack of documentation of a lumbar spine disability, to include pain that causes functional limitations, is evidence against the claim for service connection for a lumbar spine disability. While the Veteran believes he has a current a lumbar spine disability, he is not competent to provide evidence of a current disability in this case. The issue is medically complex, as it requires specialized medical education. Consequently, the Board gives more probative weight to the competent medical evidence, which found no current disability. Thus, the first element of service connection is not satisfied. However, although the Veteran does not have a current disability, even if it were to be found that he has a current disability, the evidence still does not support entitlement to service connection for a lumbar spine disability. As to an in-service disease or injury, the evidence supports a finding of a disease or injury in service indicative of a lumbar spine disability. The STRs show that in December 2011, the Veteran reported that he woke up and experienced back pain. The examiner noted that the Veteran had a history of kidney stones. In the June 2023 rating decision, the AOJ cited this incident when making a favorable finding that the in-service injury or disease element is satisfied. The Board is bound by this favorable finding. A June 2012 Post Deployment Health Reassessment shows that the Veteran reported a history of back pain and received a letter of referral for the same symptom. A June 2012 Post Deployment Health Reassessment, from the Veteran's Reserve duty, shows that he reported a history of back pain and received a letter of referral for the same symptom. As such, the Board finds the evidence supports a finding of disease or injury related to a lumbar spine disability during service, and the in-service disease or injury element is met. However, the evidence persuasively weighs against a nexus between a lumbar spine disability and service. Although a September 2012 VA treatment record shows that the Veteran reported back pain for the past two years, subsequent VA treatment records do not support continued complaints, evaluation, or treatment for back issues. For example, the June 2023 VA examiner opined that the Veteran's lumbar spine disability is not incurred in or otherwise related to service. After explaining that the examiner found that there was no current disability, the examiner also explained that there was no chronicity during service or after service, and thus a post-service event, illness, or injury is considered to be a more likely etiology of any lumbar spine disability. The examiner reviewed the evidence and provided an opinion with a rationale that was based on the specific facts of the case and medical principles. In light of the VA examiner's consideration of the Veteran's symptoms and whether there was a current disability, and review of the chronicity of care during and after service, the Board affords this opinion probative value and finds that it is evidence against a finding that a lumbar spine disability had its onset in service and is otherwise related to service. The facts upon which the examiner based the opinion are the same facts that the Board finds are the most accurate facts, which is the Veteran did not experience chronic symptoms during service. Thus, the examiner's opinion is based on an accurate set of facts. While the Veteran alleges that the lumbar spine disability is related to service, he is not competent to attribute the lumbar spine disability to service, as medical expertise is required. In this regard, the question of causation involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship. As such, the question of etiology in this case may not be competently addressed by lay evidence, and the Veteran's opinion is nonprobative evidence. At the present time, there is no competent and probative evidence of a nexus between the lumbar spine disability and service to weigh against the June 2023 VA opinion, and the nexus element of a service-connection claim is not met. As previously noted, the Secretary has determined that physical traumas are a condition that has no positive association with participation in a TERA. Thus, a TERA examination and medical opinion is not required in connection with the Veteran's claim for service connection for a lumbar spine disability. A TERA examination is separate from the June 2023 VA examination that was provided by VA during the appeal period. For the above reasons, the evidence is neither evenly balanced nor approximately so with regard to whether entitlement to service connection for a lumbar spine disability is warranted. Rather, the evidence persuasively weighs against service connection. The benefit of the doubt doctrine, see 38?U.S.C. §?5107(b), is therefore not for application. Lynch, 21 F.4th 776. 5. Entitlement to service connection for a right shoulder disability 6. Entitlement to service connection for a right wrist disability The Board has carefully reviewed the evidence of record and finds that the evidence persuasively weighs against the award of service connection for a right shoulder disability and against the award of service connection for a right wrist disability. The reasons follow. The question before the Board in this case is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease or is caused or aggravated by a service-connected disability. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.310. In order for service connection to be established, there needs to be competent evidence of a current disability. However, here the Board finds that the evidence persuasively weighs against a finding that the Veteran has a current right shoulder disability or a current right wrist disability and has not had one at any time during the pendency of the claim or recent to the filing of the claim. VA treatment records do not support complaints, symptoms, evaluation, diagnosis, or treatment for either a right shoulder disability or a right wrist disability. The Board concludes that the evidence persuasively weighs against a finding that the Veteran has current a current right shoulder disability or a current right wrist disability, to include symptoms that cause functional impairment that affects earning capacity, and has not had one at any time during the pendency of the claim or recent to the filing of the claim. 38 U.S.C. §§ 1110, 1131, 5107(b), 38 C.F.R. § 3.303(a), (d). For example, of record are medical records from 2010 to 2024, and the evidence during this time period does not support a current right shoulder disability or a current right wrist disability, to include symptoms that cause functional impairment that affects earning capacity. These records cover a 14-year period, and the lack of documentation of right shoulder or right wrist symptoms, to include pain, is evidence against the claims for service connection for a right shoulder disability and a right wrist disability. The Veteran has not provided a description of his symptoms to establish a current disability for either the right shoulder or the right wrist. Rather, he has written that he has pain, but has not provided facts to show that he has a current right shoulder disability or a right wrist disability, to include symptoms that cause functional impairment of earning capacity. VA did not provide the Veteran with a VA examination or opinion in connection with these claims. VA must provide a medical examination and/or medical opinion when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, (2) evidence establishing that an event, injury, or disease occurred in service, or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran's service or with another service-connected disability, but (4) there is insufficient competent medical evidence on file for the Secretary to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79 (2006). Here, for the reasons described above, the Board finds that the evidence does not establish competent evidence of a current disability or persistent or recurrent symptoms of a disability for either claim. For a VA examination and/or medical opinion to be warranted, all the McLendon criteria have to be met, and at least one of the criteria is not met. Therefore, entitlement to a VA examination and/or medical opinion is not warranted for this claim. As noted above, VA has conceded that the Veteran participated in TERA. Entitlement to an examination under 38 U.S.C. § 1168(a)(1) requires evidence of a current disability. However, as the facts do not establish current disabilities related to the right shoulder and the right wrist, a TERA examination and medical opinion are not warranted. For the above reasons, the evidence is neither evenly balanced nor approximately so with regard to whether entitlement to service connection for a right shoulder disability or a right wrist disability is warranted. Rather, the evidence persuasively weighs against service connection. The benefit of the doubt doctrine, see 38?U.S.C. §?5107(b), is therefore not for application. Lynch, 21 F.4th 776. A. P. SIMPSON Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Husain, Rahat 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.