Citation Nr: 1032292 Decision Date: 08/27/10 Archive Date: 09/01/10 DOCKET NO. 07-25 775 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Providence, Rhode Island THE ISSUES 1. Whether new and material evidence has been received to reopen a claim for service connection for bilateral foot disorders. 2. Whether new and material evidence has been received to reopen a claim for service connection for bilateral knee disorders. 3. Entitlement to service connection for left heel bone spurs with scar tissue. 4. Entitlement to service connection for hypertension, claimed as secondary to service-connected posttraumatic stress disorder (PTSD). 5. Entitlement to service connection for bilateral ankle disorders. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARINGS ON APPEAL Appellant ATTORNEY FOR THE BOARD L. A. Rein, Counsel INTRODUCTION The Veteran had active military service from January 1985 to January 1992. These matters come to the Board of Veterans' Appeals (Board) on appeal from rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in Providence, Rhode Island. In September 2009, the Veteran testified during a hearing before RO personnel: a transcript of that hearing is associated with the claims file. In June 2010, the Veteran testified during a videoconference hearing before the undersigned Veterans Law Judge; a transcript of that hearing is of record. FINDINGS OF FACT 1. All notification and development action needed to fairly adjudicate each claim on appeal has been accomplished. 2. A claim for service connection for bilateral pes planus was denied by a September 2003 rating decision. It was held that there was no evidence that the Veteran had a foot injury or chronic foot disability in service and that there was no evidence that the Veteran's bilateral pes planus was related to service. While the Veteran submitted a timely NOD in October 2003, and the RO issued the Veteran an SOC in July 2004, a substantive appeal was not received from the Veteran after the issuance of the July 2004 SOC. 3. Additional evidence associated with the claims file since the RO's September 2003 denial is cumulative or redundant of evidence previously of record, or does not relate to an unestablished fact necessary to substantiate the claim for service connection for bilateral foot disorders, or raise a reasonable possibility of substantiating the claim. 4. A claim for service connection for bilateral knee disorders was denied by a June 2002 rating decision. It was held that there was no current diagnosis of a left knee disability and while diagnosed with mild degenerative changes of the right knee, there was no evidence of this disability within one year after discharge from service and no nexus to service. Although notified of the denial in June 2002, the Veteran did not initiate an appeal. 5. Additional evidence associated with the claims file since the RO's June 2002 denial is cumulative or redundant of evidence previously of record, or does not relate to an unestablished fact necessary to substantiate the claim for service connection for bilateral knee disorders, or raise a reasonable possibility of substantiating the claim. 6. Although the Veteran was seen for soft tissue injury to the left foot on one occasion during active service, the Veteran denies injuring his left heel, no chronic left heel disability was shown in service or until approximately fourteen years after discharge from service, and no competent evidence of a nexus between the Veteran's current left heel bone spurs and active service. Medical evidence indicates that the Veteran's left heel pain is likely secondary to worn out orthoses rubbing against heel and bursitis from prominent posterior calcaneal tubercle. 7. The objective medical evidence indicates that a diagnosis of hypertension is questionable. 8. The only medical opinion to address the etiology of the Veteran's claimed hypertension preponderates against a finding of any relationship with the Veteran's service connected PTSD. 9. There is no objective evidence of record that the Veteran is currently diagnosed with a left ankle disorder. 10. The first post service evidence that the Veteran had a right ankle disorder is when the Veteran fractured his right ankle as a result of playing softball in May 2009, more than 16 years after discharge from service. CONCLUSIONS OF LAW 1. The RO's June 2002 decision denying the claim for service connection for arthritis, bilateral knees, is final. 38 U.S.C.A. § 7105 (West 2002); 38 C.F.R. §§ 20.302, 20.1103 (2009). 2. The RO's September 2003 decision denying the claim for service connection for bilateral pes planus is final. 38 U.S.C.A. § 7105 (West 2002); 38 C.F.R. §§ 20.302, 20.1103 (2009). 3. As new and material evidence has not been received, the criteria for reopening the claims for service connection for bilateral knee disorders and for bilateral foot disorders are not met. 38 U.S.C.A. § 5108 (West 2002); 38 C.F.R. § 3.156 (2009). 4. The criteria for service connection for left heel bone spurs with scar tissue are not met. 38 U.S.C.A. §§ 1110, 1131, 5103, 5103A, 5107 (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2009). 5. The criteria for service connection for hypertension, claimed as secondary to service-connected PTSD, are not met. 38 U.S.C.A. §§ 1110, 1131, 5103, 5103A, 5107 (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310 (2009). 6. The criteria for service connection for bilateral ankle disorders are not met. 38 U.S.C.A. §§ 1110, 1131, 5103, 5103A, 5107 (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2009). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Duties to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA), codified at 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5106, 5107, and 5126 (West 2002 & Supp. 2009) includes enhanced duties to notify and assist claimants for VA benefits. VA regulations implementing the VCAA have been codified, as amended at 38 C.F.R. §§ 3.102, 3.156(a), 3.159, and 3.326(a) (2009). Notice requirements under the VCAA essentially require VA to notify a claimant of any evidence that is necessary to substantiate the claim, as well as the evidence that VA will attempt to obtain and which evidence he or she is responsible for providing. See, e.g., Quartuccio v. Principi, 16 Vet. App. 183 (2002) (addressing the duties imposed by 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b)). As delineated in Pelegrini v. Principi, 18 Vet. App. 112 (2004), after a substantially complete application for benefits is received, proper VCAA notice must inform the claimant of any information and evidence not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; (3) that the claimant is expected to provide; and (4) must ask the claimant to provide any evidence in her or his possession that pertains to the claim, in accordance with 38 C.F.R. § 3.159(b)(1). The Board notes that, effective May 30, 2008, 38 C.F.R. § 3.159 has been revised, in part. See 73 Fed. Reg. 23,353- 23,356 (April 30, 2008). Notably, the final rule removes the third sentence of 38 C.F.R. § 3.159(b)(1), which had stated that VA will request that a claimant provide any pertinent evidence in his or her possession. VA's notice requirements apply to all five elements of a service connection claim: Veteran status, existence of a disability, a connection between the Veteran's service and the disability, degree of disability, and effective date of the disability. Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). VCAA-compliant notice must be provided to a claimant before the initial unfavorable decision on a claim for VA benefits by the agency of original jurisdiction. Id; Pelegrini, 18 Vet. App. at 112. See also Disabled American Veterans v. Secretary of Veterans Affairs, 327 F.3d 1339 (Fed. Cir. 2003). However, the VCAA notice requirements may, nonetheless, be satisfied if any errors in the timing or content of such notice are not prejudicial to the claimant. Id. With regard to the petitions to reopen the claims for service connection on appeal, February 2007 and October 2007 letters notified the Veteran that to reopen his previously denied claims for service connection for bilateral foot disorders and bilateral knee disorders, respectively, VA had to receive new and material evidence, and these letters further defined what constituted new and material evidence specific to the reason his claims were previously denied. Thus, the guidance of Kent v. Nicholson, 20 Vet. App. 1 (2006) has been satisfied by these letters. The February 2007 and October 2007 letters also provided the Veteran with information regarding disability ratings and effective dates consistent with Dingess/Hartman (cited above). With regard to the claims for service connection for a left heel spur, hypertension and bilateral ankle disorders, October 2008, June 2009, and October 2009 pre-rating letters, respectively, provided notice to the Veteran of the evidence and information needed to substantiate his claims for service connection on appeal. These letters also informed the Veteran of what information and evidence must be submitted by the Veteran, and what information and evidence would be obtained by VA. The letters further requested that the Veteran submit any additional information or evidence in his possession that pertained to his claims. The November 2008, August 2009, and February 2010 rating decisions, respectively, reflect the initial adjudication of each of these claims for service connection. The October 2008, June 2009, and October 2009 letters each provided the Veteran with information regarding disability ratings and effective dates consistent with Dingess/Hartman (cited above). Hence, these letters-which meet all four of Pelegrini's content of notice requirement- also meet the VCAA's timing of notice requirement. Additionally, the record also reflects that VA has made reasonable efforts to obtain or to assist in obtaining all relevant records pertinent to the matter on appeal. Pertinent medical evidence of record includes the Veteran's service treatment records, VA medical records, private medical records and the reports of an October 2009 VA hypertension examination. Also of record and considered in connection with the appeal is the transcript of the September 2009 hearing before RO personnel and the June 2010 Board hearing, as well as various written statements provided by the Veteran as well as by his representative, on his behalf. Under the VCAA, VA is obliged to provide an examination when the record contains competent evidence that the claimant has a current disability or signs and symptoms of a current disability, the record indicates that the disability or signs and symptoms of disability may be associated with active service; and the record does not contain sufficient information to make a decision on the claim. 38 U.S.C.A. § 5103A(d) (West 2002); McLendon v. Nicholson, 20 Vet. App. 79 (2006). The evidence of a link between current disability and service must be competent. Wells v. Principi, 326 F.3d 1381 (Fed. Cir. 2003). The Veteran's reports of a continuity of symptomatology can satisfy the requirement for evidence that the claimed disability may be related to service. McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). The threshold for finding a link between current disability and service is low. Locklear v. Nicholson, 20 Vet. App. 410 (2006); McLendon v. Nicholson, at 83. The Board notes that the Veteran was afforded a VA examination in connection with his claim for service connection for hypertension. However, the Board finds that given the complete lack of evidence of a left heel spur or any ankle disorder during service or until many years after service, such an examination is not required. There is no competent evidence of a link between the Veteran's current disabilities and service, and while the Veteran contends that he has experienced continuity of symptomatology since service, as discussed below, the evidence of record is to the contrary. In addition, VA need not conduct an examination or obtain a medical opinion with respect to the issue of whether new and material evidence has been received to reopen a previously denied claim for service connection because the duty under 38 C.F.R. § 3.159(c)(4) applies to a claim to reopen only if new and material evidence is presented or secured. 38 U.S.C.A. § 5103A(d); 38 C.F.R. § 3.159(c)(4); see also McLendon v. Nicholson, 20 Vet. App. 79 (2006). Therefore, the Board may proceed with adjudication of these appeals without fear of prejudice to the Veteran. In summary, the duties imposed by the VCAA have been considered and satisfied. Through various notices of the RO, the appellant has been notified and made aware of the evidence needed to substantiate the claims herein decided, the avenues through which he might obtain such evidence, and the allocation of responsibilities between himself and VA in obtaining such evidence. There is no additional notice that should be provided, nor is there any indication that there is additional existing evidence to obtain or development required to create any additional evidence to be considered in connection with any claim(s). Consequently, any error in the sequence of events or content of the notice is not shown to prejudice the appellant or to have any effect on the appeal. Any such error is deemed harmless and does not preclude appellate consideration of the matters herein decided, at this juncture. See Mayfield, 20 Vet. App. at 543 (rejecting the argument that the Board lacks authority to consider harmless error). See also ATD Corp. v. Lydall, Inc., 159 F.3d 534, 549 (Fed. Cir. 1998). II. Petitions to reopen A. Bilateral foot disorders In a September 2003 rating decision, the RO denied the claim for service connection for bilateral pes planus on the basis that service treatment records (STRs) were negative for any complaints or treatment for flat feet and there was no chronic injury or disease of the feet shown at the time of his discharge. In addition, there was no evidence that the Veteran diagnosed bilateral flat feet were incurred or aggravated by his military service. Evidence considered at that time of this decision included the Veteran's STRs, private and VA medical records, and a December 1996 VA examination report. At that time, the cumulative evidence showed that the Veteran had been seen for complaints, treatment, and diagnosis for bilateral pes planus. While the Veteran submitted a timely NOD in October 2003, and the RO issued the Veteran an SOC in July 2004, a substantive appeal was not received from the Veteran; therefore, the September 2003 rating decision is final. See 38 C.F.R. § 20.201. The Veteran sought to reopen his claim in June 2007. VA may reopen and review a claim that has been previously denied if new and material evidence is submitted by or on behalf of a Veteran. 38 U.S.C.A. § 5108; 38 C.F.R. § 3.156(a). See also Hodge v. West, 155 F. 3d 1356 (Fed. Cir. 1998). Regarding petitions to reopen filed on or after August 29, 2001, 38 C.F.R. § 3.156(a) defines "new" evidence as evidence not previously submitted to agency decision makers and "material" evidence as evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last final denial of the claim(s) sought to be reopened, and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a) (2009). In determining whether new and material evidence has been received, VA must initially decide whether evidence associated with the claims file since the prior final denial is, in fact, new. As indicated by the regulation cited above, and by judicial case law, "new" evidence is that which was not of record at the time of the last final disallowance (on any basis) of the claim, and is not "merely cumulative" of other evidence that was then of record. This analysis is undertaken by comparing newly received evidence with the evidence previously of record. After evidence is determined to be new, the next question is whether it is material. The provisions of 38 U.S.C.A. § 5108 require a review of all evidence submitted by or on behalf of a claimant since the last final denial on any basis to determine whether a claim must be reopened. See Evans v. Brown, 9 Vet. App. 273, 282-3 (1996). Furthermore, for purposes of the "new and material" analysis, the credibility of the evidence is presumed. Justus v. Principi, 3 Vet. App. 510, 512-513 (1992). The Board notes that its task is to first decide whether new and material evidence has been received, as opposed to whether or not the evidence actually substantiates the appellant's claim. Evidence added to the record since the RO's September 2003 final rating decision include VA medical records, private medical records, transcripts from a September 2009 RO hearing and a June 2010 Board hearing. The medical records reflect that the Veteran has received periodic treatment for bilateral pes planus. During the June 2010 Board hearing, the Veteran indicated that he believed that his bilateral foot disorder was related to his military service because his job required him to be on his feet and work on concrete. The Board finds that the additional evidence received is "new" in the sense that it was not previously before agency decision makers. However, the Board also finds that this evidence is not "material" in that it does not provide any competent evidence or opinion that the Veteran has bilateral foot disorders related to service, the central question underlying the claim for service connection. Hence, the new medical evidence does not raise a reasonable possibility of substantiating the Veteran's claim, and therefore, does not provide a basis for reopening the claim. The only additional evidence associated with the claims file consists of statements and oral testimony from the Veteran and by his representative, on his behalf. However, even if new, such lay assertions provide no basis for reopening the claim. As indicated above, this claim turns on a medical matter. As the Veteran and his representative are laypersons without the appropriate medical training or expertise, neither is competent, on the basis of assertions, alone, to provide probative (i.e., persuasive) evidence on a medical matter- such as the onset and etiology of a specific disability. See Jones v. Brown, 7 Vet. App. 134, 137 (1994); see also Bostain v. West, 11 Vet. App. 124, 127 (1998), citing Espiritu v. Derwinski, 2 Vet. App. 492 (1992). Therefore, where, as here, the claim turns on a medical matter, unsupported lay statements, even if new, cannot serve as a predicate to reopen a previously disallowed claim. See Hickson v. West, 11 Vet. App. 374 (1998); Moray v. Brown, 5 Vet. App. 211, 214 (1993). Without any competent evidence or opinion that the Veteran's currently diagnosed bilateral foot disorder is related to service, the central question underlying the claim for service connection-it does not provide a basis for reopening. Hence, the new medical evidence received does not raise a reasonable possibility of substantiating the Veteran's claim, and therefore, is not material for purposes of reopening. Under these circumstances, the Board must conclude that new and material evidence to reopen the claim for service connection for bilateral foot disorders has not been received. As such, the RO's September 2003 decision remains final, and the appeal must be denied. As the Veteran has not fulfilled the threshold burden of submitting new and material evidence to reopen the finally- disallowed claim, the benefit-of-the- doubt doctrine is not applicable. See Annoni v. Brown, 5 Vet. App. 463, 467 (1993). B. Bilateral knee disorders In a June 2002 rating decision, the RO denied the claim for service connection for arthritis, bilateral knees on the basis that there was no current diagnosis of a left knee disability and while diagnosed with mild degenerative changes of the right knee, there was no evidence of this disability within one year after discharge from service and no nexus to service. Evidence considered at that time of this decision included the Veteran's STRs, private and VA medical records, and a December 1996 VA examination report. At that time, the cumulative evidence showed that the Veteran had first been seen for complaints of bilateral knee problems in 12/96, x-rays were normal, and it was not until a November 2001 x-ray that showed the Veteran had mild degenerative changes of the right knee. The Veteran sought to reopen his claim in January 2007. VA may reopen and review a claim that has been previously denied if new and material evidence is submitted by or on behalf of a Veteran. 38 U.S.C.A. § 5108; 38 C.F.R. § 3.156(a). See also Hodge v. West, 155 F. 3d 1356 (Fed. Cir. 1998). Regarding petitions to reopen filed on or after August 29, 2001, 38 C.F.R. § 3.156(a) defines "new" evidence as evidence not previously submitted to agency decision makers and "material" evidence as evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last final denial of the claim(s) sought to be reopened, and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a) (2009). In determining whether new and material evidence has been received, VA must initially decide whether evidence associated with the claims file since the prior final denial is, in fact, new. As indicated by the regulation cited above, and by judicial case law, "new" evidence is that which was not of record at the time of the last final disallowance (on any basis) of the claim, and is not "merely cumulative" of other evidence that was then of record. This analysis is undertaken by comparing newly received evidence with the evidence previously of record. After evidence is determined to be new, the next question is whether it is material. The provisions of 38 U.S.C.A. § 5108 require a review of all evidence submitted by or on behalf of a claimant since the last final denial on any basis to determine whether a claim must be reopened. See Evans v. Brown, 9 Vet. App. 273, 282-3 (1996). Furthermore, for purposes of the "new and material" analysis, the credibility of the evidence is presumed. Justus v. Principi, 3 Vet. App. 510, 512-513 (1992). The Board notes that its task is to first decide whether new and material evidence has been received, as opposed to whether or not the evidence actually substantiates the appellant's claim. Evidence added to the record since the June 2002 final RO decision includes VA medical records, private medical records, transcripts from a September 2009 RO hearing and a June 2010 Board hearing. While VA mental health records note that the Veteran has arthritis in both knees, there is no x-ray evidence of arthritis in the left knee, or medical evidence suggesting that the Veteran's has bilateral knee disorders related to service. During September 2009 RO hearing, the Veteran testified that he was diagnosed with arthritis in his knees in early 2000. During the June 2010 Board hearing, he asserted that he had continuity of symptoms since discharge from service. The Board finds that the additional evidence received is "new" in the sense that it was not previously before agency decision makers. However, the Board also finds that this evidence is not "material" in that it does not provide any competent evidence or opinion that the Veteran currently has bilateral knee disorders related to service, the central question underlying the claim for service connection. Hence, the new medical evidence does not raise a reasonable possibility of substantiating the Veteran's claim, and therefore, does not provide a basis for reopening the claim. The only additional evidence associated with the claims file consists of statements and oral testimony from the Veteran and by his representative, on his behalf. However, even if new, such lay assertions provide no basis for reopening the claim. As indicated above, this claim turns on a medical matter. As the Veteran and his representative are laypersons without the appropriate medical training or expertise, neither is competent, on the basis of assertions, alone, to provide probative (i.e., persuasive) evidence on a medical matter- such as the onset and etiology of a specific disability. See Jones v. Brown, 7 Vet. App. 134, 137 (1994); see also Bostain v. West, 11 Vet. App. 124, 127 (1998), citing Espiritu v. Derwinski, 2 Vet. App. 492 (1992). Therefore, where, as here, the claims turns on a medical matter, unsupported lay statements, even if new, cannot serve as a predicate to reopen a previously disallowed claim. See Hickson v. West, 11 Vet. App. 374 (1998); Moray v. Brown, 5 Vet. App. 211, 214 (1993). Without any competent evidence or opinion that the Veteran's has bilateral knee disorders related to service, the central question underlying the claim for service connection-it does not provide a basis for reopening the claim. Under these circumstances, the Board must conclude that new and material evidence to reopen the claim for service connection for bilateral knee disorders has not been received. As such, the RO's June 2002 decision remains final, and the appeal must be denied. As the Veteran has not fulfilled the threshold burden of submitting new and material evidence to reopen the finally- disallowed claim, the benefit-of-the- doubt doctrine is not applicable. See Annoni v. Brown, 5 Vet. App. 463, 467 (1993). III. Service connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated during service. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303. Such a determination requires a finding of current disability that is related to an injury or disease in service. Watson v. Brown, 4 Vet. App. 309 (1993); Rabideau v. Derwinski, 2 Vet. App. 141, 143 (1992). Service connection may be granted for a disability diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability is due to disease or injury that was incurred or aggravated in service. 38 C.F.R. § 3.303(d). A. Left heel bone spurs with scar tissue Service treatment records reflect that in May 1992 the Veteran was treated for a soft tissue injury to his left foot. X-rays taken at that time were normal. VA medical records from March 1994 to December 1995 are negative for complaints, findings, or diagnosis of a left heel disorder. A January 1997 VA general medical examination report reflects that the Veteran had no complaints regarding his left foot. Examination of the feet showed mild pes planus, bilaterally. No findings relating to the left heel were noted. A November 2002 VA x-ray report notes that the Veteran complained of heel and ball of foot pain, left foot x-rays revealed mild flatfoot deformity. No spur was noted at that time. A January 2007 VA radiology record notes that the Veteran complained of left posterior-medial heel pain. The x-ray impression was plantar calcaneal spur. No other abnormality was seen. A January 2007 VA podiatry record reflects that x-ray of the left foot showed decreased calcaneal inclination angle and prominent posterior calcaneal tuburcle. The Veteran was assessed with heel pain most likely secondary to worn out orthoses rubbing against heel and bursitis from prominent posterior calcaneal tubercle. During the June 2010 Board hearing, the Veteran testified that he did not sustain an injury to his left heel in service. In this case, while post-service medical records show that the Veteran has been diagnosed with a left foot plantar calcaneal spur, there is no medical evidence indicating that such disorder was manifest in the first post-service year. In addition, the Board points out that the passage of many years between discharge from active service and the medical documentation of a claimed disability, in this case more than 14 years, is a factor that tends to weigh against a claim for service connection. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000); Shaw v. Principi, 3 Vet. App. 365 (1992). Further, there is no medical evidence or opinion even suggesting that there exists a relationship between the Veteran's currently diagnosed left foot plantar calcaneal spur and service, and neither the Veteran nor his representative has identified, presented, or alluded to the existence of any such medical evidence or opinion. On the contrary, a January 2007 VA podiatry record indicates that the Veteran's heel pain was most likely secondary to worn out orthoses rubbing against heel and bursitis from prominent posterior calcaneal tubercle. Hence, the claim for service connection for a left heel bone spur with scar tissue is denied. The only other evidence of record supporting the Veteran's claim is his own lay statements. Even if these statements could be read as claiming continuity of symptomatology since service, such history is substantially rebutted by the complete absence of complaints of a left heel disorder until more than 14 years after service. Had he been experiencing continuous symptoms, it is reasonable to expect that he would have made a claim many years earlier. Moreover, the Veteran has provided testimony that he did not injure his left heel during service. See Buchanan v. Nicholson, 451 F.3d 1331, 1336-7 (Fed. Cir. 2006). Furthermore, this claim turns on the matter of a medical nexus, or relationship, between a current disability and service - matters within the province of trained medical professionals. See Jones v. Brown, 7 Vet. App. 134, 137-38 (1994). As the Veteran and his representative are not shown to be other than laypersons without the appropriate medical training and expertise, neither is competent to render a probative opinion on a medical matter. See, e.g., Bostain v. West, 11 Vet. App. 124, 127 (1998) (citing Espiritu v. Derwinski, 2 Vet. App. 492 (1992)). See also Routen v. Brown, 10 Vet. App. 183, 186 (1997) ("a layperson is generally not capable of opining on matters requiring medical knowledge"). Hence, the lay assertions in this regard have no probative value. B. Hypertension In addition to the above, under 38 C.F.R. § 3.310(a), service connection may be granted for disability that is proximately due to or the result of a service-connected disease or injury. Such permits a grant of service connection not only for disability caused by a service-connected disability, but for the degree of disability resulting from aggravation to a nonservice- connected disability by a service-connected disability. Id. See also Allen v. Brown, 7 Vet. App. 439, 448 (1995); 38 C.F.R. § 3.310(b). In order to prevail on the issue of entitlement to secondary service connection, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical nexus evidence establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). Congress has specifically limited entitlement to service connection for disease or injury to cases where such incidents have resulted in disability. See 38 U.S.C.A. § 1131 (West 2002 & Supp. 2009). Initially, the Board notes the evidence does not show, nor does the Veteran allege, that he has hypertension that began in service or within his first post-service year. Instead, the Veteran is seeking service connection for hypertension as secondary to his service-connected PTSD. A June 2008 VA medical record reflects that the Veteran's blood pressure was 138/90. The assessment was elevated diastolic blood pressure. A July 2008 VA medical record reflects that the Veteran underwent screening for hypertension, blood pressure readings were 160/92 and 153/95 in the right arm, and 154/92 and 160/90 in the left arm. No medical diagnosis was noted. A September 2008 VA medical record reflects that the Veteran was diagnosed with elevated blood pressure without diagnosis of hypertension. An October 2008 VA PTSD examination report reflects that the Veteran has elevated blood pressure reading without a diagnosis of hypertension. An August 2009 private medical record from S.S. Lee, M.D., reflects that the Veteran blood pressure was 142/92 and that he was assessed with hypertension. An October 2009 VA hypertension examination report reflects that the Veteran contends that his hypertension was caused by his service-connected PTSD and medication that he takes for his PTSD. The Veteran stated that he had hypertension for twenty years, since the late 1980s. The Veteran has not had any symptoms from hypertension. The Veteran is not taking any medication for hypertension. Blood pressure readings on examination were 132/80, 130/78, and 134/82. The examiner noted that the Veteran had at least five blood pressure reading on different days in July when he had surgery for a fracture and those readings were within normal limits. The examiner concluded that the Veteran's high blood pressure is hard to establish at this time. The diagnosis was that the diagnosis of hypertension is still questionable. He opined that the Veteran's service-connected disability of PTSD did not cause the disability of hypertension. The Board has carefully reviewed the evidence of record, and finds the preponderance of the evidence is against the grant of service connection for hypertension, claimed as secondary to the Veteran's service-connected PTSD. In this regard, the only medical opinion to address the etiology of the Veteran's claimed hypertension weighs against the claim. As indicated above, the October 2009 VA examiner concluded that a diagnosis of hypertension was questionable. The Board notes that numerous VA medical records note that the Veteran has had elevated blood pressure without a hypertension diagnosis. Only an August 2009 private medical record shows that the Veteran was assessed with hypertension, which appears to be based on a singled blood pressure reading of 142/92. For VA purposes, hypertension is defined as diastolic pressure of 90mm or greater and isolated hypertension is defined as systolic blood pressure of predominantly 160mm or greater with a diastolic pressure of less than 90mm. 38 C.F.R. § 4.104, Code 7101. Hypertension or isolated systolic hypertension must be confirmed by readings taken two or more times on at least three different days. Id. The single reading of 142/92 in August 2009 does not support a finding of hypertension for VA purposes. However, even if the Veteran does have hypertension, the Board points out that that the October 2009 VA examiner definitively opined that the Veteran's service-connected disability of PTSD did not cause the disability of hypertension. The Board finds that the October 2009 VA examiner's opinion constitutes probative evidence on the medical nexus question- based as it was on review of the Veteran's documented medical history and assertions as well as physical examination. See Prejean v. West, 13 Vet. App. 444, 448-49 (2000); Guerrieri v. Brown, 4 Vet. App. 467, 470-471 (1993). Significantly, neither the Veteran nor his representative has presented or identified any contrary medical opinion that would, in fact, support the claim for secondary service connection. The Board also points out that VA adjudicators are not free to ignore or disregard the medical conclusions of a VA physician, and are not permitted to substitute their own judgment on a medical matter. See Colvin v. Derwinski, 1 Vet. App. 171 (1991); Willis v. Derwinski, 1 Vet. App. 66 (1991). In addition to the medical evidence, in adjudicating this claim, the Board has considered the written and oral assertions of the Veteran and his representative, but finds that this evidence provides no basis for allowance of this claim. As indicated above, this claim turn on the medical matter of current disability (and, if so, medical relationship to the Veteran's service-connected PTSD)-matters within the province of trained medical professionals. While the Veteran is competent to report symptoms as they come to him through his senses, hypertension is not the type of disorder that a lay person can provide competent evidence on the question of etiology or diagnosis. As the Veteran and his representative are not shown to be other than laypersons without the appropriate medical training and expertise, neither is competent to render a probative opinion on a medical matter. See, e.g., Bostain v. West, 11 Vet. App. 124, 127 (1998) (citing Espiritu v. Derwinski, 2 Vet. App. 492 (1992)). See also Routen v. Brown, 10 Vet. App. 183, 186 (1997) ("a layperson is generally not capable of opining on matters requiring medical knowledge"). Hence, the lay assertions in this regard have no probative value. As the preponderance of the evidence is against the Veteran's claim, the benefit-of-the-doubt doctrine does not apply C. Bilateral ankle disorders Service treatment records are negative for complaints, findings, or diagnosis of bilateral ankle disorders. Post service medical records are negative for complaints, findings, or diagnosis of a left ankle disorder. June 2009 VA medical records reflect that the Veteran stated while playing softball he was sliding in when he fractured his distal right fibula in May 2009 and was in a cast for four to six weeks. He was seen by an outside orthopedic, but since having the cast, he had had no medical follow-up. During the June 2010 Board hearing, the Veteran asserted that his bilateral ankle disorder was related to his bilateral pes planus. However, as noted above, the claim for service connection for bilateral foot disorders is not reopened, and therefore, a secondary service connection claim is moot. As noted, the initial requirement for establishing a valid claim for service connection consists of evidence of a current disability, as mentioned above, and with regard to the Veteran's claimed left ankle disorder, this objective criterion has not been met. With regard to the right ankle, the first post service evidence of a right ankle disorder is in May 2009. The Board points out that the passage of many years between discharge from active service and the medical documentation of a claimed disability, in this case more than 16 years, is a factor that tends to weigh against a claim for service connection. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000); Shaw v. Principi, 3 Vet. App. 365 (1992). Moreover, the current right ankle disorder is shown to be the result of an injury incurred while playing softball in May 2009. There is no competent medical evidence or opinion even suggesting that there exists a relationship between the Veteran's right ankle disorder and the Veteran's active service, and neither the Veteran nor his representative has identified, presented, or alluded to the existence of any such medical evidence or opinion. The only other evidence of record supporting the Veteran's claim is his own lay statements. Even if these statements could be read as claiming continuity of symptomatology since service, such history is substantially rebutted by the complete absence of complaints of any ankle disorder until more than 15 years after service. Had he been experiencing continuous symptoms, it is reasonable to expect that he would have made a claim many years earlier. Moreover, the Veteran has stated that he injured his right ankle while playing softball in May 2009. See Buchanan v. Nicholson, 451 F.3d 1331, 1336-7 (Fed. Cir. 2006). Furthermore, this claim turns on the matter of current diagnosis and medical nexus, or relationship, between a current disability and service - matters within the province of trained medical professionals. See Jones v. Brown, 7 Vet. App. 134, 137-38 (1994). As the Veteran and his representative are not shown to be other than laypersons without the appropriate medical training and expertise, neither is competent to render a probative opinion on a medical matter. See, e.g., Bostain v. West, 11 Vet. App. 124, 127 (1998) (citing Espiritu v. Derwinski, 2 Vet. App. 492 (1992)). See also Routen v. Brown, 10 Vet. App. 183, 186 (1997) ("a layperson is generally not capable of opining on matters requiring medical knowledge"). Hence, the lay assertions in this regard have no probative value. As the preponderance of the evidence is against the Veteran's claim, the benefit-of-the-doubt doctrine does not apply. ORDER As new and material evidence has not been received, the request to reopen the claim for service connection for bilateral knee disorders is denied. As new and material evidence has not been received, the request to reopen the claim for service connection for bilateral foot disorders is denied. Service connection for left heel bone spurs with scar tissue is denied. Service connection for hypertension, claimed as secondary to service-connected PTSD, is denied. Service connection for bilateral ankle disorders is denied. ____________________________________________ MICHAEL D. LYON Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs