Citation Nr: 0810263 Decision Date: 03/28/08 Archive Date: 04/09/08 DOCKET NO. 05-03 290 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Waco, Texas THE ISSUES 1. Entitlement to an increased rating for service-connected calluses of the feet, bilateral, currently evaluated as 10 percent disabling. 2. Entitlement to service connection for a bilateral ankle condition, as secondary to service-connected bilateral foot calluses. 3. Entitlement to service connection for a back condition, as secondary to service-connected bilateral foot calluses. 4. Entitlement to service connection for a knee condition, as secondary to service-connected bilateral foot calluses. 5. Entitlement to service connection for a hip condition, as secondary to service-connected bilateral foot calluses. 6. Entitlement to service connection for hypertension, as secondary to service-connected bilateral foot calluses. REPRESENTATION Appellant represented by: Texas Veterans Commission WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Mark Vichich, Associate Counsel INTRODUCTION The veteran served on active duty from October 1984 to October 1987 and from October 1989 to April 1992. This matter comes before the Board of Veterans' Appeals (Board) on appeal from August 2003, September 2004, and October 2005 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in Waco, Texas. The veteran testified before the undersigned Veterans Law Judge at a travel board hearing in January 2008; a transcript is of record. FINDINGS OF FACT 1. The competent medical evidence does not show that the veteran's service-connected calluses of the feet affect at least 20 percent of the entire body or any part of an exposed area; or that they require systemic therapy such as corticosteroids or other immunosuppressive drugs. 2. The competent medical evidence does not relate a bilateral ankle condition to a service-connected disability. 3. The competent medical evidence does not relate a back condition to a service-connected disability. 4. The competent medical evidence does not relate a knee condition to a service-connected disability. 5. The competent medical evidence does not relate a hip condition to a service-connected disability. 6. The competent medical evidence does not relate hypertension to a service-connected disability. CONCLUSIONS OF LAW 1. The schedular criteria for a disability rating in excess of 10 percent for service-connected calluses of the feet have not been met or approximated. 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. §§ 4.1-4.14, 4.20, 4.27, 4.118 Diagnostic Code 7899-7806 (2007). 2. A bilateral ankle condition is not proximately due to or the result of a service-connected disability. 38 U.S.C.A. §§ 1110, 1131 (West 2002); 38 C.F.R § 3.310 (2007). 3. A back condition is not proximately due to or the result of a service-connected disability. 38 U.S.C.A. §§ 1110, 1131 (West 2002); 38 C.F.R § 3.310 (2007). 4. A knee condition is not proximately due to or the result of a service-connected disability. 38 U.S.C.A. §§ 1110, 1131 (West 2002); 38 C.F.R § 3.310 (2007). 5. A hip condition is not proximately due to or the result of a service-connected disability. 38 U.S.C.A. §§ 1110, 1131 (West 2002); 38 C.F.R § 3.310 (2007). 6. Hypertension is not proximately due to or the result of a service-connected disability. 38 U.S.C.A. §§ 1110, 1131 (West 2002); 38 C.F.R § 3.310 (2007). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Duty to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA) imposes obligations on VA with respect to its duty to notify and assist a claimant in developing a claim. 38 U.S.C.A. §§ 5103, 5103A (West 2002 & Supp. 2007); 38 C.F.R. § 3.159 (2007). Under the VCAA, upon receipt of a complete or substantially complete application for benefits, VA is required to notify the veteran and his representative, if any, of any information and medical or lay evidence necessary to substantiate the claim. The United States Court of Appeals for Veterans Claims (hereinafter the Court) has held that these notice requirements apply to all five elements of a service connection claim, which include: (1) veteran status; (2) existence of a disability; (3) a connection between the veteran's service and the disability; (4) degree of disability; and (5) effective date of the disability. See Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). VA law and regulations also indicate that part of notifying a claimant of what is needed to substantiate a claim includes notification as to what information and evidence VA will seek to provide and what evidence the claimant is expected to provide. Further, VA must ask the claimant to provide any evidence in her or his possession that pertains to the claim. 38 U.S.C.A. § 5103 (West 2002 & Supp. 2007); 38 C.F.R. §§ 3.159(a)-(c) (2007). VCAA notice must be provided to a claimant before the initial unfavorable agency of original jurisdiction (AOJ) decision on a claim. Pelegrini v. Principi, 18 Vet. App. 112, 120 (2004). For an increased-compensation claim, VCAA requires, at a minimum, that VA notify the claimant that the evidence demonstrates a worsening or increase in severity of the disability and the effect that worsening has on the veteran's employment and daily life. Vazquez-Flores v. Peake, No. 05- 0355, (U.S. Vet. App. January 30, 2008). The notice must also provide examples of the types of medical and lay evidence that the claimant may submit (or ask the Secretary to obtain) that are relevant to establishing entitlement to increased compensation-e.g., competent lay statements describing symptoms, medical and hospitalization records, medical statements, employer statements, job application rejections, and any other evidence showing an increase in the disability or exceptional circumstances relating to the disability. Vazquez-Flores, slip op. at 5-6. The Board finds that the VA has no further duty to notify prior to Board adjudication. The RO provided notice to the veteran with regard to his back, ankle, hip, hypertension, and knee claims in correspondence dated in July 2003. In that correspondence, which was provided to the veteran prior to initial adjudication of these claims, the RO advised the veteran of what the evidence needed to show to establish entitlement to service-connected compensation benefits claimed as secondary to service-connected disability. The RO advised the veteran of VA's duties under the VCAA and the delegation of responsibility between VA and the veteran in procuring the evidence relevant to the claims, including which portion of the information and evidence necessary to substantiate the claims was to be provided by the veteran and which portion VA would attempt to obtain on behalf of the veteran. The RO also essentially requested that the veteran send any evidence in his possession that pertained to the claims, namely by requesting any additional evidence concerning the claimed condition and enough information for the RO to request records from the sources identified by the veteran. A review of the record shows that the VCAA notice did not include the elements of the degree of disability or the effective date of disability. For reasons discussed more fully below, the Board concludes that the preponderance of the evidence is against the appellant's claims for service connection. Thus, no disability ratings or effectives date will be assigned and failure to notify the veteran of these elements has resulted in no prejudice. See Sanders v. Nicholson, 487 F.3d 881, 891 (Fed. Cir. 2007) (holding that VCAA notice errors are presumed to be prejudicial and it is VA's duty to rebut the presumption). In response to the veteran's increased rating claim, the RO provided the veteran in correspondence dated in April 2005. In this correspondence, the RO advised the veteran of VA's duties under the VCAA and the delegation of responsibility between VA and the veteran in procuring the evidence relevant to the claims, including which portion of the information and evidence necessary to substantiate the claims was to be provided by the veteran and which portion VA would attempt to obtain on behalf of the veteran. The RO also essentially requested that the veteran send any evidence in his possession that pertained to the claims, namely by requesting enough information about evidence so that VA can obtain such evidence on the veteran's behalf. The April 2005 letter did not include the criteria necessary to establish entitlement to an increased rating and did not include information pertaining to the establishment of an effective date. Although the veteran has not been provided with fully compliant notice as it pertains to his increased rating claim, the Board finds that any deficiencies have resulted in no prejudice and that a decision on the merits is appropriate at this time. The veteran has submitted numerous statements describing the severity of his disability and its affect on his employment and daily life. In his VA Form 9, dated in August 2006, the veteran alleged his bilateral foot disability had gotten "worse and worse" and described how he felt it had worsened. Specifically, the veteran alleged it affected his posture because it forced him to walk differently. The veteran stated that his feet were so bad that they affected his work attendance. In a statement dated in November 2003, the veteran reported that his foot disability caused stress at work, namely from pain associated with walking in steel toe boots. Thus, the veteran demonstrated actual knowledge that he needed to show worsening or increase in severity of the disability and the effect that worsening had on his employment and daily life. Such knowledge cures any timing or content defects of the notice as it pertains to the veteran's increased rating claim. As for the failure to notify the veteran of the effective date element of a compensation claim, the Board finds no resulting prejudice. For reasons explained more fully below, the competent medical evidence does not support a rating higher than that already assigned. The competent medical evidence also does not support the veteran's secondary service connection claims. Absent a grant of benefits sought on appeal, no effective date will be assigned. Finally, the Board finds that the RO has satisfied VA's duty to assist. The RO has obtained the veteran's service medical records, VA Medical Center (VAMC) treatment records, and all private medical records that the veteran requested. Sources of private medical records associated with the claims file include Dr. R.L., Lake Point Medical Center, and Dr. R.A. The veteran has also been provided with a VA examination for each disability claimed on appeal. The veteran has not made the RO or the Board aware of any other evidence relevant to his appeal. In correspondence dated in April 2006, he informed VA that all evidence had been submitted. No further development is required to comply with the duty to assist the veteran in developing the facts pertinent to his claims. Accordingly, the Board will proceed with appellate review. II. Increased Rating Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. 38 U.S.C.A. § 1155 (West 2002 & Supp. 2007); 38 C.F.R. § 4.1 (2007). Where an increase in an existing disability rating based on established entitlement to compensation is at issue, the present level of disability is the primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). If two evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating; otherwise the lower evaluation will be assigned. 38 C.F.R. § 4.7 (2007). All benefit of the doubt will be resolved in the veteran's favor. 38 C.F.R. § 4.3 (2007). There is no specific diagnostic code for calluses of the feet. When an unlisted disease, injury, or residual condition is encountered, requiring rating by analogy, the diagnostic code number will be "built-up" as follows: The first 2 digits will be selected from that part of the schedule most closely identifying the part or system of the body involved; the last 2 digits will be "99" for all unlisted conditions. Here the veteran is rated by analogy to Diagnostic Code 7899-7806. Hyphenated diagnostic codes, such as that employed here, are used when a rating pursuant to one diagnostic code requires use of an additional diagnostic code to identify the basis for the evaluation assigned. 38 C.F.R. § 4.27 (2007). Diagnostic Code 7806 is assigned for dermatitis or eczema. 38 C.F.R. § 4.118 (2007). The veteran filed to claim for an increased rating in April 2005. The rating criteria for evaluating skin disorders were changed, effective August 30, 2002. Amendment to Part 4, Schedule for Rating Disabilities, 67 Fed. Reg. 49,590-49,599 (July 31, 2002) (codified at 38 C.F.R. § 4.118, Diagnostic Codes 7800-7833 (2003)) [Amendment to Part 4]. Thus, only the new criteria are for consideration. VAOPGCPREC 3-00. Under the new rating criteria, a 30 percent rating is assigned for dermatitis or eczema that affects at least 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected, or; systemic therapy such as corticosteroids or other immunosuppressive drugs required for a total duration of six weeks or more, but not constantly, during the past 12-month period. 38 C.F.R. § 4.118, Diagnostic Code 7806 (2007). At his travel board hearing, the veteran testified that he had to shave his calluses once a week and that this caused pain. The veteran testified that his podiatrist had given him shoe inserts, but that this put too much pressure on his heel. Regarding limitations on daily activities, the veteran testified he was unable to walk in bare feet or wear steel- toed boots. The veteran claimed to have lost jobs because of his inability to wear boots. The veteran stated that his current job required him to walk most of the time, more than 40 hours a week. Regarding treatment, the veteran said that his podiatrist had recommended surgery, but that VA recommended against it. The veteran also reported he had an exposed nerve on the bottom of his foot and that every time he shaved his foot, it bleed and was painful. The Board has considered all the medical evidence of record pertaining to the current severity of the veteran's service- connected calluses of the feet, which included VA examination reports dated in July 2005 and March 2006, and records from Dr. R.L. and Podiatric Surgical Associates of North Texas. Based on the evidence of record, the Board finds that rating in excess of 10 percent for the bilateral foot disability is not warranted. In the March 2006 examination report Dr. J.R. noted the presence of 6 calluses on the right foot ranging in size from 1.5 to 2 centimeters and 4 calluses on the left foot ranging in size from 1 to 1.5 centimeters. Dr. J.R. noted tenderness associated with the calluses and moderate disability with gradual progression. The veteran, according to the doctor, took no oral or topical medications for his feet and currently shaved them weekly. Dr. J.R. estimated the percentage of exposed area affected to be zero, and of the entire body, 3 percent. There was no scarring or disfigurement associated with the calluses according to the doctor. Among the records from Podiatric Surgical Associates of North Texas was a report of initial treatment, dated in November 2002. According to that report, Dr. R.A. found hallux valgus with mild bunion deformity bilaterally, hammertoe deformities, plantar-flexed second metatarsal. Dr. R.A. determined the veteran was a good candidate for surgery. The medical evidence also included progress notes from Dr. R.L., Internal Medicine, dated from March 2002 to January 2005. These notes reflected that Dr. R.L. detected calluses on numerous occasions. The medical evidence fails to show that the veteran's service-connected calluses of the feet effects at least 20 percent of the entire body or that they require systemic therapy such as corticosteroids. Thus, a rating in excess of 10 percent under the currently assigned Diagnostic Code is not applicable. The Board has considered the application of other diagnostic codes for skin disabilities but do not find that any of them apply. See 38 C.F.R. § 4.118, Diagnostic Codes 7800-7833 (2007). The Board has also considered the application of the Diagnostic Codes for foot disabilities. See 38 C.F.R. § 4.71a, Diagnostic Codes 5276-5284 (2007). The veteran, however, has only been service-connected for a skin disability on his feet, rather than for other foot disabilities. Hence, the Board declines to apply any of these diagnostic codes. Essentials of Evaluative Rating Lastly, the Board notes that there is no evidence of record that the veteran's service-connected calluses of the feet cause marked interference with employment (i.e., beyond that already contemplated in the assigned evaluation), or necessitated any frequent period of hospitalization, such that application of the regular schedular standards is rendered impracticable. Moreover, the veteran has not raised such an issue. The Board emphasizes that the percentage ratings assigned by the VA Schedule for Rating Disabilities represent the average impairment in earning capacity resulting from a service-connected disability. 38 C.F.R. § 4.1 (2007). In the instant case, to the extent that the veteran's service-connected calluses of the feet interfere with his employability, the currently assigned rating adequately contemplates such interference, and there is no evidentiary basis in the record for a higher rating on an extraschedular basis. Hence, the Board is not required to remand this matter to the RO for the procedural actions outlined in 38 C.F.R. § 3.321(b)(1) (2007) for assignment of an extraschedular evaluation. Bagwell v. Brown, 9 Vet. App. 337, 338-39 (1996); Floyd v. Brown, 9 Vet. App. 88, 96 (1996). III. Secondary Service Connection Legal Criteria The veteran is claiming entitlement to service connection for back, bilateral ankle, hip, and knee conditions, and hypertension, as a result of his service-connected bilateral foot disability. Service connection may be established on a secondary basis for a disability that is proximately due to or the result of a service-connected disease or injury. 38 U.S.C.A. §§ 1110, 1131 (West 2002); 38 C.F.R. § 3.310(a) (2007). Establishing service-connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. See 38 C.F.R. § 3.310(a) (2007); see also Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc) (providing that secondary service connection may also be granted for the degree of aggravation to a nonservice-connected disorder which is proximately due to or the result of a service- connected disorder) reconciling Leopoldo v. Brown, 4 Vet. App. 216 (1993) and Tobin v. Derwinski, 2 Vet. App. 34 (1991). Back, Knee, and Hip In a statement dated in July 2003, the veteran alleged that his service-connected bilateral foot disability affected his posture, which caused problems with his back, knees, hips and ankles. VA received similar written statements in April 2003, November 2003, and February 2004. At his travel board hearing, the veteran testified that he felt his bilateral foot disability caused problems with his back, knees, hips, and ankles because he had to alter the way he walked. The Board has considered the veteran's contentions, but finds that the medical evidence does not support his back, knee, or hip claims. The medical evidence pertaining to these claims included a letter and progress notes from Dr. R.L.; VA examination reports dated in July 2004, March 2005 and July 2005; radiology reports from Lake Pointe Medical Center; and a Physician's Certificate from the veteran's employer, dated in January 2004. The Board acknowledges that the competent medical evidence confirms the presence of back, bilateral knee, and bilateral hip disabilities. The first radiology report from Lake Pointe Medical Center, dated in September 2003, reflected findings of extensive degenerative changes in the left knee and mild degenerative changes of the right knee. In the second radiology report from Lake Pointe Medical Center, dated in October 2003, Dr. M.B. reported questionable mild compression deformity of the L4 superior end plate and degenerative disc disease. In the March 2005 VA joints examination report, Dr. R.J. diagnosed bilateral hip sprain, degenerative joint disease of the left knee with instability; chronic sprain of the right knee with moderate symptoms with slight progression. In the July 2005 VA examination report, Dr. M.L.'s impression was lumbosacral strain, strain of the knees, and strain of the hips. The pertinent question, therefore, is whether service-connected calluses of the feet either caused or aggravated any of these conditions. Neither the progress notes from Dr. R.L. nor the Physician's Certificate from the veteran's employer provide any support for these claims. The progress notes reflected the veteran's continuing reports of knee pain, but nothing in these notes related a chronic condition to his service-connected calluses. In the Physician's Certificate, dated in January 2004, a physician stated that the veteran's present disabling conditions include back, knee, and foot pain. The physician also stated that the veteran was unable to stand, bend, or lift more than 40 pounds. This document, however, provides no support for the veteran's service connection claims because the physician did not comment on the relationship, if any, between the veteran's service-connected calluses and the claimed conditions. The July 2004 VA examination report weighs against the veteran's back and knee claims. In that report, Dr. R.K. concluded that in his opinion, the foot problems did not cause the back and knee disorders. Dr. R.K. acknowledged that the veteran's calluses were "truly painful and quite tender," but did not believe they would upset the body mechanics enough that they would cause a degenerative process in the knees or back. Dr. R.K. even stated that the feet were probably painful enough to discourage the veteran from overusing his knees and back. Dr. R.K. also stated that surgery to the feet would not likely improve the back or knee disorders. In the report, Dr. R.K. thoroughly discussed clinical examination findings and noted that he had reviewed the veteran's claims file. Dr. R.K.'s references to previous rating decisions and examination reports confirms that he undertook careful review of all pertinent evidence. Moreover, Dr. R.K. provided reasons and bases for his opinions. The Board finds this report to be highly probative. The March 2005 and July 2005 VA examination reports weigh against the veteran's hip, back, and knee claims. In the March 2005 VA joints examination report, Dr. R.J. concluded that it was less likely than not that the veteran's hip and knee conditions were secondary to the service-connected foot condition. Dr. R.J. discussed the veteran's pertinent medical history, including his service-connected calluses of the feet. Dr. R.J. also confirmed that he had reviewed the veteran's claims file. In the July 2005 VA examination report, Dr. M.L. concluded that even though the veteran had abnormalities of the feet, they were not of the severity that would cause any mechanical stress on his knees, hips, or back. Dr. M.L. stated there was no scientific basis for such a nexus. Dr. M.L. noted that the veteran walked with a normal gait and weighed 275 pounds. In his opinion, the doctor stated, the veteran's back, knee, and hip strains were related to his obesity and the wear and tear of standing on his feet and the aging process. In his report, Dr. M.L. also discussed pertinent examination findings. Because the doctor supported his opinion with a discussion of examination findings and provided rationale for his opinion, the Board gives this it substantial weight. In a letter dated in January 2005, Dr. R.L., Internal Medicine, stated that the veteran had chronic pain in his feet and had been diagnosed with multiple foot problems. Regarding the relationship between his foot pain and other conditions, Dr. R.L. stated that the foot pain "has contributed, to some degree, to his occasional arthralgias in his knees, hips and lower back." The Board does not find Dr. R.L.'s letter to be as probative as the VA examination reports. First, Dr. R.L. attributed the veteran's knee, hip, and lower back conditions to his pain from multiple foot problems rather than just the service-connected calluses. As the medical evidence shows, the veteran has been diagnosed with other conditions such as hallux valgus and hammertoe deformities in addition to calluses of the feet. Second, Dr. R.L. provided no rationale for his opinion or otherwise explained why he felt the foot pain contributed to pain in other areas. Third, there is no evidence Dr. R.L. reviewed the veteran's claims file. For these reasons, the Board finds that the other evidence of record outweighs Dr. R.L.'s opinion. The Board declines to give any weight to the veteran's opinion that his service-connected calluses caused his hip, knee or back disorders. As a layperson, he has no professional expertise. Lay assertions regarding medical matters such as diagnosis or etiology of a disability have no probative value because laypersons are not competent to offer medical opinions. Where a claim involves issues of medical fact, such as causation or diagnosis, competent medical evidence is required. Espiritu v. Derwinski, 2 Vet. App. 492, 494-95 (1992). Ankles The veteran has also alleged he incurred an ankle disability as a result of his service-connected bilateral foot disability. In a statement dated in July 2003 and at his travel board hearing, the veteran alleged that his service- connected bilateral foot disability affected his posture and the way he walked and that this caused problems with his ankles. The evidence pertaining to a bilateral ankle condition is found in VA examination reports in March 2005 and July 2005. In the March 2005 VA joints examination report, Dr. R.J. discussed the veteran's pertinent medical history, including his service-connected calluses of the feet. Dr. R.J. also confirmed that he had reviewed the veteran's claims file. Subjective complaints pertaining to the ankles included pain and swelling. On examination, Dr. R.J. detected medial tenderness in both ankles. Dr. R.J. diagnosed chronic ankle sprain, bilateral, moderate disability with progression. A VA radiology report accompanying the examination report showed that x-rays of the ankles were negative for evidence of abnormality. Regarding the etiology of the chronic ankle sprain, Dr. R.J. concluded that it was as likely as not secondary to the service-connected foot condition. Dr. R.J. explained that the baseline manifestations of the ankle condition were pain and swelling. The increased manifestations that were proximately due to service-connected disability were those of increased pain and swelling that were secondary to the service-connected calluses of the feet. In the July 2005 VA examination report, Dr. M.L. discussed examination findings. On examination of the ankles, Dr. M.L. noted no tenderness and no swelling. The veteran was able to dorsiflex 10 degrees and plantar flex 30 degrees with 10 degrees of inversion and eversion bilaterally. Dr. M.L. did not diagnose an ankle condition. Regarding a relationship between the veteran's service- connected calluses of the feet and the ankle condition, Dr. M.L. concluded that even though the veteran had abnormalities of the feet, they were not of the severity that would cause any mechanical stress on his knees, hips, ankles, or back. Dr. M.L. stated there was no scientific basis for such a nexus. Dr. M.L. noted that the veteran walked with a normal gait and weighed 275 pounds. In his opinion, the doctor stated, the veteran's back, knee, hip, and ankle strains were related to his obesity and the wear and tear of standing on his feet and the aging process. Upon reviewing the medical evidence, the Board concludes that service-connection for a bilateral ankle disorder is not warranted. Although Dr. R.J. concluded that the service- connected disability would result in increased pain and swelling of the ankles in relation to the baseline manifestation, he provided no reasoning for this conclusion. Dr. M.L. on the other hand, supported his conclusion with medical rationale. The Board finds Dr. M.L.'s opinion to be slightly more probative and thus, the weight of the evidence is against the veteran's bilateral ankle claim. The veteran's lay statements pertaining to the etiology of his ankle sprain is afforded no weight because here, the claim involves issues of medical causation. Espiritu, 2 Vet. App. at 494-95. Hypertension In a statement dated in July 2003, the veteran alleged his hypertension was a result of the swelling he experienced in his joints. At his travel board hearing, the veteran testified that the stress associated with his feet caused the hypertension. Progress notes from Dr. R.L. confirmed a diagnosis of hypertension (see e.g. progress note dated September 2003). The progress notes do not, however, address the etiology of the hypertension or provide any evidence of a link between the hypertension and a service-connected disability. These records provide no support for the veteran's claim. The only evidence pertaining to the etiology of the veteran's hypertension is found in a letter dated in January 2005, from Dr. R.L. In that letter, Dr. R.L. stated that he did not feel the veteran's foot pain contributed to his hypertension because he could have that problem irrespective of his foot problems. This letter does not support the veteran's claim. There being no competent medical evidence in support of his claim, service connection is not warranted. The veteran's lay statements pertaining to the etiology of his hypertension is afforded no weight because here, the claim involves issues of medical causation. Espiritu, 2 Vet. App. at 494-95. ORDER 1. A rating in excess of 10 percent for service-connected calluses of the feet, bilateral, is denied. 2. Service connection for a bilateral ankle condition, as secondary to service-connected calluses of the feet, bilateral, is denied. 3. Service connection for a back condition, as secondary to service-connected calluses of the feet, bilateral, is denied. 4. Service connection for a knee condition, as secondary to service-connected calluses of the feet, bilateral, is denied. 5. Service connection for a hip condition, as secondary to service-connected calluses of the feet, bilateral, is denied. 6. Service connection for hypertension, as secondary to service-connected calluses of the feet, bilateral, is denied. ____________________________________________ John E. Ormond, Jr. Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs