Citation Nr: 0006626 Decision Date: 03/13/00 Archive Date: 03/17/00 DOCKET NO. 93-25 293 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office and Insurance Center in Philadelphia, Pennsylvania THE ISSUES 1. Entitlement to service connection for a neck disorder. 2. Entitlement to service connection for a left shoulder disorder. 3. Entitlement to service connection for degenerative disc disease of the lumbar spine, claimed on both a direct basis and as secondary to the veteran's service-connected pes planus. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESSES AT HEARINGS ON APPEAL The veteran and his wife ATTORNEY FOR THE BOARD Richard Giannecchini, Associate Counsel INTRODUCTION The veteran had active military service from June 1974 to October 1985. A perfected appeal to the Board of Veterans' Appeals (Board) of a particular decision entered by a Department of Veterans Affairs (VA) regional office (RO) consists of a Notice of Disagreement (NOD) in writing received within one year of the decision being appealed and, after a Statement of the Case (SOC) has been furnished, a substantive appeal (VA Form 9) received within 60 days of the issuance of the Statement of the Case or within the remainder of the one-year period following notification of the decision being appealed. With respect to neck and left shoulder disorders, the present appeal arises from an August 1987 rating decision, in which the RO, inter alia, denied the veteran's claims. The veteran was notified of the decision in March 1992, and filed an NOD in April 1992. An SOC was issued by the RO in June 1992, and a substantive appeal was filed by the veteran in July 1992. In September 1992, the veteran testified before a hearing officer at the VARO in Wilkes-Barre, PA. Supplemental statements of the case were issued in August 1993 and August 1999. With respect to degenerative disc disease of the lumbar spine, claimed both on a direct basis and as secondary to the veteran's service-connected pes planus, the present appeal arises from a December 1994 rating decision, in which the RO, inter alia, denied the veteran's claim. The veteran filed an NOD in March 1995, and the RO issued an SOC in May 1995. The veteran filed a substantive appeal that same month, May 1995. In June 1995, the veteran testified before a hearing officer at the VARO in Wilkes-Barre, PA. Supplemental statements of the case were issued in February 1996 and August 1999. The Board also notes that the veteran's representative, in an Appellant's Brief, dated in January 2000, filed an informal claim for entitlement to an effective date earlier than July 22, 1994, with respect to the increased rating to 10 percent for the veteran's service-connected pes planus. This matter is referred to the RO for appropriate development. FINDINGS OF FACT 1. All evidence necessary for an equitable disposition of the veteran's appeal has been obtained by the RO. 2. Service medical records document complaints and subsequent clinical findings of pain and spasm in the veteran's neck and left shoulder; no findings of pertinent abnormality were made at separation. 3. On VA examination in May 1987, the veteran's neck and left shoulder were found normal on clinical evaluation, without evidence of spasm, crepitation, or atrophy. 4. The medical evidence of record does not reflect that the veteran currently suffers from a neck or a left shoulder disability. 5. The veteran's service separation medical examination in March 1985 did not reflect any complaints or clinical evidence of a low back disability. 6. The veteran was found to suffer from degenerative disc disease of the lumbar spine in December 1991, some six years following his separation from active service. 7. There is a lack of competent medical nexus evidence linking the veteran's current degenerative disc disease of the lumbar spine to active service. 8. In a January 1995 treatment summary, a Dr. Meredick reported, in particular, that he suspected the veteran's flexible flat foot deformity may not have initiated his back problems, but that it was certainly amplifying normal motion and stresses to these areas. 9. VA examiners in July 1999 opined that it was less than likely that the veteran's degenerative disc disease of the lumbar spine was in any etiopathological way related to his bilateral foot and ankle condition, and that it was less than likely that the veteran's pes planus had aggravated his low back disability 10. The veteran's contention that he suffers from a neck disorder and left shoulder disorder, and that these disabilities had their onset in service, is not supported by any medical evidence that would render the claims for service connection for these disabilities plausible under the law. 11. The veteran has not submitted competent evidence sufficient to justify a belief by a fair and impartial individual that his claim of service connection for degenerative disc disease of the lumbar spine, either on a direct basis or as secondary to his service-connected pes planus, is plausible under the law. CONCLUSIONS OF LAW 1. The veteran has not submitted a well-grounded claim for service connection for a neck disorder. 38 U.S.C.A. § 5107(a) (West 1991). 2. The veteran has not submitted a well-grounded claim for service connection for a left shoulder disorder. 38 U.S.C.A. § 5107(a) (West 1991). 3. The veteran has not submitted a well-grounded claim for service connection for degenerative disc disease of the lumbar spine, on either a direct or a secondary basis. 38 U.S.C.A. § 5107(a) (West 1991). REASONS AND BASES FOR FINDINGS AND CONCLUSION I. Factual Basis A review of the veteran's service medical records reflects that, in December 1973, he underwent an enlistment medical examination. Upon clinical evaluation, there were no complaints or findings of left neck pain, left shoulder pain, or low back pain. In August 1978, during the course of his active service, the veteran underwent a routine medical examination. On clinical evaluation, there were no complaints or findings of left neck pain, left shoulder pain, or low back pain. Subsequently, a treatment record, dated in April 1981, noted the veteran's complaints of a sharp pain in the left side of his neck and shoulder. The examiner diagnosed the veteran with trapezius myositis/strain. In June 1981, a treatment report noted the veteran's continued complaints of pain and cramps in his left neck and left shoulder. He was diagnosed with fibromyositis of the left neck and shoulder muscles. In August 1981, the veteran underwent physical therapy, and a treatment report noted an impression of left neck strain secondary to posture. Treatment included the use of hotpacks, shoulder shrugging exercises, and postural awareness. In June 1982, the veteran sought treatment for a pulled muscle in his left shoulder. Upon clinical evaluation, there was tenderness in the left trapezius muscle, with decreased range of motion in the shoulder and neck. The diagnostic assessment was of muscle spasm. In April 1983, the veteran was treated for intermittent pain in his left neck and shoulder. The examiner's impression then was left trapezius muscle spasm/myositis. Treatment included the use of Flexeril, analgesic balm, and moist heat to the left shoulder. A follow-up treatment report, later that month, noted mild tenderness in the left trapezius muscle. The clinical assessment indicated resolving trapezius muscle spasm/myositis. That same month, April 1983, the veteran underwent a periodic medical examination. He reported suffering from intermittent myositis of the left shoulder, as well as occasional back pain. On clinical evaluation, no abnormal findings with respect to the veteran's left neck or shoulder, or with respect to his low back, were reported. Thereafter, treatment reports in July and December 1983, and in January 1984, reflected the veteran's continued complaints of pain in his left neck and shoulder. The report in July 1983 noted, "[complaint of] pain to [left] neck-shoulder. [History] of chronicity for years." Diagnoses during this period reflected findings of myositis/left trapezius spasm. In June 1984, the veteran again sought treatment for muscle spasms in his neck and left shoulder. A lab workup was reported within normal limits, and, on clinical evaluation, there was a full range of motion and no radiation with cervical compression. An associated radiographic study of the veteran's cervical spine was within normal limits. The examiner's assessment was muscle spasm secondary to stress. During a Medical Board examination in March 1985, the veteran's primary complaint pertained to his lower extremities, due to a disorder of the feet which is not in issue in the present appeal. He also complained of intermittent low back pain. Upon clinical evaluation, the veteran's neck was supple, with no masses or adenopathy noted. Deep tendon reflexes were graded as 2/4 bilaterally in both upper and lower extremities. There were no sensory deficits noted. The cervical, thoracic, and lumbar regions of the spine demonstrated full range of motion, without spasm in the paravertebral musculature. There were no complaints or findings of left neck or left shoulder pain or spasm. The examiner's diagnosis was painful pes planus deformity, bilaterally. The veteran appeared and testified before a formal Physical Evaluation Board (PEB) in May 1985. During his testimony, the only disorder which he brought to the attention of the PEB was his flat feet, which he believed rendered him unfit to continue on active duty. When he was asked whether there was any other condition which made him unfit, he responded in the negative. In February 1986, following his separation from service, the veteran filed claims for service connection, inter alia, for pain in the left side of his neck and his left shoulder. In May 1987, the veteran was medically examined for VA purposes. On clinical evaluation, his neck was noted to have an anatomical contour. Forward flexion was to 65 degrees, and backward extension was to 45 degrees. In addition, lateral flexion was to 30 degrees, with rotation bilaterally to 60 degrees. There was no spasm or crepitation, although he complained of tenderness in the left cervical region. The left shoulder was also found to have an anatomical contour. Forward flexion and abduction were to 180 degrees, external rotation to 90 degrees, and internal rotation to 80 degrees. There was no spasm, crepitation, or atrophy. Associated radiographic studies revealed no pathology in the cervical spine, and findings were within normal limits in the left shoulder. The examiner reported finding no orthopedic condition associated with the veteran's neck or left shoulder. In an August 1987 rating decision, the veteran's claims for neck and shoulder disorders were denied. The veteran has been granted service connection for bilateral pes planus since separation from service. That disorder is currently evaluated as 10 percent disabling. Thereafter, the RO received medical records from the VA Medical Center (VAMC) in Wilkes-Barre, dated from July 1991 to December 1992, and from December 1991 to February 1992. In particular, an August 1991 radiographic study of the lumbar spine revealed no abnormalities. An EMG (electromyographic) study, dated in October 1991, revealed evidence of denervation in the muscles at the bony level L3-5 consistent with radiculopathy. An MRI scan of the lumbar spine, dated in December 1991, revealed degenerative changes in the L5-S1 disc and adjacent endplates with minimal central disc herniation. A February 1992 orthopedic examination noted that the veteran's reflexes in the lower extremities were equal and active, both at the knees and ankles. Straight-leg raising was normal, as were knee and ankle motion. The examiner noted that he had reviewed the veteran's spinal X-rays, and he could not detect any narrowing of the intervertebral disc spaces. The examiner prescribed a treatment plan consisting of a physiotherapy program. In September 1992, the veteran testified before a hearing officer at the VARO in Wilkes-Barre. The veteran reported that he had complained regularly in service of neck and shoulder pain, and was treated with muscle relaxants and pain pills, but that these had not provided relief. He stated that, immediately following service, he had sought treatment for his neck and shoulder at VA medical facilities in Washington State and New York. He also reported that he was taking Elavil and Doxepin for pain. The veteran testified that he had received physical therapy for his back, but had had to stop because of pain in his neck as well as in his right shoulder and arm. He further testified that his neck and left shoulder pain were chronic, and had become progressively worse. Furthermore, as a result of the pain in these areas, he had missed an average of a day of work every couple of weeks. Subsequently, the RO received VAMC Wilkes-Barre medical records, dated from February 1992 to September 1992. In particular, in March 1992, a nerve conduction velocity (NCV) study revealed evidence of mild bilateral median nerve entrapment neuropathy at the wrist. An associated EMG study was reported normal. A May 1992 orthopedic record noted that the veteran had difficulty walking and had multiple complaints of pain throughout his body. The examiner reported finding no orthopedic explanation for the veteran's complaints. In addition, physical therapy treatment reports, dated in February 1992, noted the veteran's complaints of pain in his right scapula radiating into his right upper extremity. In July 1994, the veteran submitted a Statement in Support of Claim, dated that same month, in which he reported that back pain he was experiencing was a symptom of his service- connected pes planus. In November 1994, the veteran was medically examined for VA purposes. He reported that he had first begun to suffer from intermittent low back pain in 1983. Upon clinical evaluation, there was some tenderness to hard pressure in the right lower lumbosacral area, but no wasting of the musculature of the low back. Range of motion allowed for forward flexion to approximately 10-15 degrees, without the ability to backward extend. In addition, left lateral flexion was to 10 degrees, right lateral flexion to approximately 15 degrees, and rotation to the left and right to 25-30 degrees. An associated X-ray of the lumbar spine was within normal limits. The examiner noted that whether the veteran's back disorder was related to service would depend on the veteran's history. It was noted that the veteran had reported suffering from intermittent low back pain beginning in 1983, but that chronic pain had not begun until 1991. In a December 1994 rating decision, the RO denied the veteran service connection for degenerative disc disease of the lumbar spine with radiculopathy. In March 1995, the RO received a treatment summary from W. Douglas Hogan, M.D., dated in April 1985; Michael Montella, M.D., dated in October 1994; the VAMC Wilkes-Barre Prosthetics and Sensory Aids Service (PSAS), dated in December 1994; and a Dr. Meredick, dated in January 1995. Dr. Hogan noted findings with respect to the veteran's pes planus condition and that the veteran was using orthotics. The orthotics were reported to be well made and to provide reasonably good control in stance. Dr. Montella reported that the veteran suffered from diffuse degenerative disc disease with spinal stenosis and disc herniation at L5-S1. The veteran's prognosis was noted as fair to poor. Dr. Montella opined that the veteran was totally disabled. The Wilkes-Barre PSAS reported that the veteran required the use of a back brace, ankle brace, knee brace, corsets, and a wheelchair. Dr. Meredick, a podiatrist, noted, in particular, that because of the pronotary forces that were present in the veteran's feet, the veteran's center of gravity was certainly changed. With this change, he indicated, abnormal stresses were brought to bear, not only on the feet, but also on the ankles, knees, hips, and back. Dr. Meredick stated that, while the flexible flat foot deformity may not have initiated the veteran's back problems, it was certainly amplifying normal motion and stresses to those noted areas. In June 1995, the veteran and his wife testified before a hearing officer at the VARO in Wilkes-Barre. The veteran reported intermittent back pain beginning in 1983, and stated that it became severe and problematic beginning in 1991. He also reported that his current back pain was constant, and radiated down both of his legs, more so the right leg. The veteran testified that he had undergone nerve block injections, but that these had not provided any relief. In addition, the veteran testified that he had been using a wheelchair since July 1994, and that he wore leg braces and a back brace. He also stated that he took Naprosyn and Darvocet for pain. Furthermore, the veteran stated that he had been in an automobile accident in 1974, while on active duty in Indianapolis, IN. In a February 1996 Hearing Officer's Decision, the veteran was denied service connection for degenerative disc disease of the lumbar spine, both on a direct and secondary basis. In July 1995, the RO received VAMC Wilkes-Barre medical records, dated from February 1994 to May 1995. These records noted the veteran's complaints and treatment for degenerative disc disease of the lumbar spine as well as pes planus. In particular, an MRI scan of the lumbar spine, dated in February 1994, revealed mild degenerative disc disease at L5- S1 with small central disc protrusion, as well as mild right paracentral disc bulging at L4-5 associated with a mild degree of canal stenosis. An MRI scan of the lumbar spine, dated in July 1994, revealed no significant change from the February 1994 MRI scan. In December 1996, the veteran submitted a statement to the RO in which he reported that he had been told by physicians unofficially that, with the type of problem he had with his feet, ankles and legs, which caused his gait to be off, it would only be normal to have some type of back problem as well. Furthermore, the veteran indicated that Dr. Meredick had stated that he could not come out and opine that the veteran's back disorder was due to his foot disorder, because he did not have the veteran's full medical history with respect to his feet and ankles. Finally, the veteran reported that he was currently wearing full leg braces supplied by VA and that these had made a tremendous impact on his ability to walk and stand for extended periods of time without incurring back pain. He noted that he could now walk a block before his back began to bother him. In February 1997, the RO received VAMC Wilkes-Barre medical records, many duplicative, dated from July 1991 to January 1997. In particular, a treatment record, dated in June 1994, revealed the veteran to have undergone a nerve block procedure. A June 1996 X-ray of the veteran's lumbar spine was reported within normal limits. An MRI scan that same month, June 1996, revealed desiccation and slight bulging of the L5-S1 disc, with no evidence of spinal stenosis or disc herniation. In January 1997, the veteran was noted to have received bilateral long leg braces. He was reported as being more stable when he walked. In addition, the veteran was noted to use a wheelchair for shopping, but otherwise used a cane or Canadian crutch. In April 1997, the veteran again underwent VA medical examination. He arrived in a wheelchair, and complained of pain in his feet and legs with prolonged periods of standing and walking. On clinical evaluation, the examiner reported that there was no excessive callous formation that would normally occur with uneven pressure due to flat feet. It was also reported that the veteran appeared to have flexible flat foot, which normally was not symptomatic. There was no deformity of the veteran's feet, and there were 30 degrees of upward, and 40 degrees of downward, movement at his ankles. Associated X-rays revealed normal findings as to the lumbar and thoracic spine, and very mild osteoarthritic changes in the cervical spine. The examiner noted that he had not discussed the veteran's disc problem, but what he could make out from reviewing an MRI report and checking the veteran's reflexes was that the veteran did not have true disc herniation or any signs of significant neurological disorder that could explain his need for the extensive braces or his wheelchair. Furthermore, the examiner reported that the veteran's problems associated with his feet and legs would not limit his physical activities. Also in April 1997, the veteran underwent a VA peripheral nerves examination. On clinical evaluation, he was noted to appear to walk fairly well using his leg braces, and, after taking these off, was reported to walk with relatively hyperextended knees. There was no extensor plantar response demonstrable, no definitive sensory deficit, and a straight leg raising test in the sitting position was 75 to 90 degrees. The examiner further noted that he did not see any reflex change or definitive radicular sign. In June 1997, the RO received a VA Vocational Report pertaining to the veteran, which noted in summary, that, given his medical history and chronic severe back pain, the veteran was unable to perform any substantial gainful activity. The RO also received a medical evaluation report from Robert O'Leary, D.O., of Northeastern Rehabilitation Associates, dated in October 1994. Dr. O'Leary noted the veteran's past medical history, and found on clinical evaluation that there was tenderness and bilateral paravertebral muscular tenderness in the lumbosacral region. His impression was degenerative disc disease with severe pain. Also in June 1997, the veteran submitted a statement to the RO, in which he challenged the findings of the April 1997 VA spinal examination. In particular, the veteran noted that his leg braces had been given to him only after his records had been reviewed by a VA Prosthetics/Physical Therapy Review Board. Additionally, when the braces were removed during the course of his VA examination, the veteran reported that he had still needed to support himself with a Canadian crutch. The veteran also noted that he used sloughing cream to help keep the calluses on his feet down. Thereafter, the RO received an EMG study, dated in May 1997. The study's findings noted possible L5-S1 radiculopathy on the right, with no evidence of neuropathy in the lower extremities. The RO also received a treatment report from Michael Wolk, M.D., dated in April 1993. Dr. Wolk reported that the veteran suffered from disc herniation at L5-S1 with diffuse degenerative disc disease, as well as facet arthropathy and spinal stenosis as a result of his degenerative problems. In July 1998, the RO received medical records from Dr. Montella, dated from November 1992 to November 1994. These records, in particular, noted the veteran's complaints of low back pain. A CT (computed tomography) scan of the veteran's lumbar spine, dated in March 1993, revealed mild bulging annulus and degenerative changes at the articular facets of the L3-4, L4-5, and L5-S1 interspaces. An EMG/NCV study, dated in November 1993, revealed evidence of mild bilateral ulnar compressant neuropathy, mild median sensory neuropathy at the wrists, and no evidence of cervical radiculopathy. In April 1999, the RO received copies of medical records considered by the Social Security Administration (SSA) in its evaluation of the veteran for disability benefits from that agency. A majority of these records had been previously submitted by the veteran to the RO. Those records not previously considered, in particular, included a treatment report from Dr. Wolk, dated in December 1992, which noted the veteran's complaints of back pain, as well as right neck and shoulder pain. Dr. Wolk reported that he could not find any medical impairment that would cause the veteran's back pain. He noted that the veteran had hypersupination of the right foot at the ankle which, if left uncorrected, could result in some of the back discomfort which the veteran had been experiencing. Additional treatment reports from Dr. Wolk, dated in March 1993, noted impressions of possible spinal stenosis. In addition, a medical examination of the veteran for SSA purposes was conducted by A.G. Zale, M.D., in January 1995. The examination report revealed, on clinical evaluation, that the veteran's neck motions were normal, without masses, tenderness, or muscle spasm present; shoulders were level; the upper extremities were normal in motion; and reflexes, sensation, strength and circulation of the upper extremities were normal without atrophy. Dr. Zale diagnosed the veteran as having mild degenerative disc disease of L5-S1 with minimal central disc herniation. Additional records received by the RO included letters to the veteran from SSA notifying him that he had been denied SSA benefits in November 1994, and following reconsideration, in February 1995. In July 1999, the veteran was medically examined for VA purposes. The examiner noted the veteran's medical history, including a report by the veteran of having bounced off a car in a motor vehicle accident in 1974 while stationed at Fort Benjamin Harrison in Indianapolis. The veteran complained of chronic back pain radiating into his right lower extremity. Following a clinical evaluation, the examiner's impression was degenerative disc disease at L4-L5 and L5-S1, with right L-5 lumbar radiculopathy. Additionally, it was opined that it was less than likely that the veteran's back disorder was in any etiopathological way related to his bilateral foot and ankle condition. Furthermore, the examiner noted that it was less than likely that the veteran's foot condition aggravated his back condition. That same month, the veteran underwent a peripheral nerves examination. He complained of chronic low back pain, which was worsened by activity, sitting too long, or standing too much. The veteran indicated that he used a back brace and two leg braces. Following a clinical evaluation, the examiner's impression noted that the veteran's examination had been normal, and his complaints did not match the findings on the physical examination, or the description of the MRI scans. The examiner further noted that he could not understand why the veteran had been prescribed a back brace, leg braces, or a wheelchair. II. Analysis With regard to the veteran's appeal, the threshold question to be answered is whether he has presented well-grounded claims. 38 U.S.C.A. § 5107 (West 1991); Gilbert v. Derwinski, 1 Vet.App. 49 (1990). If he has not, the claims must fail and there is no further duty to assist in their development. 38 U.S.C.A. § 5107; Murphy v. Derwinski, 1 Vet.App. 78 (1990). This requirement has been reaffirmed by the United States Court of Appeals for the Federal Circuit in its decision in Epps v. Gober, 126 F.3d 1464, 1469 (Fed. Cir. 1997). That decision upheld the earlier decision of the United States Court of Appeals for Veterans Claims (previously known as the Court of Veterans Appeals), which made clear that it would be error for the Board to proceed to the merits of a claim which is not well grounded. Epps v. Brown, 9 Vet.App. 341 (1996). The United States Supreme Court declined to review the case. Epps v. West, 118 S. Ct. 2348 (1998). See also Morton v. West, 12 Vet.App. 477, 480-1 (1999). The Court of Appeals for Veterans Claims has also held that, in order to establish that a claim for service connection is well grounded, there must be competent evidence of: (1) a current disability (a medical diagnosis); (2) the incurrence or aggravation of a disease or injury in service (lay or medical evidence); and (3) a nexus (that is, a connection or link) between the in-service injury or aggravation and the current disability. Competent medical evidence is required to satisfy this third prong. See Elkins v. West, 12 Vet.App. 209, 213 (1999) (en banc), citing Caluza v. Brown, 7 Vet.App. 498 (1995), aff'd per curiam, 78 F.3d 604 (Fed. Cir. 1996) (table). "Although the claim need not be conclusive, the statute [38 U.S.C.A. §5107] provides that [the claim] must be accompanied by evidence" in order to be considered well grounded. Tirpak v. Derwinski, 2 Vet.App. 609, 611 (1992). In a claim of service connection, this generally means that evidence must be presented which in some fashion links the current disability to a period of military service or to an already service-connected disability. 38 U.S.C.A. § 1110 (West 1991); 38 C.F.R. § 3.303 (1999); Rabideau v. Derwinski, 2 Vet.App. 141, 143 (1992); Montgomery v. Brown, 4 Vet.App. 343 (1993). Evidence submitted in support of the claim is presumed to be true for purposes of determining whether it is well grounded. King v. Brown, 5 Vet.App. 19, 21 (1993). Lay assertions of medical diagnosis or causation, however, do not constitute competent evidence sufficient to render a claim well grounded. Grottveit v. Brown, 5 Vet.App. 91, 93(1992); Espiritu v. Derwinski, 2 Vet.App. 492, 495 (1992). To establish a showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. 38 C.F.R. § 3.303(b) (1999). If chronicity in service is not established, a showing of continuity of symptoms after discharge is required to support the claim. Id. Service connection may be granted for any disease diagnosed after discharge, when all of the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d) (1999). Under applicable criteria, service connection may be granted for a disability resulting from disease or injury which was incurred in, or aggravated by, service. 38 U.S.C.A. §§ 1110, 1131 (West 1991 & Supp. 1998). A veteran shall be granted service connection for arthritis, although not otherwise established as incurred in service, if the disease is manifested to a compensable degree within one year following service. See 38 U.S.C.A. §§ 1101, 1112, 1113 (West 1991); 38 C.F.R. §§ 3.307, 3.309 (1999). In a claim for secondary service connection, the regulations provide that service connection shall be granted for a disability which is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310 (1999). Secondary service connection may also be warranted for a non-service-connected disability when that disability is aggravated by a service-connected disability. Allen v. Brown, 7 Vet.App. 439 (1995) (en banc). The United States Court of Appeals for Veterans Claims has specifically held that "[a] claim for secondary service connection, like all claims, must be well grounded." Reiber v. Brown, 7 Vet.App. 513, 516 (1995). With respect to the claims for neck and left shoulder disorders, following a review of the evidence, the Board finds the veteran's claims are not well grounded. In reaching this conclusion, we note that the veteran's service medical records reflect numerous complaints of neck and left shoulder pain. Diagnoses included myositis, muscle spasm of the left trapezius muscle, muscle spasm secondary to stress, and left neck strain secondary to postural abnormalities. Treatment included the use of heat packs and muscle relaxants, as well as exercises. During a separation medical examination in May 1985, there were no complaints or findings of pain or spasm in the veteran's neck or left shoulder. Thereafter, following clinical evaluation during a May 1987 VA examination, no abnormalities were identified, and the examiner reported that he could not find any orthopedic condition associated with the veteran's neck or left shoulder. Furthermore, numerous EMG and NCV studies did not reflect findings indicative of any disability/disorder of the neck or left shoulder. While the veteran reported at his personal hearing that he suffered from chronic pain in his neck and left shoulder, and we have no reason to doubt this contention, the Board finds the clinical evidence of record, to include numerous VA and private medical treatment records, does not reveal a finding or a diagnosis of a neck or left shoulder disorder. Thus, the Board finds the veteran's claims are not well grounded, as there is a lack of competent medical evidence that the veteran suffers from current neck or left shoulder disabilities. The Board is mindful that the Court of Appeals for Veterans Claims has held that a disorder suffered in service will be determined to be chronic under 38 C.F.R. § 3.303(b) when there is competent medical evidence to establish its chronicity, based upon both its existence in service and its relationship to the same condition after service. Savage v. Gober, 10 Vet.App. 488, 495 (1997). Where the disorder is of a type that requires medical expertise (as opposed to mere lay observation) to demonstrate its existence, such medical evidence must be of record. Id. (citing Epps, Caluza, Grottveit, supra). In this instance, while the veteran complained of pain in his neck and left shoulder during service, there was no finding at separation, or on VA examination in 1987, of a neck or left shoulder disorder. Furthermore, the medical evidence of record does not reflect a finding of any current disability associated with the veteran's neck or left shoulder. Even where chronicity in service or within an applicable presumption period is not established, a claimant can still establish a chronic disorder, also under section 3.303(b), by demonstrating continuity of symptomatology from service until the post-service diagnosis of the condition. Savage, supra, 10 Vet.App. at 496. See also Hodges v. West, ___Vet.App.___, No. 98-1275 (Jan. 12, 2000) (holding that identical in- service and post-service diagnoses are not required for the purpose of a § 3.303(b) based well-grounded claim for service connection). In this instance, while the veteran was treated in service for neck and left shoulder pain, and he continues to complain of this pain, as noted above, there is no clinical evidence of a current neck or left shoulder disability. Furthermore, even if we accept, for the purpose of our analysis, that the veteran does currently suffer from neck and left shoulder disabilities, he has not submitted medical evidence linking these disorders to active service. See McManaway v. West, 13 Vet.App. 60, 66 (1999), noting that, even where a veteran asserts continuity of symptomatology since service, medical evidence is required to establish "a nexus between the continuous symptomatology and the current claimed condition . . . ." The Board therefore concludes that, given the lack of complaints or findings of pain or spasm associated with the veteran's neck or left shoulder at separation from service, and the lack of any clinical evidence of record reflecting a current neck or left shoulder disability, the veteran has not met the initial burden of presenting evidence of a well- grounded claim for service connection for a neck and/or left shoulder disability under the applicable law as interpreted in the Caluza and Savage precedents. See Clyburn v. West, 12 Vet.App. 296, 301 (1999), holding that continued complaints of pain after service do not suffice to establish a medical nexus, where the issue at hand is of etiology, and requires medical opinion evidence. Although the veteran is competent to testify to the pain he has experienced since active service, he is not competent to testify to the fact that what he experienced in service and since service are the same related disorders. See also Sanchez-Benitez v. West, ___Vet.App.___, No. 97-1948 (Dec. 29, 1999), in which the Court held that a diagnosis of pain, cannot, without connection to an underlying condition and a medical nexus to service, warrant service connection. Finally, while the veteran reported that he was treated at VA medical facilities for his neck and left shoulder disabilities in 1985 and 1986, attempts by the RO to obtain these records were not successful. In particular, the VAMC in Walla Walla, WA, reported the veteran as having received treatment from its facility in February 1986, but a record of the treatment was unavailable. In this instance, given that the veteran was subsequently examined in May 1987, and no neck or left shoulder disability was found; and the record contains no other finding of a neck or left shoulder disorder; the Board concludes that remanding the veteran's claims so additional attempts could be undertaken to locate these records is not warranted. Such a remand would result in unnecessarily imposing additional burdens on VA with no benefit flowing to the veteran. The Court has held that such remands are to be avoided. See Winters v. West, 12 Vet.App. 203, 207 (1999) (en banc); Soyini v. Derwinski, 1 Vet.App. 540, 546 (1991); Sabonis v. Brown, 6 Vet.App. 426, 430 (1994). With respect to the veteran's claim, on a direct basis, for degenerative disc disease of the lumbar spine, we are cognizant that he was medically discharged from service as a result of a pes planus disorder. He was also noted in April 1983 and March 1985, the latter being his separation medical examination from service, to have complained of intermittent low back pain. In neither instance, on clinical evaluation, was the veteran found to suffer from any low back abnormality or disorder. Post-service medical records reflect findings of degenerative disc disease in the veteran's lumbar spine, with the first documented evidence of the disease in a December 1991 MRI scan. While the veteran's low back disability is well documented by the clinical evidence, we find there is no medical opinion or other supportive nexus evidence of record relating the disability to active service. Thus, the Board finds the veteran's claim is not well grounded, as he has not satisfied the threshold requirement for a well-grounded claim as set forth by the Court in Caluza, above, i.e., there is a lack of competent medical evidence linking the veteran's low back disability to active service. See Clyburn, supra. Furthermore, the medical evidence of record does not support a finding that arthritis of the lumbar spine was manifested to a compensable degree within the one-year presumption period following service. See 38 U.S.C.A. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. As noted above, the first documented finding of degenerative disc disease of the lumbar spine was in 1991, some six years following the veteran's medical separation from active service for other causes. With respect to the veteran's claim, on a secondary basis, for degenerative disc disease of the lumbar spine, the Board finds, after reviewing the medical evidence before us, that the threshold issue of whether this claim is well grounded is a close question. The veteran's claim that his back disability has been aggravated by his service-connected pes planus appears quite plausible, given that the evidence reflects that an abnormal gait could cause stresses on other parts of the body, as is noted in statements from both Dr. Wolk and Dr. Meredick. Dr. Wolk noted that the veteran's hypersupination of the right foot at the ankle, if left uncorrected, could result in some back discomfort. Dr. Meredick reported that he suspected the veteran's flexible flat foot deformity may not have initiated his back problems, but that it was certainly amplifying normal motion and stresses to these areas. We note that the Court of Appeals for Veterans Claims has indicated that the probative value of a physician's statement is dependent, in part, upon the extent to which it reflects "clinical data or other rationale to support his opinion." Bloom v. West, 12 Vet.App. 185, 187 (1999). In this instance, the Board notes that neither Dr. Wolk or Dr. Meredick actually rendered an opinion as to whether the veteran's pes planus disability aggravated his low back condition, but appeared to report that the veteran's abnormal gait could be, or was, resulting in stress to his back. In July 1999, after a thorough review of the veteran's claims file, VA examiners opined that it was less than likely that the veteran's degenerative disc disease was in any etiopathological way related to his bilateral foot and ankle condition. Furthermore, they reported that it was less than likely that the veteran's foot condition had aggravated his low back disability. Thus we find, given the findings on VA examination, and the lack of any other evidence reflecting the veteran's low back disability as being aggravated by his service-connected pes planus, that the veteran has not satisfied the threshold requirement for a well-grounded claim as set forth by the Court in Caluza, above. While the Board does not doubt the sincerity of the veteran's contentions in this case, and his belief that he suffers from service-related disabilities, our decision must be based on competent medical testimony or documentation. In a claim of service connection, this generally means that medical evidence must establish that a current disability exists, and that the disability is related to a period of active military service. Competent medical evidence has not been presented establishing that the veteran currently suffers from a disability associated with his neck or left shoulder, or that his degenerative disc disease of the lumbar spine is service- related, either on a direct basis or as secondary to his service-connected pes planus. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303; Rabideau v. Derwinski, Montgomery v. Brown, both supra. Furthermore, the veteran does not meet the burden of presenting evidence of well-grounded claims merely by presenting his own testimony, because, as a lay person, he is not competent to offer medical opinions. See, e.g., Voerth v. West, 13 Vet. App. 117, 120 (1999) ("Unsupported by medical evidence, a claimant's personal belief, no matter how sincere, cannot form the basis of a well-grounded claim."). See Bostain v. West, 11 Vet.App. 124, 127 (1998), citing Espiritu, supra. See also Carbino v. Gober, 10 Vet.App. 507, 510 (1997); aff'd sub nom. Carbino v. West, 168 F.3d 32 (Fed. Cir. 1999); Routen v. Brown, 10 Vet.App. 183, 186 (1997) ("a layperson is generally not capable of opining on matters requiring medical knowledge"), aff'd sub nom. Routen v. West, 142 F.3d 1434 (Fed. Cir. 1998), cert. denied, 119 S. Ct. 404 (1998). Under the law, the veteran is free, at any time in the future, to submit new and material evidence to reopen his claims for a neck disorder; left shoulder disorder; and degenerative disc disease of the lumbar spine, on a direct basis or as secondary to his service-connected pes planus, regardless of the fact that he currently is not shown to be suffering from disabilities that may be service-connected. Such evidence would need to show, through competent medical evidence, a current disability or disabilities, and that such disability, "resulted from a disease or injury which was incurred in or aggravated by service." 38 U.S.C.A. §§ 1110, 1131 (West 1991); 38 C.F.R. § 3.303 (1999); Rabideau, Montgomery, supra. In absence of well-grounded claims, there is no duty to assist the veteran further in their development, and the Board does not have jurisdiction to adjudicate them. Morton, supra; Boeck v. Brown, 6 Vet.App. 14 (1993); Grivois v. Brown, 5 Vet. App. 136 (1994). Accordingly, as a claim that is not well grounded does not present a question of fact or law over which the Board has jurisdiction, the claims for service connection for a neck disorder; left shoulder disorder; and degenerative disc disease of the lumbar spine, either on a direct basis or secondary to the veteran's service-connected pes planus, must be denied. See Epps v. Gober, supra. ORDER 1. Service connection for a neck disorder is denied. 2. Service connection for a left shoulder disorder is denied. 3. Service connection for degenerative disc disease of the lumbar spine, either on a direct basis or as secondary to the veteran's service-connected pes planus, is denied. ANDREW J. MULLEN Member, Board of Veterans' Appeals