BVA9507412 DOCKET NO. 92-55 071 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Portland, Oregon THE ISSUES 1. Entitlement to service connection for an acquired psychiatric disorder to include post-traumatic stress disorder. 2. Entitlement to service connection for a low back disorder. 3. Entitlement to service connection for a cervical spine disorder. 4. Entitlement to service connection for degenerative changes to the thoracic spine. REPRESENTATION Appellant represented by: Oregon Department of Veterans' Affairs WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD M. G. Mazzucchelli, Associate Counsel INTRODUCTION The veteran served on active duty from July 1968 to June 1972. This appeal arises from March 1991 and subsequent rating decisions of the Seattle, Washington, regional office (RO). The March 1991 rating decision denied entitlement to service connection for residuals of a low back injury, a neck injury and post-traumatic stress disorder. In February 1992, the Board of Veterans' Appeals (Board) remanded the case by letter for a travel board hearing. A travel board hearing scheduled for April 1992 was canceled by the veteran. In July 1992, the veteran testified at a hearing before the hearing officer at the RO. A hearing officer's decision of September 1992 confirmed the earlier denial. The veteran failed to appear at a travel board hearing scheduled for November 1992. In September 1993, the Board remanded the case for further development. Subsequently, an October 1994 rating decision continued the prior denials and also denied service connection for a dorsal spine disorder and for an acquired psychiatric disorder. In January 1995, the veteran's file was transferred to the Portland, Oregon, regional office. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that he has post-traumatic stress disorder as the result of events which occurred during his shipboard service during the Vietnam war. He also contends that he has another chronic psychiatric disorder which began in service. He contends that he has chronic low back and neck disorders as the result of injuries in service, and that a congenital back disorder was aggravated during service. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), has reviewed and considered all of the evidence and material of record in the veteran's claims files. Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that the preponderance of the evidence is against the veteran's claims for service connection for an acquired psychiatric disorder to include post-traumatic stress disorder, for service connection for a low back disorder, and for service connection for a cervical spine disorder, and that the evidence supports an allowance of service connection for degenerative changes of the thoracic spine. FINDINGS OF FACT 1. The RO has obtained all relevant evidence necessary for an equitable disposition of the veteran's claim. 2. The veteran does not currently have post-traumatic stress disorder or any other psychotic or psychoneurotic disorder for which service connection may be granted. 3. A congenital back disorder was noted on the veteran's entrance into service, no trauma or other back injury was noted in the service medical records, and no abnormal spine findings were noted on the service separation examination. 4. A low back disorder was first manifested following work- related injuries many years after service. 5. A cervical spine disorder was first manifested following work-related injuries many years after service. 6. Arthritis of the cervical spine was first noted many years after the veteran's final separation from service. 7. Degenerative changes of the thoracic spine were first noted in service. CONCLUSIONS OF LAW 1. Post-traumatic stress disorder was not incurred in or aggravated by service. 38 U.S.C.A. §§ 1101, 1110 (West 1991); 38 C.F.R. §§ 3.303(d), 3.304(f) (1994). 2. An acquired psychiatric disorder was not incurred in or aggravated by service and a psychosis may not be presumed to have been incurred in service. 38 U.S.C.A. §§ 1101, 1110, 1112 (West 1991); 38 C.F.R §§ 3.303(d), 3.307(a)(3), 3.309(a) (1994). 3. A chronic low back disorder was not incurred in or aggravated by service. 38 U.S.C.A. §§ 1101, 1110 (West 1991); 38 C.F.R. § 3.303 (1994). 4. A chronic cervical spine disorder was not incurred in or aggravated by service and arthritis of the cervical spine may not be presumed to have been incurred in service. 38 U.S.C.A. §§ 1101, 1110, 1112 (1991); 38 C.F.R. §§ 3.303, 3.307(a)(3), 3.309(a) (1994). 5. Degenerative changes to the thoracic spine were incurred in service. 38 U.S.C.A. §§ 1101, 1110 (West 1991); 38 C.F.R. §§ 3.303, 3.304(b) (1994). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The veteran's claims are well grounded within the meaning of 38 U.S.C.A. § 5107(a)(West 1991). That is, he has presented claims which are plausible. All relevant facts have been properly developed and no further assistance is required to comply with the duty to assist mandated by 38 U.S.C.A. § 5107(a). I. An Acquired Psychiatric Disorder to Include Post-Traumatic Stress Disorder Service connection may be established for disability resulting from personal injury suffered or disease contracted in line of duty. 38 U.S.C.A. § 1110 (West 1991). Regulations also provide that service connection may 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) (1994). Service connection for a psychosis may be established if it is shown to be present in service or manifest to a degree of 10 percent or more within one year from the date of separation from service. 38 C.F.R. §§ 3.307(a)(3), 3.309(a) (1994). Service connection for post-traumatic stress disorder requires medical evidence establishing a clear diagnosis of the condition, credible supporting evidence that the claimed in-service stressor actually occurred, and a link, established by medical evidence, between current symptomatology and the claimed in-service stressor. If the claimed stressor is related to combat, service department evidence that the veteran engaged in combat or that the veteran was awarded the Purple Heart, Combat Infantryman Badge, or similar combat citation will be accepted, in the absence of evidence to the contrary, as conclusive evidence of the claimed in-service stressor. 38 C.F.R. § 3.304(f) (1994). The service medical records show that the veteran reported a history of depression or excessive worrying on his service entrance examination in July 1968. The veteran made a suicidal gesture of an overdose of Empirin tablets in April 1972. This was in reaction to marital problems. The veteran was hospitalized and recovered completely. There was no psychiatric diagnosis except for attempted suicide from drug overdose. The service separation examination in June 1972 noted no abnormal psychiatric findings. The veteran was hospitalized for five days in a VA facility in January 1974. He complained of drinking and depression. The veteran stated that he was never happy anymore. He admitted to temper outbursts, picking fights with his girlfriend, and being fearful. The veteran reported that his drinking was only social and that he could control it. He said he was most disturbed at his daughter having to grow up without a father. Brief Psychiatric Rating Scale indicated moderately severe anxiety, moderate emotional withdrawal, guilt feelings, tension, depressive mood, character disorder, alcohol and drug perturbation, mild hostility, uncooperativeness, lethality and suicide, very mild grandiosity and motor retardation. Prognosis was for much improved change. The veteran was given an irregular discharge due to unauthorized absence. It was expected that he would be able to resume his pre-hospital activities and would be employable. The diagnoses were neurosis, anxiety neurosis with depressive reaction and with recourse to alcohol. A psychiatric evaluation was conducted in conjunction with a Social Security claim in April 1988. The veteran reported that the pain and lack of functioning caused by his back condition occasionally got to him. He reported that he was able to talk or read to keep his mind off it, and stated that he was coping with the problem well emotionally. He kept busy with wood working, model building, and with his wife and children. The veteran stated that he had always been a homebody and that being at home was no problem for him. He stated that he enjoyed life. His appetite was fair, but decreased due to pain. His sleep was disturbed by pain only and he had good sexual interest. The veteran reported that he had never had psychiatric treatment or counseling. The veteran stated that he had some problems from his service, but that they were all over by 1981. He reported that he had stopped using alcohol and marijuana in 1982. On examination, the veteran appeared slightly hostile and was clearly defensive about his history. He did not exhibit a demeanor or tone of any warmth or openness at any time during the interview. He did not appear anxious or depressed. His handshake was firm. The veteran demonstrated a rather restricted affect which was appropriate to thought content. There was no presence or history of any delusions or phobias. He had no history of nightmares. There were no disorders of perception such as visual or auditory hallucinations. Recent and remote memory were intact and showed no impairment. There was no impairment of attention and concentration span. Judgment appeared to be intact in terms of future plans. Insight into his condition was such that he had physical pain from a physical injury. The veteran was aware that he was somewhat of a loner and preferred to be left alone. He demonstrated pathological ego defense mechanisms of denial, repression and projection. The diagnoses were history of alcohol abuse and dependence prior to November 1982 and history of marijuana abuse. These were not related to or worsened by the veteran's industrial injury. There was a personality disorder which was hard to diagnose precisely due to the veteran's closed and defensive appearance. There were character traits of passive-aggressiveness, extreme defensiveness, and a history of desiring to be left alone. Psychosocial stressors were mild and related directly to the industrial injury. The Global Assessment of Functioning (GAF) score was 70, decreased only because of the personality disorder. The veteran was hospitalized at Pinecrest Hospital in April 1989. He was admitted for abuse of alcohol, cocaine and Percocet, which the veteran stated he used to deal with pain from a work accident in 1983 which caused cervical and lumbar spine injuries. On examination, he was oriented times 3, remote and recent memory was intact, and he was of average intelligence. His speech was appropriate in rate and rhythm and affect was appropriate. He denied delusions and hallucinations and there was no sign of a thought disorder. The veteran denied suicidal or homicidal ideation. His social judgment appeared to be appropriate and he did have insight into his need for treatment. The diagnoses were narcotic dependency and alcohol abuse. A VA social survey was conducted in March 1991. The veteran's chief complaints were substance abuse, rage, anxiety, nightmares, restlessness, sleep disturbance and depression. He reported that during the Vietnam war he was stationed on the USS Coral Sea off the coast of Vietnam. He stated that his ship was never shelled by enemy guns and did not shell the shore. He reported that the distressing events during service were an incident in which two pilots were lost at sea while attempting to land on the carrier, the suicide of a friend who jumped into the ocean, and a shelling incident in DaNang while he was awaiting his flight home. The veteran stated that upon his return to the U.S., he "freaked out" and became suicidally depressed. He stated that he took an overdose of Empirin and was admitted to a psychiatric ward for thirty days. He attributed this incident to his hatred of his time in Vietnam, being spat upon at the airport upon his return, and the breakup of his marriage. He stated that soon after he began drinking heavily and had frequent nightmares, which were related to the traumatic events onboard ship. He stated that he often woke up screaming from these dreams. He reported that he moved frequently and tried to kill himself twice more. The veteran stated that all three of his marriages had been characterized by violence. He reported that he had been dry since his April 1989 alcohol treatment program. He was enrolled in school and doing well. He appeared depressed and mentioned chronic suicidal thoughts in relationship to a recently disintegrated affair. The veteran appeared to be employable. A March 1991 letter from a social worker at the Vietnam Veterans' Outreach Center in Spokane, Washington, stated that the veteran had attended over 20 group meetings since January 1990. The social worker stated that the predominant source of the veteran's present adjustment problems were his family of origin, his substance abuse and his back injury. The social worker stated that he was ambivalent about assigning the veteran a post- traumatic stress disorder diagnosis based on his substance abuse problems. The veteran reported recurring dreams about his military service, that he avoided activities that aroused memories of his military service, that he had much restlessness, difficulty concentrating and constricted feelings. This had negatively affected his ability to enjoy normal family relationships. He had been divorced three times and had other failed relationships. The social worker believed that this last symptom was more likely the result of the veteran's family of origin and drug and alcohol abuse than anything else. A VA examination was conducted in June 1994. The veteran reported that his parents had not argued much, in contrast to an earlier social work report in which he reported that there was a great deal of strife in the marriage. He stated that he had recently earned a college degree. He reported the incidents of the pilots who were lost at sea and of the coworker who committed suicide by jumping off the ship. The veteran stated that he was currently not being treated for his problems. He stated that he had anxiety and awoke at night scared about the in service stressors. He complained of nightmares and paranoia. He reported that he was a loner and a homebody, but that he had eight to ten friends and a girlfriend. The veteran stated that he knew that people were not out to get him but occasionally felt fear for some unknown reason. He complained of memory problems and reported that when he heard jets or was around military people he had mixed up feelings. He did not describe intense distress in these situations. On examination, the veteran's long and short term memory were adequate. Calculation, attention, low-level and high-level abstract thinking ability were adequate. Mood and affect were flat. There was no indication of hallucinations, delusions, or illusions. He was mildly depressed. The veteran described his typical day as including college courses and studying. He had continued use of alcohol, including binge drinking. With respect to the alleged stressors, the examiner stated that the veteran's experiences were stressful but not traumatic. The events would not result in distress in any person. The diagnoses were alcohol dependence, continuous, and passive-aggressive personality disorder. The GAF score was 70. The examiner noted that the veteran experienced some mild symptoms but was able to demonstrate good school functioning with a high grade point average and had meaningful interpersonal relationships with his friends and girlfriend. A VA social work survey was conducted in July 1994. The veteran appeared angry and frustrated with the VA system. He reported poor sleep and nightmares which usually involve dead people and from which he awakened screaming 2-4 times per month. He was proud of his recent college degree and reported that he hoped eventually to teach at the college level. He again reported the same three in service distressing events. The interviewer stated that these events might temporarily evoke significant symptoms of distress in most individuals but would not be stressful enough to cause post-traumatic stress disorder over twenty years later. The veteran continued to drink alcohol, and kept a pistol near his bed. He preferred to live in an isolated area, avoiding crowds, loud noises and war movies. In the interviewer's opinion, the veteran was a troubled individual in need of continued counseling to which he was not currently amenable. The RO contacted the U.S. Army and Joint Services Environmental Support Group (ESG) to attempt to confirm the alleged stressors. The ESG was able to partially confirm some of the events to which the veteran referred. However, this is not controlling in light of the diagnoses by the VA psychiatrists to the effect that the veteran does not have post-traumatic stress disorder. The veteran served on an aircraft carrier during the Vietnam war and has reported various incidents in service which might constitute stressors; however, the fact is that a diagnosis of post- traumatic stress disorder has not been medically established and is not shown to be appropriate. Importantly, the physician was of the opinion that the episodes described by the veteran were not adequate to produce a post-traumatic stress disorder. In the absence of medical evidence establishing a diagnosis of the condition, service connection for post-traumatic stress disorder may not be granted. 38 C.F.R. § 3.304(f) (1994). The VA examiners have diagnosed substance abuse and a personality disorder. A personality disorder is not a disability for which service connection may be granted. 38 C.F.R. § 3.303(c) (1994). Service connection for a psychosis may be established if it is shown to be present in service or manifest to a degree of 10 percent or more within one year from the date of separation from service. 38 C.F.R. §§ 3.307(a)(3), 3.309(a) (1994). While the veteran was diagnosed with a neurosis in 1974, there is no current diagnosis of any psychotic or psychoneurotic disorder. Consequently, the Board has concluded that the preponderance of the evidence is against the veteran's claim for service connection for an acquired psychiatric disorder, to include post- traumatic stress disorder. Since the weight of the evidence for and against the claim is not in relative equipoise, the reasonable doubt rule does not apply. 38 U.S.C.A. § 5107 (West 1991); 38 C.F.R. §§ 3.102, 4.3 (1994). II. Low Back Disorder The veteran contends that he aggravated a congenital back disorder in service. He also contends that he injured his low back in service. Service connection may be established for disability resulting from personal injury suffered or disease contracted in line of duty. 38 U.S.C.A. §§ 1110, 1131 (West 1991). Regulations also provide that service connection may 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) (1994). The service medical records do not show any injury to or disorder of the low back. No spine abnormalities were noted on the service separation examination in June 1972. In February 1987, Warren Adams, M.D., noted low back pain as well as pain in the posterior thigh and right leg with some numbness in the foot. X-rays at that time showed grade 1 spondylolisthesis of L5 on S1. In March 1987, Dr. Gehling diagnosed low back pain and grade 1 spondylolisthesis with mechanical low back process. The doctor felt that this was a congenital injury which was probably aggravated when the veteran fell off a roof in November 1985. Bilateral facet injections were done in March 1987 by Dr. Adams at L3-4, L4-5, and L5-S1 without any particular relief. A lumbar CT scan in July 1987 showed subluxation of L5 on S1 with bilateral spondylolysis and bulging of the L5-S1 disc and nerve root entrapment at both neural foraminal canals. In September 1987, the veteran told Dr. Demakas that his back pain dated back to an industrial injury in 1983. In October 1987, a Gill laminectomy was done with foraminotomy bilaterally at L5-S1 and bilateral posterolateral fusion L5-S1. An examination was conducted in April 1988 in conjunction with the veteran's claim for Social Security Administration benefits. The veteran reported an incident at work in July 1983 in which the full weight of a 200 pound slab slipped onto his left arm, shoulder and neck. He stated that he had some low back soreness at that time as well. At present, he reported some pressure in the low back with some pain in the backs of both legs. He stated that he did not pay too much attention to his low back due to the severity of his neck and shoulder problems. On examination, the veteran had a slow gait. He could do heel-toe walking. Romberg's sign was negative. There was a mild increase in lumbar lordosis and mild tenderness over the midline of the low back. The diagnosis was history of grade 1 spondylolisthesis L5-S1, post operative Gill laminectomy with bilateral L5-S1 foraminotomy and bilateral posterolateral fusion L5-S1. L4-5 and L5-6 central anterior fusions were done by John J. Demakas, M.D., in September 1988. A VA examination was conducted in February 1991. The veteran complained of low back problems dating from his discharge from service in 1972. He stated that he carried heavy chains which were used to tie down planes on the aircraft carrier. He also stated that he fell down with these chains on his back on many occasions. On examination, there was limitation of lumbar spine motion due to the veteran's fusion. Pin prick was normal. Absent ankle jerks were noted. The diagnosis was status lumbar spine fusion with residual pain, onset of back pain 1971 in U.S. Navy. A November 1993 report from Dr. Demakas stated that the veteran had developed some low back and leg pain following work in September 1992 with 5'x5' slabs of marble. Examination noted loss of normal curvature, well-healed scar, and marked restriction of motion in all planes. There were positive straight leg raising bilaterally. There was some sensory loss between the great and second toes on the left. The diagnosis was left L5 radiculopathy, possible failed fusion at L5-S1. A magnetic resonance imaging (MRI) test conducted in December 1993 showed status post laminectomy at L5. There was no evidence of disc herniation, stenotic lesions or epidural fibrosis. Mild anterolisthesis of L5 upon S1, apparently due to pars defects, was shown. The S1 nerve roots did not appear to be significantly compromised. A VA orthopedic examination was conducted in July 1994. The veteran reported several injuries to his back during service, a car accident and an incident handling marble which caused back injuries after service. He complained of aching pain in the low back and left lower extremity, with numbness in the toes. There were lesser symptoms on the right side. On examination, he had a normal gait and was able to heel-toe walk with some difficulty. There was a three and three-quarter inch midline lumbosacral scar, well-healed but tender. There was a palpable "step" at L5- S1. The pelvis was level. Range of motion was very limited. X- rays of the lumbosacral spine suggested a wide laminectomy at L5. There appeared to be abnormal ossification between the transverse processes of L5 and the sacral ala, bilaterally. The lateral view showed 1st degree spondylolisthesis, L5-S1. Otherwise, the disc space heights were well-maintained. The diagnosis was spondylolisthesis, L5-S1. The examiner stated that this condition may well have been aggravated by the conditions of the veteran's service as described. In considering the medical record in this case, the Board notes that kypho-scoliosis was noted on the veteran's entrance examination, and that shortly thereafter X-rays confirmed the presence of a spinal disorder showing degenerative changes and lipping in the dorsal spine. The service medical records do not show any low back trauma or pathology, and no spine abnormalities were noted on the service separation examination. The most recent VA examiner's opinion regarding possible aggravation of the veteran's low back condition during service was based upon the veteran's assertions of injuries during service. Such injuries are not substantiated by the veteran's service medical records. Moreover, the examiner's opinion is equivocal-there could have been aggravation in service-and even that equivocal opinion is conditioned on the assumption that there was a pre- existing low back condition as well as injuries in service. Accordingly, the veteran's assertion of possible aggravation of a low back condition in service is not supported by the weight of the evidence, and service connection for a low back disorder on this basis is not established. The other medical evidence indicates a later onset of low back symptomatology, specifically following work-related injuries in 1983, 1985 and 1992. The first indication of low back treatment in the record is in 1987. The veteran testified at a personal hearing in July 1992 and has submitted written statements, all to the effect that he suffered lower back injuries in service which have led to a chronic disability. The Board must assess the credibility of statements, both oral and written, pursuant to the appeal. O'Hare v. Derwinski, 1 Vet.App. 365 (1991); Ferguson v. Derwinski, 1 Vet.App 428 (1991). In a case such as this, involving specialized medical knowledge, we must particularly assess whether the witness has the necessary experience and knowledge to testify accurately. Espiritu v. Derwinski, 2 Vet.App. 492, 495 (1992). In this case, the veteran has provided inconsistent statements to different medical care providers with respect to his medical history. His assertions of in service injuries are not supported by the service medical records. The first documented treatments for a low back disorder occurred after the 1983 and 1985 back injuries. In light of the above, the Board does not consider the veteran's statements to be credible for the purpose of demonstrating that his low back disorder began in service. The medical reports linking the back symptomatology to the 1983 and 1985 work-related injuries are more probative given the closer proximity in time of these injuries to the treatments and the lack of documented back injuries in service or treatments for many years after separation from service. Consequently, the Board has concluded that the preponderance of the evidence is against the veteran's claim for service connection for a low back disorder. Since the weight of the evidence for and against the claim is not in relative equipoise, the reasonable doubt rule does not apply. 38 U.S.C.A. § 5107 (West 1991); 38 C.F.R. §§ 3.102, 4.3 (1994). III. Cervical Spine Disorder The veteran contends that he injured his neck in service, and that he now has a chronic cervical spine disorder as the result. Service connection may be established for disability resulting from personal injury suffered or disease contracted in line of duty. 38 U.S.C.A. §§ 1110, 1131 (West 1991). Regulations also provide that service connection may 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) (1994). Service connection for arthritis may be granted if it is shown to be present in service or manifest to a degree of 10 percent or more within one year from the date of final separation from service. 38 U.S.C.A. §1112 (1991); 38 C.F.R. §§ 3.307(a)(3), 3.309(a) (1994). The service medical records do not show any injuries to the neck or spine during service. No spine abnormalities were noted on the service separation examination in June 1972. The veteran has reported an incident at work in July 1983 in which the full weight of a 200 pound slab slipped onto his left arm, shoulder and neck. In November 1985, he fell 15-20 feet off of a roof, apparently landing on his head, back and shoulders in a snow bank. In October 1986, a CT scan showed mild mid and lower cervical spine degenerative changes without true evidence of disc herniation from C4-T1. There was some bulging at the C4- 5 space but no encroachment. In December 1986, Warren J. Adams, M.D., performed an anterior cervical fusion of C6-7 and a left iliac bone graft. The veteran was seen by Dr. Demakas in September 1987. He reported that he injured his neck in the July 1983 incident and was told at that time that he had a ruptured disc. On examination, there was good range of neck motion. An examination was conducted in April 1988 in conjunction with the veteran's claim for Social Security Administration benefits. The veteran again reported the incident at work in July 1983 in which the full weight of a 200 pound slab slipped onto his left arm, shoulder and neck. The veteran reported deep and throbbing neck pain which extends to the shoulders and head. There was also sometimes pain and numbness into the arms and hands. On examination, there was a mild tilt of the head to the right and the left shoulder drooped. There was increased dorsal roundback and wasting of both shoulder girdles, more left than right, and tenderness in the paravertebrals, more left than right. Tenderness was noted in the midline from about the mid dorsal up almost to the base of the skull, particularly at the C6-7 area. There were normal pulses and negative Adson's test. There was limitation of neck motion and spotty sensory impairment in the left upper extremity. The diagnoses were history of left shoulder girdle and neck sprain, probably related, history of herniated C6-7 disc, post-operative C6-7 decompression and fusion, history of degenerative disc disease and stenosis at C4-5 and C5-6. The examiners stated that they felt the neck and shoulder pathology was related to the July 1983 injury. A VA examination was conducted in February 1991. The veteran reported neck pain which began in service. On examination, there was limited rotation and extension of the cervical spine. Flexion was near normal. The diagnosis was post-operative status neck fusion with residual pain. A cervical spine MRI conducted in November 1993 showed postoperative changes with fusion at C4-5 and C5-6 and posterior bulging of the disc at the C3-4 level. This extended into the ventral subarachnoid space but did not compress the spinal cord or lateral recess. A cervical CT scan performed in January 1994 demonstrated failed fusion at C5-6 with intact fusion at C4-5 and C6-7, midline herniation at C3-4 with mild to moderate compression of the thecal sac, and moderate bilateral foraminal narrowing at C5-6 greater on the right than the left. The most recent VA examination was conducted in July 1994. The veteran reported several injuries to his neck during service, a car accident and an incident handling marble which caused neck injuries after service. He complained of constant neck pain, radiating to the left shoulder, forearm and hand. On examination, range of cervical spine motion was to 30 degrees flexion, extension to 25 degrees, abduction to 10 degrees on the right and 15 degrees on the left. Rotation was to 25 degrees on the right and 35 degrees on the left. There were well-healed anterior lower cervical incisions and a slightly increased thoracic kyphosis. X-rays of the cervical spine showed an apparent anterior fusion at the C6-7 level. The disc space at the neck cephalad level, which appeared to be C5-6, appeared to be abnormal, with a narrow intravertebral disc space. The examiner stated that the case for connection of the veteran's neck problems to the conditions of his military service appeared less definite than that of the low back pathology. The examiner stated that a reported injury suffered when the veteran was "blown over" on the ship could have contributed to difficulty in his neck. The service medical records do not show any trauma or injury to the neck during service and no spine abnormalities were noted on the service separation examination. The most recent VA examiner's opinion regarding a possible relationship of the veteran's cervical spine condition to his service was based upon the veteran's assertions of injuries during service. Such injuries are not substantiated by the veteran's service medical records. Moreover, the examiner's opinion is quite equivocal on this issue and that equivocal opinion is conditioned on the unsupported assumption that there were neck injuries in service. The Board is not required to accept unsubstantiated opinions of medical care providers. Smith v. Derwinski, 2 Vet.App. 137 (1992); Wood v. Derwinski, 1 Vet.App. 190 (1991). In this case, the Board finds the medical reports which link the neck problems to the 1983 work-related injury to be more probative. The other medical evidence of record indicates a later onset of neck symptomatology than the veteran's period of service, specifically following work-related injuries in 1983 and 1985. There is no showing of neck treatment in the record before 1983. The veteran testified at a personal hearing in July 1992 and has submitted written statements, all to the effect that he suffered neck injuries in service which have led to a chronic disability. The Board must assess the credibility of statements, both oral and written, pursuant to the appeal. O'Hare v. Derwinski, 1 Vet.App. 365 (1991); Ferguson v. Derwinski, 1 Vet.App 428 (1991). In a case such as this, involving specialized medical knowledge, we must particularly assess whether the witness has the necessary experience and knowledge to testify accurately. Espiritu v. Derwinski, 2 Vet.App. 492, 495 (1992). In this case, the veteran has provided inconsistent statements to different medical care providers with respect to his medical history. He has reported in service neck injuries to the VA examiners but not to other physicians. His assertions of in service injuries are not supported by the service medical records. The first documented treatments for a neck disorder occurred after the 1983 injury. In light of the above, the Board does not consider the veteran's statements to be credible for the purpose of demonstrating that his cervical spine disorder began in service. The first demonstration of cervical spine arthritis in the record was in 1986. The nearly 14 years between the veteran's separation from service and the first diagnosis of arthritis precludes service connection on a presumptive basis. 38 U.S.C.A. §1112 (1991); 38 C.F.R. §§ 3.307(a)(3), 3.309(a) (1994). Consequently, the Board has concluded that the preponderance of the evidence is against the veteran's claim for service connection for a cervical spine disorder. Since the weight of the evidence for and against the claim is not in relative equipoise, the reasonable doubt rule does not apply. 38 U.S.C.A. § 5107 (West 1991); 38 C.F.R. §§ 3.102, 4.3 (1994). IV. Degenerative Changes to the Thoracic Spine Service connection may be established for disability resulting from personal injury suffered or disease contracted in line of duty. 38 U.S.C.A. §§ 1110, 1131 (West 1991); 38 C.F.R. § 3.303 (1994). The veteran will be considered to have been in sound condition when examined, accepted and enrolled for service, except as to defects, infirmities, or disorders noted at entrance into service, or where clear and unmistakable (obvious or manifest) evidence demonstrates that an injury or disease existed prior thereto. Only those conditions as are recorded in examination reports are to be considered as noted. 38 C.F.R. § 3.304(b) (1994). The service medical records show that mild kypho-scoliosis was noted on the veteran's service entrance examination in July 1968. X-rays the following month revealed degenerative changes in the dorsal spine with lipping. The service medical records do not show any trauma or increase in the degenerative changes or kypho- scoliosis curvature during service. No spine abnormalities were noted on the service separation examination in June 1972. There is no indication that the veteran was ever treated for a thoracic spine disorder until the most recent VA examination in July 1994. At that time, X-rays showed Schmorl's nodes at T12 and T11, which were noted to be relatively minor in extent. Degenerative changes to the thoracic spine were not shown on the veteran's service entrance examination. These were first noted by X-ray the following month. This pathology was shown to be present on the most recent examination. The veteran's spine must be presumed to have been sound on entrance into service, except for the kypho-scoliosis noted at that time. The degenerative changes were first noted during service, and they have been confirmed by recent examination. Accordingly, service connection is granted for degenerative changes of the thoracic spine. 38 C.F.R. §§ 3.303, 3.304(b) (1994) ORDER Service connection for an acquired psychiatric disorder, to include post-traumatic stress disorder, is denied. Service connection for a lower back disorder is denied. Service connection for a cervical spine disorder is denied. Service connection for degenerative changes to the thoracic spine is granted. JAN DONSBACH Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___ (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991), a decision of the Board of Veterans' Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a Notice of Disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402 (1988). The date which appears on the face of this decision constitutes the date of mailing and the copy of this decision which you have received is your notice of the action taken on your appeal by the Board of Veterans' Appeals.