Back to BVA DecisionsDENIEDSpecial Benefit NO SPECIAL BENEFIT Docket No. 16-59 237
DEGENERATIVE ARTHRITIS OF THE SPINE (SPONDYLOSIS)
A. C. MACKENZIE · 2026 · Case ID: 26003028
Summary
The veteran served from September 1975 to September 1979 and again from October 1983 to April 1994. The veteran appeals the denial of service connection for multiple conditions, including lumbar spine disorder, right ankle disorder, left ankle disorder, left knee disorder, right knee disorder, left lower extremity disorder, right lower extremity disorder, headache disorder, eye disorder, sleep disorder, temporomandibular joint (TMJ) disorder, hypertension, and erectile dysfunction (ED). The Board reviewed the evidence, including the veteran's testimony and the findings of fact. The Board noted that for several conditions, including lumbar spine disorder, left knee disorder, and right knee disorder, there was no manifestation during service or within one year of separation, and current conditions were not attributable to service or service-connected disabilities. For other conditions like hypertension and headache disorder, the Board found no manifestation during service or within the presumptive period, and no continuity of symptomatology. The Board denied service connection for all appealed conditions, finding that the evidence did not establish a link to service or a service-connected disability, and that presumptive provisions did not apply. The case involved procedural history including a prior remand and cancellation of a hearing.
Rationale
No manifestation during service; No manifestation within one year of separation; Current condition not attributable to service
Full Decision Text
Citation Nr: 26003028 Decision Date: 03/05/26 Archive Date: 03/05/26 DOCKET NO. 16-59 237 DATE: March 5, 2026 ORDER Entitlement to service connection for a lumbar spine disorder is denied. Entitlement to service connection for a right ankle disorder is denied. Entitlement to service connection for a left ankle disorder. Entitlement to service connection for a left knee disorder. Entitlement to service connection for a right knee disorder. Entitlement to service connection for a left lower extremity disorder. Entitlement to service connection for a right lower extremity disorder. Entitlement to service connection for a headache disorder. Entitlement to service connection for an eye disorder. Entitlement to service connection for a sleep disorder. Entitlement to service connection for temporomandibular joint disorder (TMJ) is denied. Entitlement to service connection for hypertension is denied. Entitlement to service connection for erectile dysfunction (ED) is denied. FINDINGS OF FACT 1. A low back disorder was not manifested during service, arthritis was not manifested within one year of separation, and a current low back disorder is not attributable to or related to service. 2. A right ankle disorder is not attributable to or related to service or to a service-connected disability. 3. A left ankle disorder is not attributable to or related to service or to a service-connected disability. 4. A left knee disorder was not manifested during service, arthritis was not manifested within one year of separation, and a current left knee disorder is not attributable to or related to service or service-connected disability. 5. A right knee disorder was not manifested during service, arthritis was not manifested within one year of separation, and a current right knee disorder is not attributable to or related to service or service-connected disability. 6. A left lower extremity disorder is not attributable to service or to a service-connected disability. 7. A right lower extremity disorder is not attributable to service or to a service-connected disability. 8. A headache disorder was not manifested during service, arthritis was not manifested within one year of separation, and a current headache disorder is not attributable to or related to service. 9. An eye disorder is not attributable to service or to a service-connected disability. 10. A sleep disorder is not attributable to service or to a service-connected disability. 11. TMJ is not attributable to service or to a service-connected disability. 12. Hypertension was not manifested during service, or within one year of separation, and current hypertension is not attributable to or related to service. 13. ED is not attributable to service or to a service-connected disability. CONCLUSIONS OF LAW 1. Service connection for a lumbar spine disorder is not warranted. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.303, 3.306, 3.307, 3.309. 2. Service connection for a right ankle disorder is not warranted. 38 U.S.C. §§ 1101, 1110, 1131; 38 C.F.R. §§ 3.303, 3.304, 3.306, 3.310. 3. Service connection for a left ankle disorder is not warranted. 38 U.S.C. §§ 1101, 1110, 1131; 38 C.F.R. §§ 3.303, 3.304, 3.306, 3.310. 4. Service connection for a left knee disorder is not warranted. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.303, 3.306, 3.307, 3.309, 3.310. 5. Service connection for a right knee disorder is not warranted. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.303, 3.306, 3.307, 3.309, 3.310. 6. Service connection for a left lower extremity disorder is not warranted. 38 U.S.C. §§ 1101, 1110, 1131; 38 C.F.R. §§ 3.303, 3.304, 3.306, 3.310. 7. Service connection for a right lower extremity disorder is not warranted. 38 U.S.C. §§ 1101, .C. §§ 1101, 1110, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.303, 3.306, 3.307, 3.309, 3.310. 6. Service connection for a left lower extremity disorder is not warranted. 38 U.S.C. §§ 1101, 1110, 1131; 38 C.F.R. §§ 3.303, 3.304, 3.306, 3.310. 7. Service connection for a right lower extremity disorder is not warranted. 38 U.S.C. §§ 1101, 1110, 1131; 38 C.F.R. §§ 3.303, 3.304, 3.306, 3.310. 8. Service connection for a headache disorder is not warranted. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.303, 3.306, 3.307, 3.309. 9. Service connection for an eye disorder is not warranted. 38 U.S.C. §§ 1101, 1110, 1131; 38 C.F.R. §§ 3.303, 3.304, 3.306, 3.310. 10. Service connection for a sleep disorder is not warranted. 38 U.S.C. §§ 1101, 1110, 1131; 38 C.F.R. §§ 3.303, 3.304, 3.306, 3.310. 11. Service connection for TMJ is denied is not warranted. 38 U.S.C. §§ 1101, 1110, 1131; 38 C.F.R. §§ 3.303, 3.304, 3.306, 3.310. 12. Service connection for hypertension is denied is not warranted. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.303, 3.306, 3.307, 3.309. 13. Service connection for ED is denied is not warranted. 38 U.S.C. §§ 1101, 1110, 1131; 38 C.F.R. §§ 3.303, 3.304, 3.306, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1975 to September 1979 and from October 1983 to April 1994. This appeal comes before the Board of Veterans' Appeals (Board) from rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran appeared before a Veterans Law Judge in February 2020 and delivered sworn testimony via video conference hearing in Houston, Texas. In April 2020, the Board remanded to the RO the issues listed on the front page of this decision for additional development. In July 2023, the Veteran was sent a letter informing him that the Veterans Law Judge who conducted his hearing is no longer available to participate in his appeal. The Veteran was offered an opportunity for another Board hearing. In April 2024, the Veteran was scheduled for another Board hearing, but canceled it. Service Connection Service connection will be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 1153; 38 C.F.R. §§ 3.303, 3.304, 3.306. In addition, arthritis, a headache disorder, and hypertension will be presumed to have been incurred in or aggravated by service if it had become manifest to a degree of 10 percent or more within one year of a veteran's separation from service. 38 U.S.C. §§ 1101, 1110, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. With chronic diseases shown as such in service or within the presumptive period so as to permit a finding of service connection, subsequent manifestations of the same chronic disease had become manifest to a degree of 10 percent or more within one year of a veteran's separation from service. 38 U.S.C. §§ 1101, 1110, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. With chronic diseases shown as such in service or within the presumptive period so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. Continuity of symptomatology is required only where the condition noted during service or the presumptive period is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. When the fact of chronicity in service is not adequately supported, then a showing of continuity after service is required to support the claim. 38 C.F.R. § 3.303(b). This regulation pertains to "chronic diseases" enumerated in 38 C.F.R. § 3.309(a) (listing named chronic diseases). Walker v. Shinseki, 708 F.3d 1331, 1336-37 (Fed. Cir. 2013). The United States Court of Appeals for the Federal Circuit (Federal Circuit) noted that the requirement of showing a continuity of symptomatology after service is a "second route by which a veteran can establish service connection for a chronic disease" under subsection 3.303(b). Walker, supra. Showing a continuity of symptoms after service itself "establishes the link, or nexus" to service and also "confirm[s] the existence of the chronic disease while in service or [during the] presumptive period." Id. (holding that section 3.303(b) provides an "alternative path to satisfaction of the standard three-element test for entitlement to disability compensation"). Service connection may also be granted for any disease diagnosed after discharge when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). In addition, a disability may be service connected on a secondary basis by demonstrating that the disability is either (1) due to or caused by a service-connected disability, or (2) aggravated by an already service-connected disease or injury, whether or not the additional impairment is itself a separate disease or injury caused by the service-connected condition, per Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). See 38 U.S.C. § 1110; 38 C.F.R. § 3.310. In Ward v. Wilkie, 31 Vet. App. 233, 240 (2019), the United States Court of Veterans Appeals (Court) held that aggravation in the context of secondary service connection does not require that worsening be permanent. Thereafter, in Spicer v. McDonough, 61 F.4th 1360 (Fed. Cir. 2023), the Federal Circuit held that the "resulting from" language of 38 U.S.C. § 1110, which provides compensation for veterans "[f]or disability resulting from personal injury suffered or disease contracted in line of duty," requires "but-for causation." The Federal Circuit explained that "but-for causation" is a broader standard than proximate causation and can include multi-link causal chains. Id. at 1364. As such, prior directives involving secondary service connection opinion requests for a VA examiner to opine as to whether a claimed disability is "proximately due to" a service-connected disability are no longer applicable as this language limits the scope of the applicable standard. Instead, new remand directives involving the causation element of secondary service connection indicate that a VA examiner should opine as to whether a claimed disability is "due to" or "caused by" a service-connected disability. Reasonable doubt concerning any matter material to the determination is resolved in the Veteran's favor. 38 U.S -for causation" is a broader standard than proximate causation and can include multi-link causal chains. Id. at 1364. As such, prior directives involving secondary service connection opinion requests for a VA examiner to opine as to whether a claimed disability is "proximately due to" a service-connected disability are no longer applicable as this language limits the scope of the applicable standard. Instead, new remand directives involving the causation element of secondary service connection indicate that a VA examiner should opine as to whether a claimed disability is "due to" or "caused by" a service-connected disability. Reasonable doubt concerning any matter material to the determination is resolved in the Veteran's favor. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 1. Service connection for a lumbar spine disorder. During the February 2020 Board hearing, the Veteran reported that while aboard a vessel, it was icy and he slipped and fell. He stated that he injured his back, so he went to the medic and was put on light duty. He indicated that he self-treated his low back after service. He then applied for benefits from the Social Security Administration (SSA) and VA. A review of the service treatment records (STRs) reveals no complaints, findings, or treatment of a back injury or condition during either period of service. The August 1979 and April 1994 separation examinations revealed that the Veteran denied having recurrent back pain, and his physical examinations were normal. Post-service March 2001 VA records showed that the Veteran fell off a ladder and bumped his back. In August 2010, it was noted that the Veteran had low back pain for which he took medication. In November 2011, the Veteran reported back pain. In July 2013, it was noted that the Veteran had low back pain, degenerative joint disease, and mild stenosis. The Veteran was afforded a VA examination in November 2014. The Veteran reported that he started noticing mid and lower back pain in 2004. He thereafter had been told that he had degenerative disc disease. The Veteran also described having a shooting pain down into his right leg. The diagnoses were lumbar degenerative disc disease, radiculopathy of the right lower extremity, and intervertebral disease syndrome (IVDS). The Veteran subsequently underwent physical therapy for his low back pain and continued to report back symptoms. The Veteran's SSA records referred to the July 2013 VA clinical treatment report, and also subsequent VA records. Also, they referred to an August 2010 x-ray which showed degenerative joint disease and a June 2012 magnetic resonance imaging (MRI) which showed lumbar spondylosis resulting in mild spinal canal stenosis of L4-5 and annular fissure at L2-3 and L3-4. In addition, a private February 2014 record indicated that the Veteran's low back pain initiated with a 1980 slip and fall, but he had no formal treatment. Currently, he had chronic low back pain with probable degenerative arthritis with a history (as noted, provided by the Veteran) of trauma in 1980. The SSA records do not contain any other opinion regarding the etiology of a current low back disability. The Veteran was afforded another VA examination in November 2020. It was noted that the VA treatment records were obtained, reviewed, and considered. The examiner opined the low back condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. The examiner's rationale stated that a review of his record was silent for claims of lumbar spine disorder while in service. Objective examination confirmed limited range of motion and pain with diagnosis of bilateral lower extremity radiculopathy, IVDS and degenerative disc disease (DDD). The Veteran's x-rays showed DDD, and there was no evidence to support that the lumbar spine disorder had onset in, or was otherwise related to, active service. Subsequent records do not include any conflicting medical opinions. The Board may consider whether the silence of the Veteran in reporting complaints regarding his low back during service when he reported other medical complaints constitutes negative evidence. See Forshey v. West, 12 Vet. App. 71, 74 (1998), aff'd sub nom. Forshey v. Principi, 284 F.3d 1335, 1358 (Fed. Cir. 2002) (noting that the definition of evidence encompasses "negative evidence" which tends to disprove the existence of an alleged fact). In this case, it does constitute negative evidence. disorder had onset in, or was otherwise related to, active service. Subsequent records do not include any conflicting medical opinions. The Board may consider whether the silence of the Veteran in reporting complaints regarding his low back during service when he reported other medical complaints constitutes negative evidence. See Forshey v. West, 12 Vet. App. 71, 74 (1998), aff'd sub nom. Forshey v. Principi, 284 F.3d 1335, 1358 (Fed. Cir. 2002) (noting that the definition of evidence encompasses "negative evidence" which tends to disprove the existence of an alleged fact). In this case, it does constitute negative evidence. There is not just a lack of evidence; rather, there is evidence showing normal findings. See Maxson v. Gober, 230 F.3d 1330 (Fed. Cir. 2000). The absence of symptoms on separation interrupts continuity of symptomatology for degenerative arthritis and also is inconsistent with the Veteran's report of ongoing medical problems with his low back from his claimed time of inception during service. 38 C.F.R. § 3.303(b); Maxson, supra (it is proper to consider the Veteran's entire medical history, including a lengthy period of absence of complaints.). In this case, the clinical records do not show the claimed ongoing nature of residuals of the purported slip and fall injury during service. In sum, the lay evidence in this case lacks credibility, as it is in direct conflict with the clinical findings which constitute medical assessments made for the low back which were undertaken and yielded only normal results. The SSA records reflect that the Veteran told an examiner in February 2014 that his back pain began with a slip and fall in approximately 1980 (which that was between his two periods of service, it appears that the Veteran meant the alleged slip and fall during service). The examiner noted the history of the reported trauma, but there was no articulated specific independent opinion. As noted, there was no documented slip and fall during service, and the Veteran denied having an injury on his separation examination and also denied both current back problems as well as recurrent back pain. Thus, the Board does not afford probative weight to the examiner's reporting of the alleged slip and fall with resulting back pain. The Board may reject a medical opinion that is based on facts provided by the Veteran that have been found to be inaccurate because other facts present in the record contradict the facts provided by the Veteran that formed the basis for the opinion. See Kowalski v. Nicholson, 19 Vet. App. 171 (2005). Further, the November 2020 medical opinion indicated that there was no nexus between current diagnoses and service. The examiner was aware of the Veteran's medical history, provided a fully articulated opinion, and also furnished a reasoned analysis. The Board therefore attaches significant probative value to this opinion, and the most probative value in this case, as it is well reasoned, detailed, consistent with other evidence of record, and included an access to the accurate background of the Veteran. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000) (factors for assessing the probative value of a medical opinion include the thoroughness and detail of the opinion). Although the Veteran is competent to report low back symptoms, his statements regarding causation are less probative than the medical opinion, particularly as they are incongruent with the documentary record, and lack credibility, as they are contradicted by the documentary record. See King v. Shinseki, 700 F.3d 1339, 1345 (Fed. Cir. 2012) (affirming the Court's conclusion that the Board did not improperly discount the weight of a lay opinion in finding a medical expert's opinion more probative). In sum, a low back injury was not documented during service and was contemporaneously denied by the Veteran. The separation physical examination was normal. There were no complaints, findings, or diagnosis of arthritis or other back disability for 6 years; arthritis was not shown within the post-service year of either period of service. The most probative evidence establishes that current diagnosis of back disability is not attributable to service. Accordingly, service connection is not warranted. 2. Service connection for a right ankle disorder 3. Service connection for a left ankle disorder During the February 2020 Board hearing, the Veteran reported that he also injured his ankles when he slipped and fell on a vessel, at the same time when he said he injured his low back. He said he was seen by the medic and put on light duty. A review of the STRs revealed that there were no complaints, findings, or , findings, or diagnosis of arthritis or other back disability for 6 years; arthritis was not shown within the post-service year of either period of service. The most probative evidence establishes that current diagnosis of back disability is not attributable to service. Accordingly, service connection is not warranted. 2. Service connection for a right ankle disorder 3. Service connection for a left ankle disorder During the February 2020 Board hearing, the Veteran reported that he also injured his ankles when he slipped and fell on a vessel, at the same time when he said he injured his low back. He said he was seen by the medic and put on light duty. A review of the STRs revealed that there were no complaints, findings, or treatment of an ankle condition during either period of service. As noted, there was no documentation of a slip and fall injury. The August 1979 and April 1994 separation examinations revealed that the Veteran denied having bone, joint or other deformity as well as having foot trouble or lameness, and his physical examination was normal. Post-service, the Veteran was afforded a VA examination in November 2014. The examiner indicated that his VA treatment records were obtained, reviewed, and considered. These records did not or address the etiology of any claimed ankle condition. The Veteran's SSA records included a February 2014 private report, but the Veteran did not report an ankle condition. The Veteran was afforded another VA examination in November 2020. The Veteran reported that he began having progressive bilateral ankle pain over time while in service. He stated he did not seek medical attention. He said his condition has worsened in both ankles. The current diagnosis was bilateral ankle strain. The examiner opined that the claimed condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. The examiner's rationale stated that a review of his record was silent for claims of ankle strain while in service. The evidence did not show that an ankle disorder resulted from, or was aggravated by, a service-connected disability. Subsequent records do not include any conflicting medical opinions. The Veteran denied having any injury to the ankles or feet problems on his separation examinations. His physical examinations were also normal. The Veteran did not complain of ankle problems on examination until his November 2020 examination. The examiner opined that current ankle condition is not related to service. Inasmuch as the VA opinion clearly was based upon both examination of the Veteran and consideration of his documented medical history and statements, and because the rationale underlying the opinion is reasonable and consistent with the evidence of record, this opinion constitutes the most probative evidence, particularly relative to the lay evidence. See Hayes v. Brown, 5 Vet. App. 60, 69-70 (1993). Therefore, service connection is not warranted. To the extent that the Veteran claims that current ankle condition is secondary to low back disability, service connection has not been established for low back disability, so secondary service connection is not warranted. 4. Service connection for a left knee disorder 5. Service connection for a right knee disorder 6. Service connection for a left lower extremity disorder 7. Service connection for a right lower extremity disorder At the February 2020 Board hearing, the Veteran reported that he also injured his knees when he slipped and fell on a vessel, at the same time when he said he injured his low back. The Veteran explained that the claimed lower extremity issues are part and parcel of the knee (and ankle) claims. A review of the STRs revealed that there were no complaints, findings, or treatment of a knee or lower extremity condition during either period of service. There was no documented slip and fall injury. The August 1979 and April 1994 separation examinations revealed that the Veteran denied having bone, joint or other deformity or a tricked or locked knee, and his physical examination of the legs was normal. Post-service, VA records first showed that in November 2011, the Veteran reported knee pain. He continued to make complaints thereafter. On the November 2014 VA examination, peripheral neuropathy, right lower extremity, was diagnosed since 2009. The Veteran stated that Veteran stated that he had been having sharp pain with numbness and tingling of the right second toe for the last 5 years. There had been no trauma to the right foot. He reported that this had been getting worse over the past years and episodes were more frequent. The Veteran also reported right knee pain and stated that his right knee had been hurting with overuse and at rest. He indicated that this first started noticing this with training exercises in the field. The examiner diagnosed peripheral neuropathy of the right Veteran reported knee pain. He continued to make complaints thereafter. On the November 2014 VA examination, peripheral neuropathy, right lower extremity, was diagnosed since 2009. The Veteran stated that Veteran stated that he had been having sharp pain with numbness and tingling of the right second toe for the last 5 years. There had been no trauma to the right foot. He reported that this had been getting worse over the past years and episodes were more frequent. The Veteran also reported right knee pain and stated that his right knee had been hurting with overuse and at rest. He indicated that this first started noticing this with training exercises in the field. The examiner diagnosed peripheral neuropathy of the right lower extremity and right knee osteoarthritis. The Veteran's SSA records referred to the VA examination and x-rays which showed osteoarthritis. A February 2014 private report reflected that the Veteran reported that his knee pain began in 2004 secondary to a fall. The accompanying private x-rays of the right knee showed anterior superior patellar ensethophyte. The examiner indicated that the Veteran had chronic knee pain with probable degenerative joint disease. The SSA records do not contain any opinion regarding the etiology of current knee or lower extremity disorder. The Veteran was afforded another VA examination in November 2020. It was noted that the VA treatment records were obtained, reviewed, and considered. The Veteran reported that he began having progressive knee pain during service. The examiner opined that a review of the record was silent for claims of a right knee or left knee disorder while in service. X-rays on the day of the examination revealed mild to moderate osteoarthritis of the right knee and minimal osteoarthritis of the left knee. The examiner opined that there was no evidence to support that a right knee disorder or left knee disorder had its onset in, or was otherwise related to, active service. A nexus had not been established. With regard to the lower extremities, the Veteran reported that he started having nerve pain in both legs around 1980 while in service. He stated he did seek medical attention. The current diagnosis was bilateral peripheral neuropathy. The examiner indicated that a review of the record was silent for claims of a left lower extremity or right lower extremity disorder while in service. He had a current diagnosis of bilateral peripheral neuropathy of the lower extremities. There was no evidence to support that a left lower extremity disorder or right lower extremity had its onset in, or was otherwise related to, active service. A nexus had not been established. Subsequent records do not include any conflicting medical opinions. The Veteran denied having any injury to the knees or legs on his separation examinations. His physical examinations were also normal on those examinations. The Board gives more probative weight to his denials of knee and lower extremity injury and symptoms while in service versus his more recent assertions to the contrary. See Struck v. Brown, 9 Vet. App. 145 (1996) (discussing how contemporaneous medical findings may be given more probative weight than contrary evidence offered years later, long after the fact). In determining the probative value to be assigned to a medical opinion, the Board must consider three factors: whether a medical expert was fully informed of the pertinent factual premises (i.e., medical history) of the case; whether the medical expert provided a fully articulated opinion; and whether the opinion is supported by a reasoned analysis. The most probative value of a medical opinion comes from its reasoning. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). In this case the recent VA examination is being accorded the most probative weight for those reasons. In sum, an injury to either knee or either lower extremity was not documented during service and was contemporaneously denied by the Veteran. The separation physical examinations were normal. There were no complaints, findings, or diagnosis of arthritis or other knee/lower extremity disability for many years; arthritis was not shown within the post-service year of either period of service. The most probative evidence establishes that a current diagnosis of knee or lower extremity disability is not attributable to service. Accordingly, service connection is not warranted. To the extent that the Veteran claims that current knee and lower extremity disabilities are secondary to low back or ankle disability, service connection has not been established for low back or ankle disability so secondary service connection is not warranted. 8. Service connection for headaches 9. Service connection for bilateral eye disorder 10. Service connection for sleep apnea 11. Service connection for TMJ At the February 2020 Board hearing, the Veteran reported that he began having headaches, ity disability for many years; arthritis was not shown within the post-service year of either period of service. The most probative evidence establishes that a current diagnosis of knee or lower extremity disability is not attributable to service. Accordingly, service connection is not warranted. To the extent that the Veteran claims that current knee and lower extremity disabilities are secondary to low back or ankle disability, service connection has not been established for low back or ankle disability so secondary service connection is not warranted. 8. Service connection for headaches 9. Service connection for bilateral eye disorder 10. Service connection for sleep apnea 11. Service connection for TMJ At the February 2020 Board hearing, the Veteran reported that he began having headaches, blurred vision with his headaches, sleep problems, and grinding of the teeth during service. He started out as a firefighter during service then he subsequently worked as a crewman. He said he went to sick bay for his complaints. He said that while working on the flight line, he looked up at the sky, and the sun hurt his eyes. He used his own sunglasses. He was not given glasses while in the military. On separation, he said that he was not examined for any of these conditions. Post-service, he sought treatment with VA for his problems. A review of the STRs revealed that there were no complaints, findings, or treatment for headaches, eye problems, sleep apnea, or TMJ during either period of service. The August 1979 and April 1994 separation examinations revealed that the Veteran denied having any injuries to the head, eyes, or jaw. He specifically denied having frequent or severe headaches, eye troubles, frequent trouble sleeping, or that he wore glasses. He did not otherwise report any problems regarding headaches, visual problems, sleep problems, or TMJ. His physical examinations were normal and his vision was 20/20. The Veteran was examined despite his assertions to the contrary. Post-service, VA records dated in January 2014 reflected an eye examination. The Veteran had healthy eyes except for refractive error. In July 2016, the Veteran underwent a sleep study. He was thereafter diagnosed in April 2017 and treated for sleep apnea. In November 2014, the Veteran was afforded VA examinations. With regard to headaches, the Veteran reported that he started to have chronic headaches about 3 years ago. He was diagnosed with headaches. The examiner indicated that a review of the record was silent for claims of headaches while in service. There was no evidence to support that headache had their onset in, or were otherwise related to, active service. A nexus had not been established. With regard to his eyes, the Veteran reported a negative ocular history. On examination, the Veteran presented with mild ptosis, pinguecula, arcus senilis, and cataracts. The examiner indicated that these conditions were not noted to VA before the examination and were seen and diagnosed at the time of evaluation. The examiner stated that the record showed no evidence or documentation that the claimed condition(s) resulted in or caused a complaint during service. The date of onset for cataract and pinguecula onset was the current examination. A nexus could not be established with service activities for either cataracts or pinguecula. The type of cataract in each eye was of the age-related variety and at his current age of 63, were most likely caused by the normal age-related process. The pinguecula in both eyes was commonly caused by the ultraviolet radiation found in regular sunlight from being outdoors and was not considered an immediate threat to the quality of vision. With regard to sleep problems, the record was silent for claims of sleep apnea while in service or complaints of sleep apnea within one year after separation from service. As evidenced in the evidence review, the STRs were silent and diagnosis of sleep apnea was confirmed in April 2017, well after the Veteran's release from service in April 1994. A nexus had not been established. With regard to TMJ, the Veteran stated that he would have clicking and pain at the temporomandibular joint with aggressive chewing about once a month. His jaw would be stiff and start clicking and he had to stop chewing and talking to relieve the pain. He had not seen a doctor in the past about this. There had been no trauma to the jaw recently, but he was a boxer and received many hits to the face. He was diagnosed with TMJ. The examiner stated that a review of record was silent for a claim of TMJ while in service. There was no evidence that TMJ had its onset in, or are otherwise related to, active service. A nexus had not been established. With regard to TMJ, the Veteran stated that he would have clicking and pain at the temporomandibular joint with aggressive chewing about once a month. His jaw would be stiff and start clicking and he had to stop chewing and talking to relieve the pain. He had not seen a doctor in the past about this. There had been no trauma to the jaw recently, but he was a boxer and received many hits to the face. He was diagnosed with TMJ. The examiner stated that a review of record was silent for a claim of TMJ while in service. There was no evidence that TMJ had its onset in, or are otherwise related to, active service. A nexus had not been established. The Veteran's SSA records include a February 2014 report. The Veteran indicated that his vision had worsened over the past 6-7 years. He also reported TMJ and headaches. The Veteran was afforded another VA examination in November 2020. On examination, the Veteran was diagnosed with migraine headaches. The examiner indicated that the record was silent for claims of headaches while in service. There was no evidence to support that headache had their onset in, or were otherwise related to, active service. A nexus had not been established. The Veteran was also diagnosed with bilateral nuclear sclerotic cataract and bilateral pinguecula. A record review showed no evidence or documentation that the claimed conditions resulted in or caused a complaint during service. The date of onset was November 2014. A nexus could not be established with service activities for either cataracts or pinguecula. The type of cataract in each eye was of the age-related variety and caused by the normal age-related process. The pinguecula in both eyes was commonly caused by the ultraviolet radiation found in regular sunlight from being outdoors. With regard to sleep apnea, a review the record was silent for claims of sleep apnea while in service or complaints of sleep apnea within one year after separation from service. As evidenced in the evidence review, STRs were silent and diagnosis of sleep apnea was confirmed in April 2017, after separation from service in April 1994. A nexus had not been established. With regard to TMJ, a review of the record was silent for a claim of TMJ while in service. There was no evidence that TMJ had its onset in, or was otherwise related to, active service. A nexus had not been established. Subsequent records do not include any conflicting medical opinions. In sum, the STRs did not reflect complaints, findings, or a diagnosis of a headache disorder, an eye condition, sleep apnea, or TMJ. The Veteran denied having any headaches, eye problems, sleep problems, or jaw issues on his separation examinations. There were no diagnoses within one year. There were no diagnoses until 2014. The VA medical opinions did not relate any of the current diagnoses to service. The most recent VA examination had the benefit of the review of the historical medical record as well as the historical reports by the Veteran regarding his claimed disabilities. The Board assigns this opinion the greatest probative weight, as it was based on examination of the Veteran, the Veteran's record, and included a rationale for the conclusions. See Bloom v. West, 12 Vet. App. 185, 187 (1999); Black v. Brown, 10 Vet. App. 279, 284 (1997). There is no lay or medical evidence of similar probative value, particularly given the Veteran's reported history. Therefore, service connection is not warranted for any claimed disability. To the extent that the Veteran claims that current eye conditions, sleep apnea, and TMJ condition are secondary to headaches, service connection has not been established for headaches, so secondary service connection is not warranted. 12. Service connection for hypertension 13. Service connection for ED At the February 2020 Board hearing, the Veteran reported that his problems with hypertension began toward the end of his second period of service. He said that he went to sick bay for it. He asserted that he was not examined at separation for it. He said that his current medication for hypertension caused his ED. His STRs reflected that on his first separation examination, his blood pressure was 92/60. During his second period of service, his blood pressure was 132/80 in April 1984, 102/68 in September 1984, 122/86 in October 1995, and 112/67 on the separation examination. On separation, the Veteran denied having high or low blood pressure. The Veteran did not report having ED, nor was it diagnosed. Post-service, VA records dated in second period of service. He said that he went to sick bay for it. He asserted that he was not examined at separation for it. He said that his current medication for hypertension caused his ED. His STRs reflected that on his first separation examination, his blood pressure was 92/60. During his second period of service, his blood pressure was 132/80 in April 1984, 102/68 in September 1984, 122/86 in October 1995, and 112/67 on the separation examination. On separation, the Veteran denied having high or low blood pressure. The Veteran did not report having ED, nor was it diagnosed. Post-service, VA records dated in July 2013 noted that the Veteran had hypertension and ED. The SSA records noted that the Veteran had hypertension, as well. In November 2014, the Veteran was afforded a VA examination. At that time, the Veteran stated that he first started noticing ED about 5 years ago when he was diagnosed with hypertension. The examination reported indicated that the ED was due to peripheral vascular disease. In November 2020, the Veteran was afforded VA examinations. With regard to hypertension, the Veteran stated that he was diagnosed with hypertension while in service. The examiner indicated that a review of the record was silent for claims of hypertension while in service or a diagnosis of hypertension occurring within one year after separation from service. There was no evidence to support that currently diagnosed hypertension had onset in either of the Veteran's periods of service or within one year of service discharge, or is otherwise etiologically related to the Veteran's active service. A nexus had not been established. With regard to ED, the Veteran stated he started having symptoms of ED around 1990 (during service) after being prescribed hypertension medication. The examiner indicated that a review of the record was silent for claims of ED during service. There was no evidence to support that ED had onset in, or are otherwise related to, active service. A nexus had not been established. Subsequent records do not include any conflicting medical opinions. Although the Veteran now asserts in-service treatment and diagnosis of hypertension during service, that assertion is not substantiated in the record. His in-service blood pressure readings including at separation do not show hypertension nor is there any record of medication being prescribed until years after service. The record also does not show hypertension within one year of service. ED was not shown or diagnosed until years after service as well. It has been attributed to peripheral vascular disease and/or hypertension medication. The Veteran did not claim that he had hypertension during service until filing a claim for VA disability compensation. Statements made for VA disability compensation purposes are of lesser probative value than his previous more contemporaneous in-service history in which he denied hypertension. See Pond v. West, 12 Vet. App. 341 (1999) (although Board must take into consideration his statements, it may consider whether self-interest may be a factor in making such statements). Moreover, the STRs were entirely negative for hypertension, directly contradicting the Veteran's currently presented history. Therefore, the only evidence of a nexus between the Veteran's currently claimed hypertension and ED is the Veteran's own lay history. The United States Court of Appeals for the Federal Circuit (Federal Circuit) has recognized that in some cases, lay testimony falls short in proving an issue that requires medical knowledge. See Colantonio v. Shinseki, 606 F.3d 1378, 1382 (Fed. Cir. 2010). However, in this case, the Veteran's statements lack credibility, as his contentions are incongruent with the record, and his assertions are outweighed by the medical evidence in this case which is not in his favor. The VA examination opinions, rendered by a medical professional, are afforded more probative weight. See Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993) (holding that the probative value of medical opinion evidence is based on the personal examination of the patient, the knowledge and skill in analyzing the data, and the medical conclusion reached). Therefore, service connection is not warranted for hypertension or ED. To the extent that the Veteran claims that ED is secondary to hypertension, service connection has not been established for hypertension, so secondary service connection is not warranted. A. C. MACKENZIE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Connolly, Jacqueline 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. personal examination of the patient, the knowledge and skill in analyzing the data, and the medical conclusion reached). Therefore, service connection is not warranted for hypertension or ED. To the extent that the Veteran claims that ED is secondary to hypertension, service connection has not been established for hypertension, so secondary service connection is not warranted. A. C. MACKENZIE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Connolly, Jacqueline 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.