Citation Nr: 1318484 Decision Date: 06/06/13 Archive Date: 06/11/13 DOCKET NO. 09-18 914A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Columbia, South Carolina THE ISSUES 1. Entitlement to service connection for a left knee disorder. 2. Entitlement to service connection for a low back disorder, to include a herniated disk. 3. Entitlement to service connection for bilateral foot disorder. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESSES AT HEARING ON APPEAL The Veteran and his spouse ATTORNEY FOR THE BOARD J. Murray, Associate Counsel INTRODUCTION The Veteran had active service from June 1956 to December 1959. This appeal comes before the Board of Veterans' Appeals (Board) from a December 2008 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO) located in Cleveland, Ohio. In that rating decision, the RO denied benefits sought on appeal. The Veteran perfected an appeal to those denials. Since then, the jurisdiction has been transferred the RO located in Columbia, South Carolina. In January 2011, the Veteran appeared at a Board videoconference hearing held before the undersigned. The Veteran was provided an opportunity to set forth his contentions at the hearing. The record reflects that at this hearing the undersigned set forth the issues to be discussed at the hearing, focused on the elements necessary to substantiate the claims, and sought to identify any further development that was required to help substantiate the claims. These actions satisfied the duties a Veterans Law Judge has to explain fully the issue and to suggest the submission of evidence that may have been overlooked. See Bryant v. Shinseki, 23 Vet. App. 488, 492 (2010) (holding that the requirements of 38 C.F.R. § 3.103(c)(2) apply to a hearing before the Board). A copy of the hearing transcript has been associated with the claims folder. In August 2011, the Board remanded the matters on appeal to the RO (via the Appeals Management Center (AMC)) for additional development. The Board instructed that the records associated with the Veteran's Social Security Administration (SSA) disability benefits should be obtained and associated with the claims folder, as well as outstanding identified records of pertinent private treatment. In addition, the Veteran was to be afforded a VA examination to determine the nature and etiology of his claimed disorders. A review of the record reflects that attempts to obtain the Veteran's SSA records and identified private treatment records were unsuccessful. The Veteran was afforded a VA examination in September 2011. The Board finds that there has been substantial compliance with its remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998); see also Dyment v. West, 13 Vet. App. 141, 146-47 (1999) (noting that Stegall requires substantial compliance with remand orders, rather than absolute compliance.) A review of the Virtual VA paperless claims processing system does not reveal any additional documents pertinent to the present appeal. The Veteran also initiated an appeal from a June 2008 RO rating decision which denied service connection for bilateral hearing loss, tinnitus, and a right knee condition. His substantive appeal, however, received in January 2010, was found by the RO to be untimely, and he did not appeal the March 2010 notification of an untimely substantive appeal. Accordingly, any such issues are not before the Board. Please note that the Veteran's appeal has been advanced on the docket pursuant to 38 C.F.R. § 20.900(c) (2012). 38 U.S.C.A. § 7107(a)(2) (West 2002). FINDINGS OF FACT 1. The Veteran's degenerative arthritis of low back disorder first manifested many years after service, and the preponderance of the competent evidence is against a finding that his current low back disorders, to include degenerative arthritis and a herniated disc, are related to any aspect of his service. 2. The Veteran's arthritis of the left knee first manifested many years after service, and the preponderance of the competent evidence is against a finding that his current left knee disorder, to include osteoarthritis and internal derangement, is related to any aspect of his service. 3. The Veteran's current bilateral foot disorder first manifested after service, and the preponderance of the competent evidence is against a finding that his current bilateral foot disorder, to include hammertoes, claw foot and hallux valgus, is related to any aspect of his service. CONCLUSIONS OF LAW 1. The criteria for service connection for low back disorder have not been met. 38 U.S.C.A. §§ 1101, 1110, 1112 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2012). 2. The criteria for service connection for a left knee disorder have not been met. 38 U.S.C.A. §§ 1101, 1110, 1112 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2012). 3. The criteria for service connection for bilateral foot disorder have not been met. 38 U.S.C.A. §§ 1101, 1110, 1112 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS 1. VA's Duty to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA) and implementing regulations requires VA to provide claimants with notice and assistance in substantiating a claim. See 38 U.S.C.A. §§ 5102, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a). Proper VCAA notice must inform the claimant of any information and evidence not in the 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, 186 (2002). These notice requirements 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. Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). Proper VCAA notice must be provided to a claimant prior to the initial unfavorable decision on the claim. Pelegrini v. Principi, 18 Vet. App. 112, 119-20 (2004). In this case, the Veteran was advised in November 2008, prior to the initial unfavorable rating decision, of the evidence and information necessary to substantiate his claims, and the responsibilities of the Veteran and VA in obtaining such evidence. He was further advised of the evidence and information necessary to establish a disability rating and an effective date, in accordance with Dingess/Hartman. Accordingly, with respect to VCAA notice, there is no prejudice to the Veteran in the Board's proceeding with the issuance of a decision on the merits as to both his hearing loss and tinnitus service-connection claims. With regard to the duty to assist, the Veteran's VA treatment records dated from 2003 to the present day, and his lay statements of argument have been obtained. Some of the private treatment records identified by the Veteran have been associated with the claims folder; however most of those identified records are unavailable. See November 2011 negative response from Dr. Seeder, as well as November 2011 report of contact with the Veteran regarding unavailable treatment records from Dr. Young Sun Lee. It is clear that the Veteran's service treatment records are missing. The Board is cognizant that in the case where a veteran's service medical records are unavailable through no fault of his own, a heightened duty exists to assist the veteran in the development of the case. See O'Hare v. Derwinski, 1 Vet App. 365 (1991); Layno v. Brown, 6 Vet. App. 465, 469 (1994). In this case, VA has attempted to obtain any available records, however these attempts were not successful and the Board finds that no useful purpose would be served in remanding this matter for more development. Here, the RO has attempted to locate the Veteran's service records. The RO submitted an information request in May 2007, asking for the Veteran's medical and dental records. In August 2007, the National Personnel Records Center (NPRC) responded that the Veteran's records were fire-related, and that no service treatment records or records from the Surgeon General's Office could be recovered. There is no indication that other service treatment records, if in existence at one time, still exist. The RO also notified the Veteran that his service treatment records were unavailable, and requested that he send any records he may have, or any information as to their whereabouts to VA. See the November 2007 letter to the Veteran. The Veteran responded that he did not have any records and cannot send them to VA. The Board finds that the VA has satisfied its heightened duty to assist the Veteran. In such situations, the Board also has a heightened obligation to explain its findings and conclusions, and to consider fully the benefit-of-the-doubt rule. See Cuevas v. Principi, 3 Vet. App. 542, 584 (1992); O'Hare v. Derwinski, 1 Vet. App. 365, 367 (1991). The Board is mindful of this obligation in its determination below. Also, the Board notes that records from the Social Security Administration (SSA) are unavailable. The RO was notified of their unavailability in September 2011. In October 2011, the RO notified the Veteran that medical records from SSA were unavailable. He was asked to provide any records in his possession, which he did not. The RO made a formal finding on the unavailability of medical records from the SSA in January 2012. Any further attempts to obtain these records would be futile. 38 C.F.R. § 3.159(c)(2). Given VA's heightened duty to assist the Veteran, the Board in its August 2011 remand directives instructed the RO/AMC to provide the Veteran with a VA examination in conjunction with his claims. The Veteran was afforded a VA examination in September 2011. The VA examiner reviewed the claims folders and recorded the Veteran's reported history and the clinical findings in the examination report, and he provided a comprehensive statement in support of his conclusions. The Board finds that the medical opinion is adequate for adjudication purposes, and the adequacy of this medical opinion is discussed in further details below. See Barr v. Nicholson, 21 Vet. App. 303 (2007). The RO/AMC has substantially complied with the Board's August 2011 remand instructions. Stegall v. West, 11 Vet. App. 268, 271 (1998). The Veteran has not identified, and the record does not otherwise indicate, any additional existing evidence that is necessary for a fair adjudication of the claim that has not been obtained. See Bernard v. Brown, 4 Vet. App. 384 (1993). For the foregoing reasons, the Board therefore finds that VA has satisfied its duty to notify and its duty to assist pursuant to the VCAA. See 38 U.S.C.A. §§ 5102 and 5103; 38 C.F.R. §§ 3.159(b), 20.1102; Pelegrini, supra; Quartuccio v. Principi, 16 Vet. App. 183 (2002). 2. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. §§ 1110; 38 C.F.R. § 3.303(a). Where a veteran served continuously for 90 days or more during a period of war or during peacetime service after December 31, 1946, service connection may also be allowed on a presumptive basis for arthritis and organic neurological disorders, and if the disability becomes manifest to a compensable degree within one year after the veteran's separation from service. 38 U.S.C.A. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. For the showing of chronic disease in service, including arthritis and organic neurological disorders, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. If a condition noted during service is not shown to be chronic, then generally, a showing of continuity of symptoms after service is required for service connection. See 38 C.F.R. § 3.303(b). The chronicity provision of 38 U.S.C.A. § 3.303(b) is applicable where the evidence, regardless of its date, shows that the Veteran had a chronic condition in service or during an applicable presumption period and still has such condition. 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 C.F.R. § 3.303(d). To prevail on the issue of service connection, generally, there must be competent evidence showing: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Disability which is proximately due to or the result of a service-connected disease or injury shall be service connected. 38 C.F.R. § 3.310. Secondary service connection is permitted based on aggravation; compensation is payable for the degree of aggravation of a non-service-connected disability caused by a service-connected disability. Allen v. Brown, 7 Vet. App. 439 (1995). 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 caused or aggravated by a service-connected disability. The determination as to whether the requirements for service connection are met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. 38 U.S.C.A. § 7104(a); Baldwin v. West, 13 Vet. App. 1 (1999); 38 C.F.R. § 3.303(a). If there is at least an approximate balance of positive and negative evidence regarding any issue material to the claim, the claimant shall be given the benefit of the doubt in resolving each such issue. 38 U.S.C.A. § 5107 (West 2002); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); 38 C.F.R. §§ 3.102 (2008). On the other hand, if the Board determines that the preponderance of the evidence is against the claim, it has necessarily found that the evidence is not in approximate balance, and the benefit of the doubt rule is not applicable. Ortiz, 274 F.3d at 1365. In this case, the Veteran seeks entitlement to service connection for a low back disorder, a left knee disorder and bilateral foot disorder. The Veteran contends that he suffers from chronic left knee, low back, and bilateral foot disabilities due to injuries he sustained in service. At his Board hearing, the Veteran testified that he injured his left knee and low back in an accident in which he fell a distance of about ten feet, apparently from a ladder, landing on a concrete surface. He asserts that he injured his feet when he was marching in formation, and slipped on something, turning his ankle. As noted above in the Duty to Assist section, the Veteran's service records are presumed destroyed from a 1973 fire-related incident and are unavailable. The record does contain the Veteran's statement and testimony regarding his in-service injuries and subsequent treatment. He reports that when he was stationed at Vance Air Force Base, in Enid, Oklahoma in 1957, he fell ten to twelve feet from a ladder and landed on his right knee and right side of his body. He believes that he blacked out from the pain of the injuries that he sustained and when he awoke, he was being treated at the military medical facility. X-rays of his spine did not reveal any abnormalities and he was informed that he had bruise on his left side. The Veteran reports that his right knee and back were immobilized with braces and he was placed on bed rest for a month or so, followed by light duty for six months. The Veteran reports that he continued to wear the right knee and back braces for the following months until he returned to full duty. The Veteran denied any back problems at the time of his separation from service, but he feels that his back problems became progressively worse over the years. He denied seeking treatment for his back or left knee until 1990 or 1991, when his problems became increasingly worse. See the January 2011 Board hearing transcript, pages 4, 6, 8, and 13; and the Veteran's reported medical history contained in the report of a September 2011 VA examination. With respect to his feet, the Veteran reports that he injured his right foot while walking during a parade and he step in a hole. He was informed that he had a bad ankle sprain and his entire right foot became swollen. The Veteran also believes that he was issued shoes that were too small during his period of service. As result of the prolonged standing and marching in shoes that were too small for his feet, the Veteran argues that he developed his current bilateral foot disorders. The Veteran reports that he first sought treatment for his feet four years after his separation from service. See the January 2011 Board hearing transcript, pages 11, 18 and 20; and the Veteran's reported medical history contained in the report of a September 2011 VA examination. There is no post-service treatment for more than two decades after the Veteran's separation from service. A December 1983 private operation summary report shows that Dr. Young Sun Lee performed an arthrotomy and lateral meniscetomy on the Veteran's left knee to treat a torn lateral meniscus. Dr. Lee noted that the Veteran had presented with complaints of continuous pain, swelling and limited range of motion in his left knee since a June 1983 injury when he stepped down and twisted his left knee. He was first treated with a left knee joint aspiration and arthroscopy in October 1983 after stress x-ray revealed torn lateral meniscus. His left knee problems became progressively worse and he was seen in the Emergency Room in December 1983. Clinical evaluation revealed lateral joint line pain and laxity, swelling and limited motion. He underwent surgical procedure on his left knee. There was no mention of a left knee injury prior to June 1983 or reports of any knee problems dating back to the Veteran's period of service. In June 1993, SSA granted disability benefits effective as of December 1989, when the Veteran alleged that he was no longer able to work because of severe pain in his low back that radiated into his right left, knee, and foot. In his decision, the SSA adjudicator noted his review of the medical records, including the report by a SSA advising physician. None of those records used by the SSA adjudicator are of record. However, the SSA adjudicator summarized the physician's findings regarding the Veteran's spine, knee and foot disabilities. The physician stated that the Veteran had chronic low back pain radiating down into his right leg since a 1979 industrial injury. It was noted that early degenerative changes were first identified by x-ray in August 1991 by Dr. Seeder. The Veteran was identified with chronic radicular low back pain that was status post 1979 industrial back injury. It was noted that the 1979 industrial injury greatly reduced the Veteran's ability to perform basic work-related activities. Symptomatology of the right knee was associated with the right leg radiculopathy. The physician did not note awareness or comment on injuries during the Veteran's military service. Subsequent VA treatment records starting in 2003 show treatment for low back, left knee, and foot problems on numerous occasions. A February 2004 VA treatment shows that the Veteran presented with complaints of bilateral knee pain, worse on left than right, and lumbar pain with left thigh pain. It was noted that the Veteran had a remote history of left knee surgery. He had previous x-rays that revealed mild tricompartmental degenerative changes in both knees. He was diagnosed with degenerative joint disease in both knees and lumbar pain likely due to degenerative disc stenosis. VA podiatry treatment records show that the Veteran was treated for hammer toes, calluses, onycomyosis, and foot weakness and numbness associated with degenerative disc problems. Subsequent records continue to show treatment for similar complaints. Pursuant to the Board's August 2011 remand directives, the Veteran was afforded a VA examination in September 2011 to determine whether there was any likely connection between his current low back, left knee and bilateral foot problems and his periods of service. Specifically, the examiner was instructed to review the entire claims file and to consider the Veteran's reports of in-service injuries and continuity of symptomatology since then as well as the findings from the clinical examination. The report of the September 2011 VA examination shows that the VA examiner reviewed the claims folder, including the 1983 private operation report and the 1993 SSA decision, and recorded the Veteran's reported medical history involving his in-service low back and right knee injury as well as right foot injury. Based on the findings from the clinical examination, including an x-ray report, the VA examiner provided the following diagnoses: left knee degenerative joint disease and internal derangement, status point medial collateral injury and meniscus tear; lumbar spine degenerative joint disease and lumbar stenosis with neurogenic claudication; and bilateral hammertoes, hallux valgus and claw foot. With regard to the Veteran's low back, the September 2011 VA examiner opined that the currently diagnosed low back disorders were less likely than not incurred in or caused by the Veteran's claimed in service injury. In support of the medical conclusion, the examiner noted that the Veteran had previously reported an industrial back injury in 1979 and there was no evidence of any back complaints prior to 1979. While the examiner noted that the a review of the claims folder does allow substantiation of a military service related injury, there was no evidence to support a chronic low back disorder between military service and prior to the 1979 industrial back injury. Moreover, the record contains the findings of the SSA physician that etiologically relates the Veteran's current back disorder to the 1979 industrial back injury. The examiner concluded the evidence failed to demonstrate that the Veteran's current lumbar spine condition was caused by or related to his military service. With regard to the Veteran's left knee disorder, the September 2011 VA examiner opined that the current diagnosed left knee disorder was less likely than not incurred in or caused by the Veteran's claimed in service injury. In support of his medical opinion, the examiner noted that a left knee injury is well documented in 1983, which comes many years after the Veteran's separation from service, and there is no documentation of any left knee problems prior to 1983. The examiner noted that the clinical evaluation and x-rays findings as well as the surgical notes strongly suggest a knee injury of substance in 1983, and there is no evidence of a left knee injury prior to 1983 or the sequelea of a left knee injury prior to 1983. The examiner concluded that the Veteran's current left knee condition would appear to be secondary to the 1983 injury and not related to his period of service. Regarding the Veteran's bilateral foot disorders, the September 2011 VA examiner opined that the current diagnosed bilateral foot disorders are likely related to his lumbar spine condition and spinal stenosis with neurogenic claudication. The examiner concluded that based on a review of the claims folder, there was no evidence to support a diagnosed foot disorder that was caused by or related to the Veteran's period of service. In this case, the Veteran seeks entitlement to service connection for his current diagnosed disorders involving his low back, left knee and feet. However, the Board finds that not one of the currently diagnosed disorders was incurred in service or within the first year thereafter. In addition, the Board finds that the preponderance of the evidence is against the finding that the Veteran's current diagnosed disorders are otherwise related to his period of service. While the Veteran's service treatment records are unavailable, the Veteran has provided lay statement and testimony indicating that he injured his spine and feet during his period of service. However, the Veteran has not asserted, and the medical evidence of record does not show, that he sought any treatment immediately following his separation from service for spine, left knee, and feet, or within the first year after separation. Indeed, the record shows that the Veteran did not seek treatment for his low back until 1979 or his left knee until 1983, and there is no medical treatment for foot complaints until 2003. The first x-ray evidence of degenerative arthritis involving the Veteran's low back is not shown until August 1991 or involving his left knee until 2004. Presumptive service connection is clearly not in order. See 38 C.F.R. § §3.303, 3.307, 3.309. The remaining question on appeal is whether the Veteran's current diagnosed disorders are related to his reported in-service injuries. Based on a review of the competent evidence, the Board finds that the preponderance of the evidence is against a finding that his current disorders are related to his period of service. With regard to the decades-long evidentiary gap in this case between active service and the earliest manifestations of claimed disorders, the Board finds this gap in time significant, and, as noted above, it weighs against the existence of a link between current back disorder and his time in service. See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (holding that the Board may consider a prolonged period without medical complaint when deciding a claim). In addition, the record lacks any medical evidence that links the Veteran's current low back, left knee, and bilateral foot disorders to his military service. Indeed, the September 2011 VA examiner provided medical opinions that heavily weigh against the Veteran's claims. The VA examiner opined that it was less likely than not that the Veteran's current diagnosed disorders involving lumbar spine, left knee and feet are caused by or related to his period of service, to include his reported in-service injuries. Instead, the VA examiner found that the Veteran's current lumbar spine and left knee disorder were related to post-service intervening injuries that are well documented by the record and the Veteran's current bilateral foot disorders are secondary to his lumbar spine stenosis with neurogenic claudication. In addition, although the Veteran did not report his history of inservice back and knee injury to the SSA examiners, the Board places some probative weight on the opinions of the SSA physician in 1993 and the medical advisor at the SSA hearing who concluded that the lumbar spine disorder manifested were related to the 1979 industrial back injury. The Board finds it highly pertinent that there is no contradictory medical opinion of record. The Veteran has been accorded ample opportunity to furnish medical and other evidence in support of his service-connection claims, and against the reasoned conclusions of the VA examiner; he has not done so. See 38 U.S.C.A. § 5107(a) (it is a claimant's responsibility to support a claim for VA benefits). The Board considered whether the Veteran's lay evidence constitutes competent and credible evidence of etiology in this particular case. Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition; (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing the symptoms at the time support at later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir 2006). In this case, the Board concludes that the etiologies of degenerative disease of the spine and left knee, as well as secondary bilateral foot disorders, are a complex matter requiring medical expertise. Although the Veteran is competent to report his symptoms of pain and immobility, diagnosis of these diseases and determination of their causes requires medical examination, imaging, and detailed assessment of medical history. The Board concludes that the Veteran does not possess the necessary medical training and is not competent to provide an etiology of the disorders. As noted above in the legal criteria above, under 38 C.F.R. § 3.303(b), an alternative method of establishing the second and third service-connection element for certain chronic diseases, including arthritis, is through a demonstration of continuity of symptomatology. See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Indeed, the Veteran has asserted at times during the appeal period that he has experienced low back and knee pain since his service period to the present day. The Board accepts the Veteran's accounts that he injured his spine and knee when he fell from a ladder during his period of service. The Board also acknowledges the competence of the Veteran's statements that he has had symptoms involving his spine and knee since his period of service. These are competent recitations of facts as he recalls them. Competency of evidence, however, 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"). The United States Court of Appeals for Veterans Claims has made clear that the Board cannot determine that competent lay evidence lacks credibility merely because it is unaccompanied by contemporaneous medical evidence. See Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). In this case, the Board places less probative weight on the report of injuries and continuity of symptoms after service because it is inconsistent with service and post service treatment records. The Board places less probative weight on the Veteran's contended spine and knee injuries because he made no mention of a history of injuries to any VA or private clinicians throughout his treatment after the 1979 and 1983 incidents prior to a 2008 claim. Accordingly, the Board finds that the preponderance of the evidence is against a finding that the Veteran's current low back, left knee, and bilateral foot disorders had their onset in service or are otherwise related to his period of service. The evidence in this case is not so evenly balanced to allow application of the benefit-of-the-doubt rule as required by law and VA regulations. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102. The preponderance is against the Veteran's claims, and they must be denied. ORDER Entitlement to service connection for a low back disorder is denied. Entitlement to service connection for a left knee disorder is denied. Entitlement to service connection for bilateral foot disorder is denied. ____________________________________________ A. C. MACKENZIE Acting Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs