Citation Nr: 1322280 Decision Date: 07/11/13 Archive Date: 07/18/13 DOCKET NO. 10-04 096 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Nashville, Tennessee THE ISSUES 1. Entitlement to service connection for a bilateral knee disorder. 2. Entitlement to service connection for a right hip disorder. 3. Entitlement to service connection for a right shoulder disorder. REPRESENTATION Veteran represented by: Tennessee Department of Veterans' Affairs ATTORNEY FOR THE BOARD E. Pomeranz, Counsel INTRODUCTION The Veteran served on active duty from January 13, 2009 to February 18, 2009. This matter comes before the Board of Veterans' Appeals (Board) on appeal of a May 2009 rating action by the Department of Veterans Affairs (VA) Regional Office (RO) located in Nashville, Tennessee. In June 2011 and September 2012, the Board remanded this case for additional development. The purposes of these remands have been met and the case is ready for appellate consideration. FINDINGS OF FACT 1. In the Veteran's August 2008 enlistment examination, it was noted that he had been diagnosed with bilateral patellar chondromalacia. Specifically, patellar realignment surgery was performed on the Veteran's right knee in August 2001 and that same surgery was performed on the Veteran's left knee in June 2002; private surgical reports for each procedure were attached to the enlistment examination report. 2. The pre-existing bilateral patellar chondromalacia did not increase in severity during service. 3. There is no competent evidence of record showing a current diagnosis of a right hip disorder. 4. There is no competent evidence of record showing a current diagnosis of a right shoulder disorder. CONCLUSIONS OF LAW 1. A pre-existing bilateral knee disorder, to include bilateral patellar chondromalacia, was not aggravated by active military service. 38 U.S.C.A. §§ 1110, 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2012). 2. Entitlement to service connection for a right hip disorder is not warranted. 38 U.S.C.A. §§ 1110, 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310 (2012). 3. Entitlement to service connection for a right shoulder disorder is not warranted. 38 U.S.C.A. §§ 1110, 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Veterans Claims Assistance Act of 2000 (VCAA) The VCAA enhanced VA's duty to notify a claimant as to the information and evidence necessary to substantiate a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2012). The VCAA also redefined the obligations of VA with respect to the duty to assist the veteran with the claim. Id. In the instant case, the Board finds that VA fulfilled its duties to the Veteran under the VCAA. Duty to Notify VA has a duty to notify the veteran of any information and evidence needed to substantiate and complete a claim. 38 U.S.C.A. §§ 5102, 5103. The Board concludes that the letter dated in March 2009 that was sent to the Veteran adequately apprised him of the information and evidence needed to substantiate the claims. The RO thus complied with VCAA's notification requirements. In order to meet the requirements of 38 U.S.C. § 5103(a) and 38 C.F.R. § 3.159(b), VCAA notice must: (1) inform the claimant about the information and evidence necessary to substantiate the claim; (2) inform the claimant about the information and evidence that VA will seek to provide; and (3) inform the claimant about the information and evidence the claimant is expected to provide. Beverly v. Nicholson, 19 Vet. App. 394, 403 (2005) (outlining VCAA notice requirements). Additionally, on March 3, 2006, the United States Court of Appeals for Veterans' Claims (Court) issued a decision in Dingess v. Nicholson, 19 Vet. App. 473, 484, 486 (2006), which held that the VCAA notice requirements of 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) apply to all five elements of a service connection claim. Those five elements include: (1) veteran status; (2) existence of a disability; (3) a connection between the veteran's service and the disability; (4) degree of disability; and (5) effective date of the disability. The Board finds that VA has met these duties with regard to the claims adjudicated on the merits in this decision. There is no issue as to providing an appropriate application form or completeness of the application. Written notice provided in March 2009 fulfills the provisions of 38 U.S.C.A. § 5103(a). That is, the Veteran received notice of the evidence needed to substantiate his claims, the avenues by which he might obtain such evidence, and the allocation of responsibilities between himself and VA in obtaining such evidence. See Beverly, 19 Vet. App. at 394, 403; see also Mayfield v. Nicholson, 19 Vet. App. 103, 109-12 (2005) (Mayfield I) rev'd on other grounds, 444 F.3d 1328 (Fed. Cir. 2006). In addition, the March 2009 letter also informed the Veteran about how VA determines effective dates and disability ratings, as required by Dingess. The Board also recognizes that, according to Pelegrini v. Principi, 18 Vet. App. 112, 119-20 (2004), proper VCAA notice must "precede an initial unfavorable [agency of original jurisdiction (AOJ)] decision on a service-connection claim." VA did provide such notice to the Veteran prior to the May 2009 decision that is the subject of this appeal in its March 2009 letter. With respect to the Dingess requirements, the Veteran was provided with notice of what type of information and evidence was needed to substantiate the claims, as well as the type of evidence necessary to establish a rating or effective date of an award (see letter from RO, dated in March 2009), and such notice was provided prior to the initial decision of the RO. See Dingess, supra. Accordingly, the RO provided proper VCAA notice at the required time. The Veteran has been provided the opportunity to respond to VA correspondence and over the course of the appeal has had multiple opportunities to submit and identify evidence. Furthermore, he has been provided a meaningful opportunity to participate effectively in the processing of his claims by VA. Duty to Assist VA also has a duty to assist the veteran in obtaining evidence necessary to substantiate the claim. 38 U.S.C.A. § 5103A(a) ("The Secretary shall make reasonable efforts to assist a claimant in obtaining evidence necessary to substantiate the . . . claim"). This duty includes assisting the veteran in obtaining records and providing medical examinations or obtaining medical opinions when such are necessary to make a decision on the claim. 38 U.S.C.A. § 5103A(b), (c), (d) (setting forth Secretary's various duties to claimant). VA informed the Veteran of its duty to assist in obtaining records and supportive evidence. In this regard, the Veteran's service treatment records, have been obtained, to the extent available. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159. In addition, as explained further below, the RO made an attempt to schedule the Veteran for a VA compensation and pension (C&P) examinations but he failed to appear without good cause. The Board notes substantial compliance with the remand directives in its previous remands in June 2011 and September 2012, to the extent possible. See Stegall v. West, 11 Vet. App. 268 (1998). Specifically, in the June 2011 remand, the Board noted that according to the Veteran, he had been treated for his right hip during service at Reid Clinic, WHMC at Lackland Air Force Base, Texas. Despite efforts by the RO, records of that treatment had not been associated with the Veteran's service treatment records. On remand, the Board requested that the RO make an additional attempt to obtain the Veteran's complete service treatment records, to include all clinical records, as well as his service personnel records. In addition, because the Veteran had stated that he was seeking treatment for his claimed disabilities but had not identified any medical care providers, the RO was requested to ask the Veteran to identify any and all treatment facilities where he had been treated for his claimed disorders since his separation from service and make arrangements to obtain any identified records. Pursuant to the June 2011 remand, the RO sent letters to the Veteran in August 2011 and October 2011, and requested that he complete and return an enclosed consent form so that they could obtain any treatment information identified. The RO sent the letters to an address in Kingsport, Tennessee. However, although the Kingsport address was the Veteran's address at the time he filed his initial claim in March 2009, in his January 2010 substantive appeal (VA Form 9), he had provided a new address in Johnson City, Tennessee. Thus, both letters were returned as undeliverable. In addition, in August 2012, the RO sent a supplemental statement of the case (SSOC) to the Kingsport address and it was returned as undeliverable. In August 2011, the RO contacted the National Personnel Records Center (NPRC) and requested the Veteran's complete service treatment records, to include all clinical records. A negative reply was subsequently received from the NPRC. However, the RO did obtain the Veteran's personnel records. In September 2012, the Board once again remanded this case. The Board stated that because the August 2011 and October 2011 letters, and the August 2012 SSOC, had all been sent to the Veteran's old Kingsport address instead of his new address in Johnson City, those documents needed to be resent to his current address of record. In addition, with regard to the claimed disabilities on appeal, the Veteran maintained that his preexisting bilateral knee disability worsened during service and that during basic training, he reinjured his knees and hips. He also noted that after his discharge, he continued to have problems with his knees and hips. The Veteran made no specific contentions as to his right shoulder. Thus, upon remand, the RO was to afford the Veteran a VA orthopedic examination of his knees and right hip to determine whether his pre-existing bilateral knee disorder was aggravated during service and to determine the etiology of any right hip disorder, if found. In September 2012, the RO sent a letter to the Veteran's new address in Johnson City and attached copies of the August 2011 and October 2011 letters, and the August 2012 SSOC. In November 2012, the RO then sent a letter to the Veteran at his old Kingsport address. These letters were returned as undeliverable. In January 2013, the RO obtained a Basic Report wherein it was noted that the Veteran's current address was a post office box in Church Hill, Tennessee. Thus, later in January 2013, the RO sent a letter to the Veteran's new address in Church Hill and attached copies of the August 2011 and October 2011 letters, and the August 2012 SSOC. In March 2013, the VA Medical Center (VAMC) in Mountain Home, Tennessee, sent a letter to the Veteran notifying him of his VA examination, scheduled for April 2013. The RO sent the letter to the Veteran's old Kingsport address. In March 2013, the RO contacted the Mountain Home VAMC and discovered that the letter notifying the Veteran of his upcoming VA examination was sent to his old Kingsport address. The RO provided the Mountain Home VAMC with the Veteran's new Church Hill address and the notification letter was resent to that address. In a VA Form 21-0820, Report of General Information, dated in April 2013, it was noted that the RO called the Veteran to verify his correct contact information. However, there was no response. In April 2013, the RO issued an SSOC. The RO sent the SSOC to the Veteran's Church Hill address but it was returned as undeliverable. In light of the above, the Board acknowledges that throughout the course of his appeal, correspondence from VA to the Veteran has been sent to various addresses, to include a post office box in Church Hill, and addresses in Johnson City and Kingsport. This correspondence was returned as undeliverable. Review of the claims folder makes clear that the Veteran last corresponded with VA over three years ago in January 2010, at which time he indicated that his new address was in Johnson City. There is no indication that the Veteran subsequently submitted a change of address form. If, per chance, he had changed addresses without informing VA, it is well established that it was his responsibility to keep VA advised of his whereabouts. If he did not do so, "there is no burden on the part of the VA to turn up heaven and earth to find him." See Hyson v. Brown, 5 Vet. App. 262, 265 (1993). Moreover, the Board notes that the duty to assist is not a one-way street. Wood v. Derwinski, 1 Vet. App. 190 (1991). Accordingly, the Board finds that the RO has complied with the instructions from the Board's June 2011 and September 2012 remands, to the extent possible. See Stegall, 11 Vet. App. at 268. Hence, no further notice or assistance to the Veteran is required to fulfill VA's duty to assist the Veteran in the development of the claims. See Soyini v. Derwinski, 1 Vet. App. 540, 546 (1991). Because VA's duties to notify and assist have been met, there is no prejudice to the Veteran in adjudicating this appeal. II. Pertinent Laws and Regulations Service connection is granted for disability resulting from disease or injury incurred in or aggravated by active military service in the line of duty. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge when the evidence, including that pertinent to service, establishes the disease was incurred in service. 38 C.F.R. § 3.303(d). In interpreting sections 1110 and 1131 of the statute and section 3.303(a) of the regulations, the Federal Circuit Court held that a three-element test must be satisfied in order to establish entitlement to service connection. Specifically, the evidence must show (1) the existence of a current disability; (2) in-service incurrence or aggravation of a relevant disease or injury; and (3) a causal relationship between the current disability and the disease or injury incurred or aggravated during service (the "nexus" requirement). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013) (citing Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004))). Under 38 C.F.R. § 3.303(b), claims for certain chronic diseases-namely those listed in 38 C.F.R. § 3.309(a)-benefit from a somewhat more relaxed evidentiary standard. See Walker, supra, (holding that "[t]he clear purpose of the regulation is to relax the requirements of § 3.303(a) for establishing service connection for certain chronic diseases."). When a chronic disease is established during active service, then subsequent manifestations of the same chronic disease at any later date, however remote, will be entitled to service connection, unless clearly attributable to causes unrelated to service ("intercurrent causes"). 38 C.F.R. § 3.303(b). In this case, there is no evidence showing that the Veteran has a "chronic disease" listed under 38 C.F.R. § 3.309(a). Regardless, because the Veteran had less than 90 days of service, 38 C.F.R. § 3.303(b) does not apply and, as such, the Veteran is not permitted to show continuity of symptomatology since his service as an alternative means of etiologically linking his claimed disabilities to his military service. See Walker, supra. Lay evidence nonetheless 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 symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Lay persons can also provide an eye-witness account of an individual's visible symptoms. See Davidson v. Shinseki, 581 F.3d 1313 (2009) (noting that a layperson may comment on lay-observable symptoms). Competency of evidence differs from weight and credibility. The former is a legal concept determining whether testimony may be heard and considered by the trier of fact, while the latter is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) ("although interest may affect the credibility of testimony, it does not affect competency to testify"). In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. See Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The standard of proof to be applied in decisions on claims for veterans' benefits is set forth in 38 U.S.C.A. § 5107. A veteran is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence. See also 38 C.F.R. § 3.102. When a veteran seeks benefits and the evidence is in relative equipoise, the veteran prevails. See Gilbert, 1 Vet. App. at 49. The preponderance of the evidence must be against the claim for benefits to be denied. See Alemany v. Brown, 9 Vet. App. 518 (1996). III. Bilateral Knee Disorder A veteran will be considered to have been in sound condition when examined, accepted, and enrolled for service, except as to defects, infirmities, or disorders noted at entrance into service, or where clear and unmistakable evidence demonstrates that an injury or disease existed prior thereto and was not aggravated by service. 38 U.S.C.A. § 1111. Only such conditions as are recorded in examination reports are to be considered as noted. 38 C.F.R. § 3.304(b). Applying the legal criteria above, the Board notes that the Veteran's service treatment records do contain evidence that the Veteran had a bilateral knee condition prior to his induction into service. Specifically, the Veteran's August 2008 enlistment examination report contains a notation indicating that he had bilateral patellar chondromalacia. Patellar realignment surgery was performed on each of the Veteran's knees; on the right knee in August 2001 and on the left knee in June 2002. Surgical reports for each procedure were attached to the Veteran's enlistment examination report. On this record, it was recommended that a waiver be requested in order for the Veteran to be inducted into service. The waiver request was granted. Thus, the Veteran's bilateral patellar chondromalacia was "noted" when he entered active duty, and the presumption of soundness does not apply. If a pre-existing disability is noted upon entry into service, the veteran cannot bring a claim for service connection for that disability, but the veteran may bring a claim for aggravation of that disability. In that case, 38 U.S.C.A. § 1153 applies and the burden falls on the veteran to establish aggravation. See Jensen v. Brown, 19 F.3d 1413, 1417 (Fed. Cir. 1994). A pre-existing disability or disease will be considered to have been aggravated by active service when there is an increase in disability during service, unless there is clear and unmistakable evidence (obvious and manifest) that the increase in disability is due to the natural progress of the disability or disease. 38 U.S.C.A. § 1153; 38 C.F.R. § 3.306 (a), (b). Aggravation of a pre-existing condition may not be conceded where the disability underwent no increase in severity during service on the basis of all the evidence of record pertaining to the manifestations of the disability prior to, during, and subsequent to service. 38 U.S.C.A. § 1153; 38 C.F.R. § 3.306(b). See Falzone v. Brown, 8 Vet. App. 398, 402 (1995) (holding that the presumption of aggravation created by section 3.306 applies only if there is an increase in severity during service); Akins v. Derwinski, 1 Vet. App. 228, 231 (1991). VA may show a lack of aggravation by establishing that there was no increase in disability during service or that any increase in disability was due to the natural progress of the pre-existing condition. 38 U.S.C.A. § 1153. Temporary or intermittent flare-ups during service of a pre-existing injury or disease are not sufficient to be considered "aggravation in service" unless the underlying condition, as contrasted to symptoms, is worsened. Jensen v. Brown, 4 Vet. App. 304, 306-307 (1993), citing Hunt v. Derwinski, 1 Vet. App. 292 (1991). The preponderance of the evidence of record demonstrates that the Veteran's pre-existing bilateral patellar chondromalacia was not aggravated by service. 38 U.S.C.A. § 1153; 38 C.F.R. § 3.306. Other than the enlistment examination where the Veteran's pre-existing bilateral patellar chondromalacia was noted, the Veteran's service treatment records are negative for any complaints or findings of a bilateral knee disorder, to include bilateral patellar chondromalacia. The Veteran's DD-214 shows that he was given an entry level separation due to an adjustment disorder. In this regard, the Veteran's personnel records include a Memorandum, dated in February 2009, wherein it was noted that in January 2009, the Veteran sought treatment for problems with anxiety, panic-like attacks, and depression since being removed from training and placed on a medical hold for a hip problem. He returned later and reported that his hip was not fractured and that he would be returned to duty. However, the Veteran stated that he did not want to return to duty. He indicated that he was worried that he could not handle it physically or emotionally. The Veteran also noted that he had a new daughter and was depressed that he would miss milestones in her development. Following mental status evaluation, he was diagnosed with an adjustment disorder with mixed anxiety and depressed mood. The diagnoses did not meet retention standards for continued military service. His disorders were so severe that his ability to function in the military environment was significantly impaired. Thus, it was recommended that he be processed for expeditious administrative separation. He was subsequently discharged. In this case, although a VA C&P examination was scheduled for April 2013 in order to determine whether the Veteran's pre-existing bilateral knee disorder was aggravated during service, the Veteran failed to appear. The letters notifying the Veteran of the examination (one sent to an address in Kingsport and the other to an address in Church Hill) were returned as undeliverable. The Veteran has not provided an updated mailing address, and as discussed in more detail above, efforts to locate him have been unsuccessful. Therefore, the claim will be adjudicated based on the evidence of record. See 38 C.F.R. § 3.655(b) (2012). The only evidence of record supporting the Veteran's claim is his own opinion that his pre-existing bilateral patellar chondromalacia was aggravated during service. He maintains that during service, he reinjured his knees. The Veteran also reports that after his discharge, he continued to have problems with his knees. In this regard, the Veteran is competent to give evidence about observable symptoms such as pain in his knees. Layno v. Brown, 6 Vet. App. 465, 469 (1994); Jandreau, supra ("Sometimes the layperson will be competent to identify the condition where the condition is simple, for example a broken leg, and sometimes not, for example, a form of cancer. ") However, the Veteran is not competent in this instance to opine that his pre-existing bilateral patellar chondromalacia was aggravated during service as that is a complex medical question that requires medical expertise and training, including knowledge of the etiology and progression of disease, and correlation with past medical records and reported history. The Veteran's bilateral patellar chondromalacia is not a simple medical condition and as a lay person, the Veteran is not qualified through education, training, or experience to provide an opinion on whether such disability was aggravated during service. The question of aggravation of the underlying condition would not be subject to lay observation, as contrasted with the situations contemplated by Jandreau and Barr v. Nicholson, 21 Vet. App. 303 (2007) (lay testimony is competent to establish the presence of varicose veins). Here, the Veteran's lay opinion on aggravation is not competent evidence and cannot be considered as evidence favorable to the claim. In light of the above, there is no competent evidence showing that the Veteran's pre-existing bilateral patellar chondromalacia increased in severity during active service. Thus, the Board finds that there is a preponderance of evidence against the Veteran's claim for service connection for a bilateral knee disorder, to include bilateral patellar chondromalacia, and that the claim must be denied. In reaching this decision, the Board has considered the doctrine of reasonable doubt. However, as there is a preponderance of evidence against the Veteran's claim, the doctrine is not for application. 38 U.S.C.A. § 5107(b); Ortiz v. Principi, 274 F.3d 1361, 1364, 1365 (Fed. Cir. 2001) (holding that "the benefit of the doubt rule is inapplicable when the preponderance of the evidence is found to be against the claimant"); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). IV. Right Hip and Shoulder Disorders At the outset, with respect to the Veteran's claim for service connection for a right hip disorder, although a VA C&P examination was scheduled for April 2013 in order to determine whether the Veteran had a right hip disorder, and if so, whether the right hip disorder was related to his period of active service, the Veteran failed to appear. The letters notifying the Veteran of the examination (one sent to an address in Kingsport and the other to an address in Church Hill) were returned as undeliverable. The Veteran has not provided an updated mailing address, and as discussed in more detail above, efforts to locate him have been unsuccessful. Therefore, the claim will be adjudicated based on the evidence of record. See 38 C.F.R. § 3.655(b) (2012). Service connection requires a finding of the existence of a current disability and a determination of a relationship between that disability and an injury or disease incurred in service. See Watson v. Brown, 4 Vet. App. 309, 314 (1993); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The Veteran's service treatment records are negative for any complaints or findings of a right shoulder disorder. With respect to any right hip problems, the records show that in February 2009, it was noted that the Veteran had hip pain in training that resolved and he completed physical therapy. There was no indication whether it was the Veteran's right hip or left hip. In a February 2009 Memorandum, it was noted that in January 2009, the Veteran was removed from training and placed on a medical hold for a hip problem. However, it was later determined that the Veteran's hip was not fractured and that he would be returned to duty. Thus, although the Veteran had hip pain, no underlying hip disability was diagnosed. In this regard, the Board observes that a symptom, such as pain alone, without a diagnosed or identifiable underlying malady or condition, does not in and of itself constitute a disability for which service connection may be granted. Sanchez-Benitez v. Principi, 259 F.3d 1356 (Fed. Cir. 2001). Therefore, the Veteran's service treatment records are negative for any findings of a right hip disorder. In the instant case, there is no competent evidence showing a current diagnosis of a right hip disorder or a right shoulder disorder. The only evidence of record supporting the Veteran's claims is his own lay opinion that he currently has right hip and shoulder disorders. He has reported that he injured his right hip during service and that after his discharge, he continued to have problems with his right hip. The Veteran has not made any specific contentions regarding his right shoulder. The Veteran is certainly competent to testify as to symptoms such as pain in his right hip and presumably right shoulder. However, as stated above, a symptom, such as pain alone, without a diagnosed or identifiable underlying malady or condition, does not in and of itself constitute a disability for which service connection may be granted. See Sanchez-Benitez, supra. In this case, no underlying right hip or right shoulder disorder has been diagnosed. While the Veteran is competent to give evidence about observable symptoms such as experiencing pain in his right hip and shoulder, he is not competent to give an opinion as to whether he has a right hip and/or shoulder disorder as this issue involves highly complex medical questions. Determining the etiology of complex medical conditions requires medical training and would not be subject to lay observation, as contrasted with the situations contemplated by Jandreau and Barr. Here, the Veteran's lay opinion that he has a right hip disorder and a right shoulder disorder is not competent evidence and lacks probative value Given that there is no competent evidence of record of a current right hip disorder or a current right shoulder disorder, the Board finds that there is a preponderance of evidence against the Veteran's claims for service connection for right hip and shoulder disorders and that the claims must be denied. In reaching this decision, the Board has considered the doctrine of reasonable doubt. However, as there is a preponderance of evidence against the Veteran's claims, the doctrine is not for application. 38 U.S.C.A. § 5107(b); Ortiz, supra; Gilbert, 1 Vet. App. at 49. ORDER Entitlement to service connection for a bilateral knee disorder, to include bilateral patellar chondromalacia, is denied. Entitlement to service connection for a right hip disorder is denied. Entitlement to service connection for a right shoulder disorder is denied. ____________________________________________ P. M. DILORENZO Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs