Citation Nr: 1006507 Decision Date: 02/22/10 Archive Date: 03/02/10 DOCKET NO. 05-18 713 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Winston- Salem, North Carolina THE ISSUES 1. Entitlement to a rating in excess of 10 percent for bilateral pes planus prior to October 8, 2008. 2. Entitlement to a rating in excess of 30 percent for bilateral pes planus with since October 8, 2008. 3. Entitlement to service connection for a right knee disorder, to include as secondary to bilateral pes planus. 4. Entitlement to service connection for a left hip disorder, to include as secondary to bilateral pes planus. 5. Entitlement to service connection for a right leg disorder, characterized a muscle strain, to include as secondary to bilateral pes planus. REPRESENTATION Appellant represented by: The American Legion WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD B. Thomas Knope, Associate Counsel INTRODUCTION The Veteran served on active duty from November 1975 to September 1976. This matter is on appeal from the Winston-Salem, North Carolina, Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Acting Veterans Law Judge in June 2008. A transcript of the hearing is of record. This case was remanded by the Board in August 2008 for further development and is now ready for disposition. FINDINGS OF FACT 1. Prior to October 8, 2008, the Veteran's pes planus was characterized by pain and tenderness to palpation. Severe disability with marked deformity, pain on manipulation and use accentuated, indication of swelling on use and characteristic callosities have not been shown. 2. Since October 8, 2008, the Veteran's pes planus was characterized by pain and swelling while walking. Heel valgus was 5 degrees bilaterally and the right foot demonstrated marked pronation, but symptoms were improved through the use of orthopedic inserts. Pronounced disability with marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo achillis on manipulation, and that which is not improved by orthopedic shoes or appliances have not been shown. 3. The Veteran's right knee and left hip disorders are not related to a service-connected disability or to active duty service. 4. A right leg disorder is not currently shown. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 10 percent for bilateral pes planus prior to October 8, 2008 have not been met. 38 U.S.C.A. §§ 1155, 5103(a), 5103A, 5107 (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.14, 4.40, 4.45, 4.59, 4.71, 4.71a, Diagnostic Code (DC) 5276 (2009). 2. The criteria for a rating in excess of 30 percent for bilateral pes planus since October 8, 2008 have not been met. 38 U.S.C.A. §§ 1155, 5103(a), 5103A, 5107 (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.14, 4.40, 4.45, 4.59, 4.71, 4.71a, DC 5276 (2009). 3. A chronic right knee disorder was not incurred or aggravated by active duty, and is not due to service- connected disability. 38 U.S.C.A. §§ 1110, 5103(a), 5103A, 5107(b) (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310 (2009). 4. A chronic left hip disorder was not incurred or aggravated by active duty, and is not due to service- connected disability. 38 U.S.C.A. §§ 1110, 5103(a), 5103A, 5107(b) (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310 (2009). 5. A right leg disorder, characterized a muscle strain is not attributable to active duty or to a service-connected disability, and is not currently shown. 38 U.S.C.A. §§ 1110, 5103(a), 5103A, 5107(b) (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310 (2009). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Board has reviewed all of the evidence in the Veteran's claims folder. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, the extensive evidence of record. Indeed, the Federal Circuit has held that the Board must review the entire record, but does not have to discuss each piece of evidence. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). Therefore, the Board will summarize the relevant evidence where appropriate, and the Board's analysis below will focus specifically on what the evidence shows, or fails to show, as to each claim. Veterans Claims Assistance Act of 2000 As provided for by the Veterans Claims Assistance Act of 2000 (VCAA), VA has a duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2009). Proper notice from VA must inform the claimant of any information and medical or lay evidence not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; and (3) that the claimant is expected to provide. Quartuccio v. Principi, 16 Vet. App. 183 (2002). This notice must be provided prior to an initial unfavorable decision on a claim by the RO. Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006); Pelegrini v. Principi, 18 Vet. App. 112 (2004). In addition, the notice requirements of the VCAA apply to all five elements of a service-connection claim, including: (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). Further, this notice must include information that a disability rating and an effective date for the award of benefits will be assigned if service connection is awarded. Id. at 486. The Veteran's pes planus claim arises from his disagreement with the initial evaluation following the grant of service connection. Courts have held that once service connection is granted the claim is substantiated, additional notice is not required and any defect in the notice is not prejudicial. Hartman v. Nicholson, 483 F.3d 1311 (Fed. Cir. 2007); Dunlap v. Nicholson, 21 Vet. App. 112 (2007). Therefore, no further notice is needed under VCAA. Regarding his service connection claims, the VCAA duty to notify was satisfied by way of letters sent to the Veteran in June and October 2004 that fully addressed all notice elements and were sent prior to the initial RO decision in this matter. The letters informed him of what evidence was required to substantiate the claims and of his and VA's respective duties for obtaining evidence. Under these circumstances, the Board finds that the notification requirements of the VCAA have been satisfied as to both timing and content. With respect to the Dingess requirements, in September 2008, the RO provided the Veteran with notice of what type of information and evidence was needed to establish disability ratings, as well as notice of the type of evidence necessary to establish an effective date. With that letter, the RO effectively satisfied the remaining notice requirements with respect to all issues on appeal. Therefore, adequate notice was provided to the Veteran prior to the transfer and certification of his case to the Board and complied with the requirements of 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b). Next, VA has a duty to assist a veteran in the development of the claim. This duty includes assisting him or her in the procurement of service treatment records and other pertinent records, and providing an examination when necessary. See 38 U.S.C.A. § 5103A (West 2002); 38 C.F.R. § 3.159 (2009). In determining whether a medical examination be provided or medical opinion obtained, there are four factors to consider: (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability; (2) evidence establishing an in-service event, injury, or disease, or manifestations during the presumptive period; (3) an indication that the disability or symptoms may be associated with service; and (4) whether there otherwise is sufficient competent medical evidence of record to make a decision on the claim. With respect to the third factor, the types of evidence that "indicate" that a current disorder "may be associated" with service include, but are not limited to, medical evidence that suggests a nexus but is too equivocal or lacking in specificity to support a decision on the merits, or credible evidence of continuity of symptomatology such as pain or other symptoms capable of lay observation. McLendon v. Nicholson, 20 Vet. App. 79 (2006). After a careful review of the file, the Board finds that all necessary development has been accomplished, and therefore appellate review may proceed without prejudice to the Veteran. See Bernard v. Brown, 4 Vet. App. 384 (1993). First, the RO has obtained the Veteran's service treatment records and VA outpatient treatment records. Further, the Veteran submitted private treatment records and he was provided an opportunity to set forth his contentions during the hearing before the undersigned Veterans Law Judge in June 2008. Next, specific VA medical examinations pertinent to the issues on appeal were obtained in January 2005 and October 2008. The Board finds that these examinations were adequate for evaluation purposes. Specifically, the examiners reviewed the claims file, interviewed the Veteran and conducted a physical examination. Moreover, there is no indication that the VA examiners were not fully aware of the Veteran's past medical history or that they misstated any relevant fact. Therefore, the available records and medical evidence have been obtained in order to make adequate determinations as to these claims. Therefore, the available records and medical evidence have been obtained in order to make adequate determinations as to these claims. Significantly, neither the Veteran nor his representative has identified, and the record does not otherwise indicate, any additional existing evidence that is necessary for a fair adjudication of the claims that has not been obtained. Hence, no further notice or assistance is required to fulfill VA's duty to assist in the development of the claims. Smith v. Gober, 14 Vet. App. 227 (2000), aff'd, 281 F.3d 1384 (Fed. Cir. 2002); Dela Cruz v. Principi, 15 Vet. App. 143 (2001); see also Quartuccio v. Principi, 16 Vet. App. 183 (2002). Increased Ratings for Bilateral Pes Planus Disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. See 38 C.F.R. § 4.1 (2009). Separate diagnostic codes identify the various disabilities. 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. Part 4 (2009). However, the Board has been directed to consider only those factors contained wholly in the rating criteria. See Massey v. Brown, 7 Vet. App. 204, 208 (1994); but see Mauerhan v. Principi, 16 Vet. App. 436 (2002) (finding it appropriate to consider factors outside the specific rating criteria in determining level of occupational and social impairment). Where there is a question as to which of two separate evaluations shall be applied, the higher evaluation will be assigned if the disability more closely approximates the criteria required for that particular rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (2009). When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability, such doubt will be resolved in favor of the Veteran. 38 C.F.R. § 4.3 (2009). A disability of the musculoskeletal system is primarily the inability, due to damage or infection in the parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. It is essential that the examination on which ratings are based adequately portray the anatomical damage, and the functional loss, with respect to all these elements. The functional loss may be due to absence of part, or all, of the necessary bones, joints and muscles, or associated structures, or to deformity, adhesions, defective enervation, or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. §§ 4.10, 4.40, 4.45 (2009). The Court of Appeals for Veterans Claims (CAVC) has held that the RO must analyze the evidence of pain, weakened movement, excess fatigability, or incoordination and determine the level of associated functional loss under 38 C.F.R. § 4.40, which requires the VA to regard as "seriously disabled" any part of the musculoskeletal system that becomes painful on use. See DeLuca v. Brown, 8 Vet. App. 202 (1995). The provisions of 38 C.F.R. § 4.14 (avoidance of pyramiding) do not forbid consideration of a higher rating based on greater limitation of motion due to pain on use, including during flare-ups. The Board notes that the guidance provided by the CAVC in DeLuca must be followed in adjudicating claims where a rating under the diagnostic codes governing limitation of motion should be considered. Furthermore, the intent of the rating schedule is to recognize painful motion with joint or periarticular pathology as productive of disability. Thus, actually painful, unstable, or malaligned joints, due to healed injury, are as entitled to at least the minimum compensable rating for the joint. The joints should be tested for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with the range of the opposite undamaged joint. See 38 C.F.R. § 4.59 (2009). In cases where the Veteran's claim arises from a disagreement with the initial evaluation following the grant of service connection, the Board shall consider the entire period of claim to see if the evidence warrants the assignment of different ratings for different periods of time during these claims a practice known as "staged" ratings. Fenderson v. West, 12 Vet. App. 119 (1999). Finally, in this case, the Veteran's disability rating was increased during the pendency of this appeal. The Court of Appeals for Veterans Claims has held that a rating decision issued subsequent to a notice of disagreement which grants less than the maximum available rating does not abrogate the pending appeal. See AB v. Brown, 6 Vet. App. 35, 38 (1993); see also Corchado v. Derwinski, 1 Vet. App. 160 (1991). Since the RO granted only a portion of the Veteran's increased rating claim, his appeals properly remain before the Board for review. Entitlement to a Rating in Excess of 10 Percent Prior to October 8, 2008 Prior to October 8, 2008, the Veteran was rated at 10 percent for his bilateral pes planus under 38 C.F.R. § 4.71a, DC 5276. This diagnostic code contemplates a 10 percent rating when his disability is of a moderate level, with a weight bearing line over or medial to the great toe, inward bowing of the tendo achillis, and pain on manipulation and use of the feet. In order to be entitled to the next higher 30 percent evaluation, the evidence must show severe disability with marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use and characteristic callosities. In this case, the Board concludes that a 30 percent prior to October 8, 2008 is not warranted, as the evidence is more representative of a 10 percent disability rating. First, the evidence does not show severe disability with marked deformity. At his VA physical examination in January 2005, the Veteran stated that he once wore orthopedic shoes that were prescribed by his physician until they wore out, but has not worn any such shoes since then, even though they did help. Upon examination, the VA examiner noted no residual arch in the right foot and some residual arch in the left. Additionally, he had 30 degrees of misalignment of the right Achilles tendon, but no misalignment in the left Achilles tendon. Therefore, while some misalignment was evidence, marked deformity has not been shown. Regarding pain, the VA examiner observed that the Veteran's right foot was palpably tender in the mid-foot and point tender in the heel. Tenderness in the left foot, while present, was not at the same extent as the right foot. While the Veteran complained that his feet will hurt after walking, the evidence does not indicate that the pain is accentuated by use. Based on the evidence from this examination, the Board concludes that his disability more closely approximates a 10 percent rating, rather than a 30 percent rating, prior to October 8, 2008. In conclusion, as marked deformity or use accentuated pain has not been shown prior to October 8, 2008, a rating in excess of 10 percent prior to that date is not warranted. Entitlement to a Rating in Excess of 30 Percent Since October 8, 2008 In a July 2009 decision, the RO increased the Veteran's disability rating for his service-connected pes planus to 30 percent, effective October 8, 2008. In order to warrant a rating in excess of 30 percent, the evidence must show a pronounced disability with marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo achillis on manipulation, and that which is not improved by orthopedic shoes or appliances. Here, the evidence does not indicate that a rating in excess of 30 percent is warranted since October 8, 2008. The 30 percent rating was based primarily on a second VA examination that the Veteran underwent in October 2008. There, he indicated experiencing pain, swelling and redness in both feet while walking, which limits his ability to walk more than a quarter of a mile. However, while the examiner observed some tenderness in the right foot, no tenderness was observed on the left foot. In neither case did the evidence indicate that the tenderness was extreme in nature. Next, the VA examiner observed normal Achilles alignment bilaterally. While pronation of the left foot was mild, marked pronation was observed in the right foot. Heel valgus was 5 degrees bilaterally. However, marked inward displacement or severe spasm of the tendo achillis was not indicated. Of additional note, the evidence indicates that the use of orthopedic inserts, such as the ones he was prescribed in May 2008, yield some improvement. Overall, although the Veteran's right foot did demonstrate marked pronation, the evidence indicates that many of his symptoms were exacerbated by the fact that he was not apparently wearing orthopedic shoes or appliances for a considerable length of time. The Veteran indicated that the orthotics he was prescribed in May 2008 have helped. Moreover, while the evidence indicates pain with some tenderness, the evidence indicates that a 30 percent is more appropriate. Next, the Board has also considered his statements that his disability merits a higher rating. In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. See Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Competency of evidence differs from weight and credibility. The former is a legal concept determining whether testimony may be heard and considered by the trier of fact, while the latter is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) ("although interest may affect the credibility of testimony, it does not affect competency to testify"). In this case, the Veteran is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses. Layno, 6 Vet. App. at 470. He is not, however, competent to identify a specific level of his pes planus disability according to the appropriate diagnostic codes. On the other hand, such competent evidence has been provided by the medical personnel who have examined him during the current appeal and who have rendered pertinent opinions in conjunction with the evaluations. The medical findings (as provided in the examination reports) directly address the criteria under which these disabilities are evaluated. Next, the Board will consider whether referral for an extraschedular evaluation is warranted. The question of an extraschedular rating is a component of a claim for an increased rating. Bagwell v. Brown, 9 Vet. App. 337, 339 (1996). Although the Board may not assign an extraschedular rating in the first instance, it must specifically adjudicate whether to refer a case for extraschedular evaluation when the issue either is raised by the claimant or is reasonably raised by the evidence of record. Barringer v. Peake, 22 Vet. App. 242 (2008). Under the provisions of 38 C.F.R. § 3.321(b)(1) (2009), the Under Secretary for Benefits or the Director, Compensation and Pension Service, is authorized to approve an extraschedular evaluation if the case "presents such an exceptional or unusual disability picture with such related factors as marked interference with employment or frequent periods of hospitalization as to render impractical the application of the regular schedular standards." Id. Therefore, there must be a comparison between the level of severity and symptomatology of the claimant's service- connected disability with the established criteria found in the rating schedule for that disability. Thun v. Peake, 22 Vet. App. 111 (2008). In this case, the Veteran left his employment to pursue studies as student. Moreover, for the period he was employed, the rating criteria reasonably describe his disability level and symptomatology, and provide for higher ratings for additional or more severe symptoms than currently shown by the evidence. Thus, his disability picture is contemplated by the rating schedule, and the assigned schedular evaluation is, therefore, adequate. Consequently, referral to the Under Secretary for Benefits or the Director, Compensation and Pension Service, under 38 C.F.R. § 3.321 is not warranted. In sum, after a careful review of the evidence of record, the Board finds that the benefit of the doubt rule is not applicable and the appeals are denied. Service Connection Claims Under the relevant laws and regulations, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C.A. § 1131 (West 2002). If a chronic disease is shown in service, subsequent manifestations of the same chronic disease at any later date, however remote, may be service connected, unless clearly attributable to intercurrent causes. 38 C.F.R. § 3.303(b) (2009). However, continuity of symptoms is required where a condition in service is noted but is not, in fact, chronic or where a diagnosis of chronicity may be legitimately questioned. 38 C.F.R. § 3.303(b) (2009). Further, service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 U.S.C.A. § 1113(b) (West 2002); 38 C.F.R. § 3.303(d) (2009). The Board must determine whether the evidence supports the claim or is in relative equipoise, with the appellant prevailing in either case, or whether the preponderance of the evidence is against the claim, in which case, service connection must be denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). In addition to the regulations cited above, service connection is warranted for a disability which is aggravated by, proximately due to, or the result of a service-connected disease or injury. 38 C.F.R. § 3.310 (2009). Any additional impairment of earning capacity resulting from an already service-connected condition, regardless of whether or not the additional impairment is itself a separate disease or injury caused by the service-connected condition, should also be compensated. Allen v. Brown, 7 Vet. App. 439 (1995). When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. Id. Service connection may only be granted for a current disability. When a claimed condition is not shown, there may be no grant of service connection. See 38 U.S.C.A. § 1110 (West 2002); Rabideau v. Derwinski, 2 Vet. App. 141 (1992) (Congress specifically limits entitlement for service- connected disease or injury to cases where such incidents have resulted in a disability). "In the absence of proof of a present disability there can be no valid claim." See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Entitlement to Service Connection for a Right Knee and Left Hip Disorder on a Secondary Basis The Veteran has asserted that his right knee disorder and left hip disorders were caused by an abnormal gait resulting from his service-connected pes planus. Regarding his right knee disorder claim, he complained in October 2004 of knee pain, where he mentioned that he had a history of trauma to the right knee and now has had pain for the past two weeks. At an evaluation in December 2004, the Veteran again complained of pain in the right knee since the previous week, although he also stated that he had pain for the past 10 years. X-rays taken at that time indicated a small suprapatellar effusion, but no acute osseous abnormalities. The Veteran was treated for pain in both knees throughout 2005. Most notably in May 2005, where he complained of bilateral knee pain for the past 4-5 months. He did not recall any recent injury, but stated that he sprained his right knee approximately 3-4 years previously when his ankle gave out and twisted his leg. An MRI in the right knee in September 2005 indicated a complex tear of the body and posterior horn of the medial meniscus. Regarding the Veteran's claimed left hip disorder, the evidence indicates that he was involved in a motor vehicle accident in August 1998, after which he complained of significant tenderness upon internal or external rotation of the left hip. However, the diagnosis was limited to a left hip contusion and no chronic disorder was observed. It was not until May 2008 that he next complained of left hip pain again, which he now attributed to his abnormal gait. Regarding both claims, the Veteran underwent a VA examination in October 2008 undertaken to specifically address his right knee and left hip complaints. There, the VA examiner opined that there was "no evidence" to suggest that the Veteran's foot disability was a causal factor in the development of his hip or knee disorders. In providing this opinion, the examiner reflected that the evidence suggested prior right knee trauma, and neither issue appeared chronic in nature, based on the evidence in the claims file. As noted above, in finding this examination adequate for evaluation purposes, and assigning high probative value to it, the Board notes that the examiner reviewed the claims file, obtained a reported history from the Veteran, and conducted a complete examination. There is no indication that the VA examiner was not fully aware of the Veteran's past medical history or that he misstated any relevant fact. Therefore, in the absence of other clinical evidence relating his right knee and left hip disorders to his service- connected disability, the Board finds this opinion to be of great probative value. In sum, after a careful review of the evidence of record, the Board finds that the benefit of the doubt rule is not applicable, and service connection on a secondary basis is not warranted. Entitlement to Service Connection for a Right Knee and Left Hip Disorder on a Direct Basis Next, although the Veteran has primarily asserted that his right knee and left hip disorders are attributable to his service-connected pes planus, the Board has also considered the claim on a direct basis. See Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). However, this aspect of the appeal must also be denied. First, the service treatment records reflect no complaints of, treatment for, or a diagnosis related to the right knee and left hip or any symptoms reasonably attributed thereto. At the time of discharge, the clinical evaluation of the Veteran's lower extremities was normal. Therefore, no chronic right knee of left hip disorder was noted in service. It was not until August 1998 when the Veteran first complained of a left hip disorder, approximately 22 years after his release from active duty. Moreover, in that case, his hip disorder appeared the result of a motor vehicle accident rather than active duty. Additionally, his first complaints of a right knee disorder were not until October 2004, approximately 28 years after he was released from active duty. Therefore, the competent evidence does not indicate a continuity of symptoms. In addition to the absence of documented post-service symptomatology related to the low back for many years, the evidence includes the Veteran's statements and sworn testimony asserting continuity of symptoms. As noted above, the Board acknowledges that lay evidence concerning continuity of symptoms after service, if credible, is ultimately competent, regardless of the lack of contemporaneous medical evidence. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. See Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). The Veteran is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses. Layno, 6 Vet. App. at 470. In determining whether statements submitted by a veteran are credible, the Board may consider internal consistency, facial plausibility, and consistency with other evidence submitted on behalf of the claimant. Caluza v. Brown, 7 Vet. App. 498 (1995). The Board is not required to accept an appellant's uncorroborated account of his active service experiences. Wood v. Derwinski, 1 Vet. App. 190 (1991). In this case, the Board finds that the Veteran's reported history of continued symptomatology since active service, while competent, is nonetheless not credible. In this case, the Board emphasizes the multi-year gap between discharge from active duty service (1976) and initial reported symptoms related to a left hip disorder (August 1998) and his right knee disorder (October 2004). See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (lengthy period of absence of medical complaints for condition can be considered as a factor in resolving claim); see also Mense v. Derwinski, 1 Vet. App. 354, 356 (1991). Additionally, the Veteran's recollection of the onset of symptoms to different times. Specifically, at a medical evaluation in April 2005, he stated that he injured his right knee 10 years before (nine years after he left active duty). Moreover, in May 2005, he complained of knee pain for only the last 4-5 months. Madden v. Gober, 125 F.3d 1477, 1481 (Board entitled to discount the credibility of evidence in light of its own inherent characteristics and its relationship to other items of evidence). Therefore, continuity has not here been established. Next, service connection may be granted when the evidence establishes a medical nexus between active duty service and current complaints. In this case, the Board finds that the weight of the competent evidence does not attribute the Veteran's right knee disorder or left hip disorder to active duty. Specifically, the evidence does not indicate a relationship between his right knee pathology or any left hip pathology and active duty service. Although the Veteran complained of experienced right knee pain while in service, these episodes were not accompanied by any pathology. Moreover, the service treatment records do not indicate any trauma or injury while in service. In sum, in the absence of actual pathology to the right knee or left hip during service or for many years thereafter, and no nexus between current complaints and active duty, the evidence does not support service connection for either issue on a direct basis. Entitlement to Service Connection for a Right Leg Disorder The Veteran has also claimed entitlement to service connection for a disorder to his right let. The service treatment records indicate that in March 1976, he complained of a "dull ache" in his right leg and hip. Although there was no tenderness in the upper or lower leg, he was diagnosed with a mild muscle strain in the right leg. He was prescribed with heat treatment and the disorder did not recur. Additionally, no such disorder was mentioned at his separation physical examinations in August 1976. Since that time, the record does not reflect treatment or symptoms related to a right leg disorder. Based on this evidence, there is no competent evidence of a chronic right leg disorder currently. At best, there are complaints of symptomatology without underlying pathology. Symptoms alone cannot be compensable without an in-service disease or injury to which the pain can be connected by competent evidence. See Sanchez-Benitez v. West, 25 F.3d 1356 (Fed. Cir. 2001). With respect to all three claims, the Board has also considered the Veteran's statements asserting a nexus between his right knee, left hip and right leg disorders and his service-connected disability or active duty service. In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. See Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). As was noted above, competency of evidence differs from weight and credibility. Specifically, the Veteran is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses. Layno, 6 Vet. App. at 470. However, knee, hip or leg disorders are not the types of conditions that a lay person can provide competent evidence on questions of etiology or diagnosis. On the other hand, such competent evidence has been provided by the medical personnel who have examined and/or treated the Veteran during the current appeal and by service records obtained and associated with the claims file. The Board attaches greater probative weight to the clinical findings than to his statements. See Cartright, 2 Vet. App. at 25. In light of the above discussion, the Board concludes that the competent evidence is against the claims for service connection for disorders to the right knee, left hip and right leg. Consequently, the appeals are denied. ORDER A rating in excess of 10 percent for bilateral pes planus with right plantar fasciitis prior to October 8, 2008 is denied. A rating in excess of 30 percent for bilateral pes planus with right plantar fasciitis since October 8, 2008 is denied. Service connection for a right knee disorder, to include as secondary to bilateral pes planus, is denied. Service connection for a left hip disorder, to include as secondary to bilateral pes planus, is denied. Service connection for a right leg disorder, characterized a muscle strain, to include as secondary to bilateral pes planus, is denied. ______________________________________________ KELLI A. KORDICH Acting Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs