Citation Nr: 1320497 Decision Date: 06/25/13 Archive Date: 07/05/13 DOCKET NO. 06-14 739 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Roanoke, Virginia THE ISSUE Entitlement to service connection for a right foot disability. REPRESENTATION Appellant represented by: Daniel G. Krasnegor, Attorney ATTORNEY FOR THE BOARD Jeanne Schlegel, Counsel INTRODUCTION The Veteran served on active duty from October 1977 to October 1980. This appeal to the Board of Veterans' Appeals (Board) arose from an October 2005 rating decision in which the RO denied service connection for a right foot disability. In October 2005, the Veteran filed a notice of disagreement. A statement of the case (SOC) was issued in April 2006, and the Veteran filed a substantive appeal (via a VA Form 9, Appeal to the Board of Veterans' Appeals) later in April 2006. In January 2010, the Board denied service connection for a right foot disability. The Veteran appealed the Board's January 2010 decision to the United States Court of Appeals for Veterans Claims (Court). In September 2010, the Court granted the Joint Motion for Remand filed by representatives for both parties, vacating the Board's decision, and remanding the claim on appeal to the Board for further proceedings consistent with the Joint Motion. While the Veteran was previously represented by The American Legion, in November 2010, the Veteran granted a power-of-attorney in favor of private attorney Daniel G. Krasnegor with regard to the claim on appeal. In March 2011, March 2012, and December 2012, the Board remanded the claim for service connection to the RO for additional development. At this point, there has been substantial compliance with those remand directives, and the case has returned to the Board for appellate consideration. See also D'Aries v. Peake, 22 Vet. App. 97 (2008) (finding that only substantial compliance, rather than strict compliance, with the terms of a Board's remand). Subsequently, the RO has continued to deny the claim (as reflected, most recently, in an April 2013 supplemental SOC (SSOC)), and has returned this matter to the Board for further appellate consideration. A June 2013 review of the Virtual VA electronic records storage system does not reveal any additional documents not currently associated with the paper claims file. FINDINGS OF FACT 1. All notification and development action needed to fairly adjudicate the claim on appeal has been accomplished. 2. A foot condition diagnosed as hallux valgus of the feet, was initially identified upon VA examination of 2011; this condition was not incurred during service and is not shown to be etiologically related to service or any incident therein. 3. A foot condition diagnosed as a right foot plantar wart, was initially diagnosed as shown by private records dated in late 2005; this condition was not incurred during service and is not shown to be etiologically related to service or any incident therein. 4. Right foot calluses have not been manifested chronically and continually since being treated on a single occasion during service in 1979. 5. A right foot callus treated in 1979 was not the etiological cause of any currently claimed right foot disability. CONCLUSION OF LAW The criteria for service connection for a right foot disability are not met. 38 U.S.C.A. §§ 1131, 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.159, 3.303, 3.307, 3.309 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSION I. Due Process Considerations The Veterans Claims Assistance Act of 2000, 38 U.S.C.A. §§ 5100, 5102-5103A, 5106, 5107, 5126 (West 2002 & Supp. 2012), 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a) (2012), requires VA to assist a claimant at the time that he or she files a claim for benefits. As part of this assistance, VA is required to notify claimants of what they must do to substantiate their claims. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b)(1). Specifically, VA must inform the claimant of any information and evidence not of record (1) that is necessary to substantiate the claim; (2) that the claimant is to provide; and (3) that VA will attempt to obtain. See Beverly v. Nicholson, 19 Vet. App. 394, 403 (2005) (outlining VCAA notice requirements). 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). The RO informed the Veteran of VA's duty to assist him in the development of evidence pertinent to his service connection claim in a letters dated in January 2005, March 2006, May 2011, and April 2012, wherein he was advised of the provisions relating to the VCAA. Specifically, the Veteran was advised that VA would assist him with obtaining relevant records from any Federal agency, which may include medical records from the military, from VA hospitals (including private facilities where VA authorized treatment), or from the Social Security Administration. With respect to private treatment records, the letter informed the Veteran that VA would make reasonable efforts to obtain private or non-Federal medical records, to include records from State or local governments, private doctors and hospitals, or current or former employers. Furthermore, the VA included copies of VA Form 21-4142, Authorization and Consent to Release Information, which the Veteran could complete to release private medical records to the VA. 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 a 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). Specifically, this information must include notice that a disability rating and an effective date for the award of benefits will be assigned if service connection is awarded. Id. at 486. This specific notification was furnished in this case pursuant to a March 2006 duty to assist letter. The Board also finds that all of the relevant facts have been properly developed, and that all available evidence necessary for an equitable resolution of the claim on appeal has been obtained. The Veteran's service treatment records (STRs) and post-service VA and private treatment records were obtained. In addition lay statements have also been added to the file along with contentions and arguments provided by the Veteran and his attorney. VA's duty to assist also includes obtaining an examination and medical opinion when necessary to make an adequate determination. See Duenas v. Principi, 18 Vet. App. 512 (2004). During the appeal period, VA examinations and opinions were obtained for the file in July 2011, June 2012, and March 2013, addressing the service connection claims in appellate status, and all of the theories of entitlement, based on variously diagnosed foot conditions. The Veteran and his attorney have not maintained that these examination reports are collectively inadequate, or fail to address the pertinent arguments raised. See Sickels v. Shinseki, 643 F.3d 1362 (Fed. Cir. 2011), (in the absence of a challenge to the adequacy of the examination, the Board is not required to explicitly explain why each medical opinion is adequate). Accordingly, the Board finds that under the circumstances of this case, VA has satisfied the notification and duty to assist provisions of the VCAA and that no further actions need be undertaken on the Veteran's behalf. See 38 U.S.C.A. § 5103A and 38 C.F.R. § 3.159(c)-(e). The Board finds that as to the claim being decided herein on appeal, all necessary development has been accomplished, and therefore appellate review may proceed without prejudice to the appellant. See Bernard v. Brown, 4 Vet. App. 384 (1993). Significantly, the Veteran has not specifically 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. Hence, no further notice or assistance is required to fulfill VA's duty to assist the appellant in the development of the claim. 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). II. Service Connection The Veteran's filed an original service connection claim for a right foot disability in January 2005, indicating that his foot problems began in 1979 and were treated at the Naval Hospital in Camp LeJune, NC. The STRs show that the Veteran's feet were normal when he was examined for enlistment in June 1977. At that time, he denied a medical history of foot trouble. A November 1979 service treatment record reveals that the Veteran complained of a sore on the side of his right foot, causing him pain. There was a two-centimeter, raised callus with a scab, as if it had bled at one time. On examination, there was a callus on the lateral aspect of the right foot. Debridement was performed, and the Veteran was advised to wear a soft shoe. When examined for separation in August 1980, the Veteran's feet were normal . In a written statement dated in February 2005 and received by the RO in April 2005, the Veteran indicated that while in service, his right foot had a bone come through the side, which caused his foot to hurt constantly and caused his ankle and leg to swell at times. He stated that could not run or walk long distances or stand for long periods of time. He mentioned that he purchased his shoes one or two sizes large, so that he did not irritate the bone on his foot. Private treatment records of Dr. J.D. dated from November 2005 to January 2006 include a November 2005 entry indicating that the Veteran was seen for a follow-up evaluation of corns and calluses. It was noted that treatment last provided for a thick hyperkeratotic lesion on the side of the right foot (5th met base) helped, but the Veteran reported that this problem always returned. Physical examination revealed an encapsulated lesion at the right 5th met base, diagnosed as a plantar wart or molluscum of the right 5th metatarsal base (possibly of viral origin). In January 2006, the Veteran underwent removal of a 3.1 cm plantar wart of the right foot; post-operative condition was stable. A February 2006 record indicated that there was no recurrence or pathology related to the wart and the assessment indication that the condition had resolved. In a June 2006 written statement, the Veteran indicated that the acute callosity that was treated in service is the same that he incurred post-service. He maintained that the condition was treated during service, but did not go away. He also stated that he had to wear soft shoes since leaving service. The file contains 3 lay statements attesting to the Veteran's foot problems for years and to problems he has had walking and with mobility, post-surgery of 2006. Pursuant to a Board Remand of March 2011, a VA examination was requested. In July 2011, a VA examination was conducted and the claims folder was reviewed. The Veteran gave a history of a bone coming through his foot during service, and reported that he had limped around for years thereafter. He reported that in 2005 or 2006 a piece of bone had been removed from his right outer foot, and complained that his foot condition had become worse since that time. The Veteran complained of foot pain, swelling, stiffness and limited ability to walk and stand. X-ray films of the right foot and ankle were normal. Mild right foot hallux valgus was diagnosed. The examiner opined that this condition was not caused by or the result of service or any incident therein. The examiner explained that a callus formation over the right foot was diagnosed by a treating specialist (podiatrist) during service, and that from 1980 until 2005, there were no interval records to substantiate a claim of on-going problems with the right foot. It was noted that a plantar wart, evaluated and treated in 2005 and 2006, resolved after surgical treatment and was no longer evident or diagnosed on current physical examination, nor were any residual effects shown. The examiner also clarified that no callus of the right foot had been shown on examination or diagnosed. The Veteran's complaints were acknowledged and the examiner explained that the only objective finding of the right foot evident on examination was a mild hallux valgus deformity, which was shown bilaterally, and was completely distinct from the location of either the callus diagnosed in service or the plantar wart treated post-service. The report indicated that the Veteran had been without callus or wart formations of the lateral foot for over 5 years. The examiner emphasized that there was no plausible mechanism for a prior callus causing hallux valgus or limited range of motion of the right ankle. Ultimately, the examiner opined that the Veteran's only currently manifested right foot condition, hallux valgus, was not related to service or any incident or injury therein, including a foot callus diagnosed in 1979. In September 2011, private medical records of Dr. W.S. F. dated in 2009 and 2010 were received. In September 2009, the Veteran was seen with complaints of lumbar pain radiating into the legs, especially on the left side, which he reports began in July 2009. Films revealed disc degeneration at L2-S1 and 7 mm of leg shortening on the left side. When seen in December 2009, the Veteran complained of low back pain with radiation into the left calf and foot. Later in December 2009, the Veteran complained of mild lumbar pain with right leg pain and weakness. Low back pain radiating into the right foot was documented in January and February 2010 records. When last seen in August 2010, the doctor noted that treatment consisted of spinal adjustment at L3 and L5 and electrical muscle stimulation. Private medical records of Dr. B.H. also received in September 2011 and dated from October to December 2010 document the Veteran's primary treatment for back problems. The records also mention symptoms of tingling of the hands, stiffness in the legs, and burning of the feet (October 2010). In October 2011, medical records dated in 2009 were received from a private pain clinic. These records described the Veteran's symptoms of low back pain, radiating into the legs and calves, being treated with lumbar epidural steroid injections. In a Board Remand of March 2012, it was noted that in argument presented in March 2012, the Veteran's representative had pointed out that while the July 2011 VA examiner provided an opinion with respect to the only right foot disability present at the time of examination-hallux valgus-the examiner failed to address whether the Veteran's surgically removed plantar wart was related to service. The Board therefore determined that the July 2011 opinion was insufficient to resolve the Veteran's service connection claim and requested that the claims file should be returned to the July 2011 VA examiner for an opinion addressing whether the surgically removed plantar wart had its onset in or is medically related to service. In June 2012, the same VA examiner who had conducted the July 2011 VA examination provided an addendum to that report, indicating review of the claims file and the prior VA examination report. The examiner observed that a plantar wart had not been diagnosed during service, callus formation was diagnosed. The examiner emphasized that this diagnosis was rendered by a podiatrist, a foot specialist, and that as such the examiner had no reason to doubt the in-service diagnosis. It was also pointed out that there were 25 years between the Veteran's service and the diagnosis and treatment for plantar wart shown in 2005 and 2006, and no records to substantiate a contention that the Veteran had a plantar wart during service which was an on-going problem until treated in 2006. The examiner opined that the wart more likely arose at some time following the Veteran's service, closer in time to the treatment sought for it. The examiner concluded that it was less likely than not that the plantar wart which was surgically removed in 2006 (found to be resolved upon VA examination of 2011), had its onset in or was otherwise medically related to the Veteran's military service. In a Board Remand of December 2012, it was noted that in argument presented in September 2012, the Veteran's attorney requested VA assistance in obtaining treatment records from Dr. J.D. for the time period prior to November 2005. It was also noted that an attempt to obtain further treatment and surgical records for right foot surgery performed at Martha Jefferson Hospital in Charlottesville, VA in approximately 2005 to 2007was warranted. Action to undertake the aforementioned development was requested in the Remand. In February 2013, additional records from Dr. J.D. were received, most of which were duplicative. However, a previously unseen record of October 2005 was submitted for the file reflecting that the Veteran presented with ankle and foot pain on the side of his right foot. Specifically, he complained of a hard lesion on the side of the right foot at the base of the 5th metatarsal, reporting that he has had this for 25 years, since he was in service. Impressions of intractable plantar hyperkeratosis of the right foot over the 5th metatarsal base, right bunionette, and right foot pain were made. In March 2013, another opinion was provided for the file by a VA physician. The report reflects review and summary of the pertinent evidence in the claims file. Ultimately the doctor opined that there was no evidence of chronicity of corns and calluses that began in service; this was described as an event that was treated and resolved. Analysis The Veteran contends that service connection is warranted for a right foot disability. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. § 1131; 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); see also Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); Rabideau v. Derwinski, 2 Vet. App. 141, 143 (1992). Service connection may be granted for any disease diagnosed after discharge from service when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). With chronic disease shown as such in service (or within the presumptive period under § 3.307) so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service-connected, unless clearly attributed to intercurrent causes. Continuity of symptomatology is required only where the condition noted during service (or in the presumptive period) is questioned. When the fact of chronicity in service is not adequately supported, then the showing of continuity after discharge is required to support the claim. 38 C.F.R. § 3.303(b). The United States Court of Appeals for the Federal Circuit (Federal Circuit) recently clarified that the provisions of 38 C.F.R. § 3.303(b) pertaining to the award of service connection on the basis of continuity of symptomatology apply to chronic diseases as defined in 38 C.F.R. § 3.309(a). See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Generally, in order to prevail on the issue of service connection, there must be (1) evidence of a current disability; (2) medical evidence, or in certain circumstances, lay evidence of in-service occurrence or aggravation of a disease or injury; and (3) evidence of a nexus between an in-service injury or disease and the current disability. See Hickson v. West, 12 Vet. App. 247, 253 (1999). The Board notes that the requirement that a claimant have a current disability before service connection may be awarded for that disability is satisfied when a claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim, even if no disability is present at the time of the claim's adjudication. McClain v. Nicholson, 21 Vet. App. 319 (2007). The file contains a clinical diagnosis of hallux valgus made upon VA examination of 2011; as such that current disability is established. In addition, because in this case, the Veteran filed the current claim for service connection for right foot disability in January 2005, and the medical evidence establishes a diagnosis of plantar wart in late 2005 with surgical removal in January 2006, establishing the presence of that current disability within the meaning of McClain. As such, Hickson element (1), evidence of current disability, has been established. In addition, as will be discussed herein, the Veteran has also maintained that his claimed foot condition is currently manifested by corns and calluses, which have been chronic and continuous since service. With regard to Hickson element (2), in-service incurrence, the file contains a sole entry related to right foot problems. A November 1979 treatment record reveals that the Veteran complained of a sore on the side of his right foot, causing him pain. There was a two-centimeter, raised callus with a scab, as if it had bled at one time. On examination, there was a callus on the lateral aspect of the right foot. Debridement was performed, and the Veteran was advised to wear a soft shoe. When examined for separation in August 1980, the Veteran's feet were normal. In essence, following the finding of a right foot callus in November 1979, there was no indication of any residuals or recurrence of that or any other right foot symptomatology, for nearly the next year, until the Veteran was discharged in October 1980. Further, no complaints, findings, abnormalities, or diagnoses relating to the feet were documented on the August 1980 separation examination report. The Board observes that the Veteran's separation physical examination report is highly probative as to his condition at the time of his release from active duty, as it was generated with the specific purpose of ascertaining his then-physical condition, as opposed to his current assertions made many decades after the service that are being proffered in an attempt to secure VA compensation benefits. See White v. Illinois, 502 U.S. 346, 355-56 (1991) (noting that statements made for the purpose of medical diagnosis or treatment are exceptionally trustworthy because the declarant has a strong motive to tell the truth in order to receive a proper diagnosis or treatment). The remaining question therefore, is whether any right foot disability was incurred during or as a result of the Veteran's active military service, as claimed. The Federal Circuit has held that a Veteran seeking disability benefits must establish the existence of a disability and a connection between the Veteran's service and the disability claimed. Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000). Factors for assessing the probative value of a medical nexus opinion are the physician's access to the claims file and the thoroughness and detail of the opinion. See Prejean v. West, 13 Vet. App. 444, 448-49 (2000). With respect to hallux valgus, this foot condition was initially diagnosed in 2011, more than 30 years after the Veteran's discharge from service. There were no prior clinical diagnoses of hallux valgus. Upon VA examination of July 2011, the examiner emphasized that the only objective finding of the right foot evident on examination was a mild hallux valgus deformity, which was shown bilaterally, and was completely distinct from the location of either the callus diagnosed in service or the plantar wart treated post-service. The examiner explained that there was no plausible mechanism for a prior callus causing hallux valgus or limited range of motion of the right ankle. Ultimately, the examiner opined that the Veteran's only currently manifested right foot condition, hallux valgus, was not related to service or any incident or injury therein, including a foot callus diagnosed in 1979. The negative opinion provided by the VA examiner in 2011, relating to the foot disability diagnosed as hallux valgus, is found to be of high probative value in this case, as it was made based upon consideration of a comprehensive historical record and claims file review, and is supported persuasive and logical rationale based on an accurate factual history. The Board finds no adequate basis to reject this competent medical opinion based on a lack of credibility or probative value, nor has any contrary competent medical evidence been provided on this point. Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997); Evans v. West, 12 Vet. App. 22, 26 (1998). Accordingly, a right foot condition diagnosed as hallux valgus is not shown to have been incurred or otherwise etiologically related to service. Also diagnosed in this case is a plantar wart of the right foot, initially diagnosed in late 2005 and surgically treated in early 2006. The Veteran and his representative maintain that this condition is a residual/continuation of the callus treated during service in 1979, or that it is otherwise etiologically related thereto. The July 2011 VA examination report notes that a plantar wart was evaluated and treated in 2005 and 2006, resolving after surgical treatment. It was further explained this condition was no longer evident or diagnosed on that physical examination, nor were any residual effects shown. In June 2012, an addendum to the July 2011 VA examination report was provided by the same VA examiner, who indicated review of the claims file and the prior VA examination report. The examiner observed that a plantar wart had not been diagnosed during service, callus formation was diagnosed. The examiner emphasized that this diagnosis was rendered by a podiatrist, a foot specialist, and that as such the examiner had no reason to doubt the in-service diagnosis. It was also pointed out that there were 25 years between the Veteran's service and the diagnosis and treatment for plantar wart shown in 2005 and 2006, and no records to substantiate a contention that the Veteran had a plantar wart during service which was an on-going problem until treated in 2006. The examiner opined that the wart more likely arose at some time following the Veteran's service, closer in time to the treatment sought for it. The examiner concluded that it was less likely than not that the plantar wart which was surgically removed in 2006 (found to be resolved upon VA examination of 2011), had its onset in or was otherwise medically related to the Veteran's military service. Again, the Board finds no adequate basis to reject this competent medical opinion based on a lack of credibility or probative value Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997); Evans v. West, 12 Vet. App. 22, 26 (1998). In addition, again the Veteran has not provided any competent medical evidence to rebut the aforementioned opinions or to otherwise diminish their probative weight and neither the Veteran nor his representative have maintained that the June 2012 opinion was in any way inadequate or incomplete in terms of addressing the plantar wart manifestation. See Wray v. Brown, 7 Vet. App. 488, 492-93 (1995). Finally, the Veteran has maintained that corns and calluses have been chronic and continuous since service. The Board acknowledges that a callus on the lateral aspect of the right foot was diagnosed on a single occasion in service in November 1979. However, that condition was not shown to be chronic, continuous, or recurrent, even throughout the rest of the Veteran's period of service ending in October 1980, and no foot abnormality was shown upon the August 1980 separation examination, refuting the Veteran's contentions to that the condition was chronic and continuous in service. Post-service, following the sole treatment for calluses in service, right foot calluses are not mentioned again until referenced in a private medical records of late 2005, 25 years after the Veteran's period of service. The Board points out that the private medical records which include mention of corns and calluses ultimately failed to include any such clinical diagnosis in 2005 or 2006; instead diagnosing the Veteran's symptoms as a plantar wart of the right foot which was ultimately surgically treated in 2006 and did not recur thereafter. In a July 2011 VA examination report, the examiner explained that a callus formation over the right foot was diagnosed by a treating specialist (podiatrist) during service, and that from 1980 until 2005, there were no interval records to substantiate a claim of on-going problems with the right foot. Evidence of a prolonged period without medical complaint and the amount of time that elapsed since military service, can be considered as evidence against the claim. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). In March 2013, a VA opinion was provided for the file based on a review and summary of the pertinent evidence in the claims file. Ultimately the doctor opined that there was no evidence of chronicity of corns and calluses that began in service. Essentially, this was described as an acute event that was treated and resolved during service. VA medical opinions provided in both 2011 and 2013 addressing the question of a relationship between the currently claimed right condition and a callus treated during service in 1979 were not supportive of the claim, and were based on a comprehensive and accurate review of the history of the case, with rationale explaining the opinions supported by evidence pertaining to his specific case. Accordingly, these opinions are found to carry significant weight. See Nieves-Rodriguez, 22 Vet. App. 295 (2008). The Veteran has not provided any competent medical evidence to rebut these opinions or otherwise diminish their probative weight. See Wray v. Brown, 7 Vet. App. 488, 492-93 (1995). Significantly, no contrary medical evidence or opinion specific to this Veteran has been presented or identified. In essence, the Veteran and his representative have argued that where, as here, the record lacks evidence of a nexus, a veteran may be entitled to disability benefits if he establishes continuity of symptomatology between the presently claimed condition and in-service injury or disease. 38 C.F.R. § 3.303(b) (2012). Accordingly, in addition to the medical and other evidence discussed above, the Board has considered the Veteran's lay assertions advanced in support of his claim. However, no such lay assertions provide persuasive support for the claim. With respect to the Veteran's assertions of continuity of symptomatology since service, the Board recognizes that the Veteran is competent, as a layperson, to report that about which he has personal knowledge, to include his own symptoms. See, e.g., Layno v. Brown, 6 Vet. App. 465, 470 (1994); Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). However, such report must be weighed against the medical and other evidence. Cf. Buchanan v. Nicholson, 451 F. 3d 1331 (Fed. Cir. 2006). Here, his assertions as to continuity are refuted by a negative separation examination of 1980; a 25 year gap during which the Veteran did not complain of foot problems, seek treatment or file a claim for compensation; and highly probative and competent VA medical opinions. Moreover, the Board points out that the U.S. Court of Appeals for the Federal Circuit recently clarified that the continuity of symptomatology language in 38 C.F.R. § 3.303(b) "restricts itself to chronic diseases" found in 38 C.F.R. § 3.309(a). See Walker v. Shinseki, 708 F.3d 1331, 1336 (Fed.Cir.2013) "Nothing in § 3.303(b) suggests that the regulation would have any effect beyond affording an alternative route for proving service connection for chronic diseases."). As the Veteran's claimed right foot condition (not manifested by arthritis) is not a chronic condition under 38 C.F.R. § 3.309(a), the Walker case provides that the Veteran may not establish continuity of symptomatology in lieu of a medical nexus. Finally, to the extent that the Veteran himself asserts he suffers from a current foot disorder, claimed as calluses/corns/; plantar wart; or hallux valgus, as a result service, to include treatment for a callus therein in 1979, the Board does not question the Veteran's sincerity in his belief that the claimed condition is etiologically related to such a cause. Although lay persons are competent to provide opinions on some medical issues(see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011)), as to the specific issue in this case-diagnosis of complex medical disability, particularly where, as here, different symptoms and diagnoses of the right foot have been made since service, and providing an opinion as to its etiology-falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007) (lay persons not competent to diagnose cancer)." Accordingly, a right foot disability is not shown to have been incurred or otherwise etiologically related to service and for the foregoing reasons, the service connection for a right foot disability must be denied. In reaching the conclusion to deny the claim, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the Veteran's claim, that doctrine is not applicable in the instant appeal. See 38 U.S.C.A. § 5107(b) (West 2002 & Supp. 2012); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990). ORDER Service connection for a right foot disability is denied. ____________________________________________ JACQUELINE E. MONROE Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs