Citation Nr: 20052013 Decision Date: 08/05/20 Archive Date: 08/05/20 DOCKET NO. 14-36 173 DATE: August 5, 2020 ORDER Entitlement to service connection for a bilateral foot disorder, to include plantar fasciitis, left foot hallux valgus and bone spurs, is denied. Entitlement to service connection for gynecological disorders and residuals of a hysterectomy is denied. Entitlement to service connection for a bladder disorder, to include stress incontinence as secondary to residuals of a hysterectomy, is denied. FINDINGS OF FACT 1. A bilateral foot disorder, to include plantar fasciitis, hallux valgus and bone spurs, did not manifest in active duty service or within a year of separation from active duty service. A bilateral foot disorder, to include bone spurs, is not otherwise attributable to active duty service. 2. Gynecological disorders and residuals of a hysterectomy did not manifest in active duty service. Residuals of a hysterectomy are not otherwise attributable to active duty service. 3. A bladder disorder did not manifest in active duty service or within a year of separation from active duty service. A bladder disorder was not proximately caused by, or aggravated by, a service-connected disability. A bladder disorder is not otherwise attributable to active duty service. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a bilateral foot disorder, to include bone spurs, have not been met. 38 U.S.C. § 1101, 1110, 1113, 1131, 1137, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309 (2019). 2. The criteria for entitlement to service connection for gynecological disorders and residuals of a hysterectomy have not been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2019). 3. The criteria for entitlement to service connection for a bladder disorder, to include as secondary to residuals of a hysterectomy, have not been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304. 3.310 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty in the United States Army from March 1981 to March 1985, with subsequent training service with the United States Army National Guard from September 1985 to March 1987 and from September 1996 to February 1998. This case comes before the Board of Veterans’ Appeals (Board) on appeal from a March 2010 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In December 2015, the Veteran testified at a hearing before a Veterans Law Judge (VLJ). A copy of that proceeding has been associated with the claims file. In February 2018 correspondence to the Veteran, VA informed the Veteran that the Veterans Law Judge who held her hearing was no longer employed at the Board; VA requested that the Veteran respond within 30 days of receipt of this letter if she desired another hearing. The Veteran did not respond to this letter. Therefore, the Board finds that the Veteran does not desire another hearing. Threshold Issue A review of the evidence of record reveals that the RO made exhaustive attempts to obtain all of the Veteran’s service treatment records (STRs) and military personnel records. See, e.g., February 27, 2013 MAP-D Development Letter; April 4, 3013 MAP-D Development Letter; June 4, 29, 2013 MAP-D Development Letter; July 6, 2013 MAP-D Development Letter; August 5, 2013, MAP-D Development Letter; October 21, 2013 MAP-D Development Letter; October 22, 2013 VA Form 21-0820; December 16, 2013, 2013 VA Form 21-0820; January 16, 2014 MAP-D Development Letter; March 3, 2014 Third Party Correspondence; and April 8, 2014 Third Party Correspondence. Moreover, the RO informed the Veteran of all the efforts undertaken to obtain the totality of her STRs, requesting that she provide copies if available. See, e.g., April 9, 2017 Notification Letter; May 13, 2014 Correspondence. These extensive efforts were unproductive as correspondent parties found that a large portion of the Veteran service records were either lost or destroyed and are unavailable for review. Therefore, the Board has a heightened obligation to explain its findings and conclusions and to consider carefully the benefit-of-the-doubt rule. See O’Hare v. Derwinski, 1 Vet. App. 365, 367 (1991). The O’Hare precedent does not lower the threshold for an allowance of a claim; there is no reverse presumption for granting a claim. The legal standard for proving a claim is not lowered; rather, the Board’s obligation to discuss and evaluate evidence is heightened. See Russo v. Brown, 9 Vet. App. 46 (1996). Case law does not establish a heightened “benefit of the doubt,” only a heightened duty of the Board to consider the applicability of the benefit-of-the-doubt doctrine, to assist the claimant in developing the claim, and to explain its decision when a claimant’s medical records have been lost or destroyed. See Ussery v. Brown, 8 Vet. App. 64 (1995). Thus, missing STRs and personnel records alone are indeed unfortunate, but their absence does not obviate the need for the Veteran to still have competent and credible evidence supporting his claim for service connection by showing he has the claimed disability. See Milostan v. Brown, 4 Vet. App. 250, 252 (1993) (citing Moore v. Derwinski, 1 Vet. App. 401 (1991) and O’Hare, supra. Service Connection The Veteran contend that the disabilities, as noted above, were incurred in, aggravated by, or otherwise attributable to, active duty service. Competent medical evidence is evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions. Competent medical evidence may also include statements conveying sound medical principles found in medical treatises. It also includes statements contained in authoritative writings, such as medical and scientific articles and research reports or analyses. 38 C.F.R. § 3.159(a)(1). Competent lay evidence is any evidence not requiring that the proponent have specialized education, training, or experience. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159 (a)(2). This may include some medical matters, such as describing symptoms or relating a contemporaneous medical diagnosis. Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007); Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). A layperson is generally not capable of opining on matters requiring medical knowledge. Routen v. Brown, 10 Vet. App. 183, 186 (1997): see also Bostain v. West, 11 Vet. App. 124, 127 (1998). If the evidence is competent, the Board must then determine if the evidence is credible. Barr v. Nicholson, 21 Vet. App. 303, 308 (2007). After determining the competency and credibility of evidence, the Board must then weigh its probative value. In this regard, the Board may properly consider internal inconsistency, facial plausibility, and consistency with other evidence submitted on behalf of the claimant. Caluza v. Brown, 7 Vet. App. 498, 511 (1995). In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded the claimant. In order to establish service connection on a direct basis, the record must contain competent evidence of: (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. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303; Shedden v. Principi, 381 F. 3d 1163, 1167 (Fed. Cir. 2004). Disorders diagnosed after discharge will still be service connected if all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d); see also Combee v. Brown, 34 F. 3d 1039, 1043 (Fed. Cir. 1994). Some chronic diseases—to include degenerative arthritis—may be presumed to have been incurred in service, if they become manifest to a degree of ten percent or more within the applicable presumptive period. 38 U.S.C.§§ 1101(3), 1112(a); 38 C.F.R. §§ 3.307(a), 3.309(a). For those listed chronic conditions, a showing of continuity of symptoms affords an alternative route to service connection. 38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F. 3d 1331 (Fed. Cir. 2013). All have a presumptive period of one year following separation from service. 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). Evidence and Analysis In addition to active duty service from 1981 to 1985, the Veteran participated in two periods of National Guard service that each included about 60 points of inactive duty training and 15 days of active duty training. The Veteran’s military occupation was supply specialist. The Veteran’s available STRs from September 1996 to September 1997 (a portion of the Veteran’s United States Army National Guard Service) are silent for complaints, treatment, or diagnoses of a bilateral foot disorder, to include bone spurs; residuals of a hysterectomy; or a bladder disorder, to include as a residual of a hysterectomy. In May 1997, the Veteran achieved passing scored in a National Guard physical readiness test that included pushups, sit-ups, and a two mile run. A May 1997 VA medical record—identified as a “routine gyn. Exam.” The clinician noted mild prolapse of the uterus but an otherwise normal examination. There was no previous history of abnormal Pap smears. A concurrent pathology report showed mild acute cervicitis and the presence of squamous metaplasia but negative for malignant cells. In September 1999 a record of private GYN examination, a clinician noted that the Veteran worked as a postal clerk. The Veteran reported no voiding difficulty but heavier periods while not using a contraceptives and also some fatigue at the end of a workday. The clinician noted a normal uterus and an overall normal GYN examination. In VA podiatry clinic notes of September 1997, a podiatric surgeon noted that the Veteran was cleared for removal of phalanx in the right fifth toe for a bone spur. At this time, the Veteran reported that chemical corn removers worsened her right fifth toe symptoms. In an October 1999 United States Postal Service (USPS) Disability/Return to Work Medical Certificate, Dr. P., a private podiatrist, indicated that the Veteran underwent right fifth toe surgery on September 21, 1999. Dr. P. indicated a work restriction on one month, as the Veteran endorsed that she had to stand at work. In an associated report, the Veteran subjectively reported that she had experienced right fifth toe symptoms for 8 years. Moreover. Dr. P.’s “bony overgrowth procedure” at right fifth toe is described herein. These materials do not mention any etiology related to any aspect of any period of the Veteran’s service. In a May 2002 private GYN examination, the Veteran denied any vaginal discharge but was experiencing stress incontinence and occasional urinary frequency. On this encounter, the clinician diagnosed prolapsing uterus and a referral to Dr. W-M. In March 2003, a private physician noted that the Veteran was undergoing artificial menopause and low sexual desire and adjusted medications to reduce hot flashes. Private medical records from CJW (received by VA in June 2009) disclose that the Veteran underwent a laparoscopic assisted vaginal hysterectomy in June 2003. The Veteran’s pre- and post-operative diagnoses were symptomatic uterine fibroids, pelvic relaxation, unresponsive to conservative measures, associated with dysmenorrhea and menorrhagia. A clinician indicated that the Veteran was in stable condition after the procedure. Other associated records include laboratory workups and gynecological clinical notes. These records are wholly silent as to any etiology related to any aspect of any period of the Veteran’s service. In a June 2009 lay statement, the Veteran reported that she sprained her left ankle and experienced a great deal of trouble wearing military boots. She conveyed that during her enlistments from March 1981 to March 1985 and from September 1996 to February 1998 that she wore military boots on a regular basis—marching and running during physical training. The Veteran reported that she “ended up” with bone spurs on her pinky (sic) toes. She underwent right toe surgery in 1999 and was “incapacitated” for 6 weeks. The left toe bone spur has been aggravated over the years; the Veteran indicated that he wore soft and flat shoes and was limited to ambulating on thickly padded floors. Lastly, the Veteran wrote that she did not seek any treatment during active duty service because she thought that her toes did not warrant any care. In another June 2009 account, the Veteran wrote that she was diagnosed with a prolapsed uterus in 2002, adding that her gynecologist told her that this was the result of heavy lifting that started during her periods of service. The Veteran indicated that she underwent surgery, which caused heavy “cycles,” clotting, cramping and occasional incontinence. After surgery, the Veteran wrote that she experienced early menopause, which caused hot and cold flashes; high cholesterol; and borderline diabetes mellitus. Moreover, vaginal dryness impacted sexual relations and contributed to her divorce. The Veteran also experienced associated depression, headaches, vitamin D deficiency, night sweats, incontinence, mood swings, and pelvic inflammation. Lastly, the Veteran wrote that she was enclosing her surgery report; however, she could not obtain other treatment records because her physician closed her practice. The Veteran’s (ex) sister-in-law submitted a lay statement in June 2009. This lay informant wrote that the Veteran’s “entire attitude and well-being” has been affected by her menopause—induced by surgery. She claimed that she witnessed the Veteran’s regular mood swings and absences from family events. Moreover, the Veteran endorsed her marital problems; insomnia; headaches; memory lapses; and compulsive worry about toilet facilities. Two other lay informants submitted statements this same month. In pertinent part, they repeated the contention of the (ex) sister-in-law, underscoring marital problems; insomnia; headaches; memory lapses; and compulsive worry about toilet facilities. Both informants highlighted the “genesis” of this cluster of symptoms as the Veteran’s hysterectomy and early menopause. In her September 2014 Substantive Appeal (VA Form 9), the Veteran wrote that her hysterectomy “conditions” and bladder had worsened. Further, the Veteran noted that she had been diagnosed with plantar fasciitis and pes planus. At the December 2015 Board hearing, the Veteran testified that she experienced issues with military boots that she wore most of the time in service, rubbing on her fifth toes. Unlike her earlier lay statement of June 2009, the Veteran testified that she went to sick call approximately on 4 occasions for her fifth toe issues. See December 7, 2015 Hearing Transcript, p. 6. The Veteran also testified that she sought gynecological consultation in 2003 because her uterus was drooping, noting her extensive lifting duties in service. According to the Veteran, as her drooping progressed this gynecologist indicated that heavy lifting caused her uterus issues. This eventually led to her hysterectomy; however (as the Veteran noted in her account), she could not obtain the gynecological record which dealt with her drooping pre-hysterectomy symptoms. This same month, VA received a letter from Dr. M., a private gynecologist. Dr. M. wrote that she treated the Veteran from 2000 until “around 2007.” The Veteran, according to Dr. M., underwent a hysterectomy secondary to uterine prolapse and pelvic pain. Dr. M. opined that she had advised the Veteran that heavy lifting may have contributed to the prolapse and recommended that the Veteran refrain from such lifting. The Veteran tolerated surgery well. Lastly, Dr. M. noted that she recommended that the Veteran use a support belt for lifting (if such could not be avoided). This support belt would hopefully prevent any future prolapse of the vagina, bladder, and rectum. Dr. M.’s letter referred to heavy lifting but did not directly address lifting in service or in occupations after service. A review of the Veteran’s VA treatment records reveals that the Veteran conveyed her toes’ account; hysterectomy account; and bladder issues to VA clinicians. Moreover, clinicians noted the Veteran’s surgical procedures. The Veteran was afforded both podiatric clinic and gynecological clinic consultations and services, including imaging, educational programming, nutritional guidance, and medication monitoring. In April 2017, the Veteran was afforded a battery of VA examinations. In each examination instance, a clinician reviewed the claims file; considered the Veteran’s subjective endorsements; and conducted an evaluation. Upon gynecological conditions examination, the clinician provided diagnoses of uterine prolapse and uterine fibroids. The clinician noted the Veteran’s accounts and applicable medical history, the clinician opined that the Veteran had no current symptoms related to her gynecological diagnoses. The clinician did note that the Veteran underwent a hysterectomy in June 2003. Stress incontinence that required absorbent material that is changed less than two times per day was indicated. No functional impacts on the Veteran’s ability to work were reported. The clinician opined that residuals of a hysterectomy were less likely than not incurred in or caused by the Veteran’s claimed in-service injury, event, or illness. As a rationale for this negative nexus opinion, the clinician opined that the Veteran left service in 1985. The notation as to mild uterine prolapse dated from May 1997. The Veteran’s hysterectomy was performed in 2003. Dr. M.’s letter of 2015 stated that heavy lifting could have contributed to the Veteran’s uterine prolapse; however, this was not related to the Veteran’s service. Upon foot conditions examination, the clinician provided diagnoses of bilateral flat feet; bilateral heel bone spurs; and bone spurs right fifth digit. Upon conveying the Veteran’s subjective accounts and applicable medical history, the clinician opined that bilateral flat feet caused pain on use and displayed characteristic calluses. The clinician further noted that bilateral plantar and retrocalcaneal spur formation were present, of moderate degree. X-ray imaging of April 2017 did not disclose traumatic arthritis; however, it did disclose posterior and retrocalcaneal spur formation bilaterally. The clinician opined that the above-noted bilateral foot diagnoses were less likely than not incurred in or caused by the Veteran’s claimed in-service injury, event, or illness. As a rationale for this negative nexus opinion, the clinician noted that while the Veteran endorsed multiple medical visits for foot issues during service; however, there is no associated medical evidence to reflect these endorsed visits. Upon urinary tract conditions examination, the clinician provided a diagnosis of mixed urinary incontinence. Upon consideration of the Veteran’s subjective accounts and applicable medical history, the clinician reported voiding dysfunction that requires absorbent material that is changed less than two times per day. No functional impacts on the Veteran’s ability to work were reported. The clinician opined that the Veteran’s current mixed urinary incontinence is less likely than not proximately due to or the results of a service-connected disability. As a rationale, the clinician opined that while records diagnosed stress incontinence, reports of March and July 2003 do not document urinary incontinence. In August 2019, the Veteran was afforded another battery of VA examinations. In each examination instance, a clinician reviewed the claims file; considered the Veteran’s subjective endorsements; and conducted an evaluation. Upon gynecological conditions examination, a clinician provided diagnoses of status post prolapsed uterus and hysterectomy and female sexual arousal disorder (FSAD). Upon consideration of the Veteran’s subjective accounts and applicable medical history, the clinician reported symptoms of urinary stress incontinence; hot flashes; insomnia; and dry skin. Noting the date and extent of the Veteran’s 2003 hysterectomy, the clinician reported incontinence that requires absorbent material that is changed less than two times a day. According to the clinician, the Veteran’s FSAD is at least as likely as not attributable to status post prolapsed uterus and hysterectomy. No functional impacts on the Veteran’s ability to work were reported. The clinician opined that the Veteran’s hysterectomy was less likely as not due to heavy lifting as a medical supply specialist. As a rationale for this negative nexus opinion, the clinician noted that the Veteran separated in 1985, which was 20 years before her hysterectomy. (The Board has corrected a two-year error in the rationale, which in no ways negates the rationale provided; and, as such, in no way prejudices the Veteran.) The Veteran was diagnosed with uterine prolapse in 2002. Mild uterine prolapse, according to the clinician, generally does not require treatment and definitely does not result in heavy vaginal bleeding, which the Veteran claims started in service. Moreover, the Veteran’s fibroid tumors are the most likely reason for the Veteran’s heavy bleeding and hysterectomy. Repeated heavy lifting could contribute to a mild uterine prolapse, but this would generally not result in a need for a hysterectomy. And, there are no medical records which report heavy vaginal bleeding or other vaginal concerns in service, hence it is unlikely that heavy lifting reportedly done in service would account for a hysterectomy two decades later. Upon urinary tract conditions examination, the clinician provided a diagnosis of stress incontinence. Upon conveying the Veteran’s subjective accounts and applicable medical history, the clinician reported voiding dysfunction that requires absorbent material that is changed less than two times per day. No functional impacts on the Veteran’s ability to work were reported. The clinician opined that the Veteran’s stress incontinence is at least as likely as not a residual of hysterectomy, because hysterectomy can result in bladder displacement which results in urinary incontinence. However, this clinician did not acknowledge the private medical reports of stress incontinence prior to the hysterectomy. She did not indicate that the Veteran’s stress incontinence was aggravated beyond its natural progression by an in-service event, injury, or illness. Thus, even though this clinician provided a positive nexus for stress incontinence and hysterectomy, the clinician did not opine that the Veteran’s stress incontinence was proximately caused by, or aggravated beyond its natural progression by, the Veteran’s residuals of a hysterectomy. This clinician noted a medical association between hysterectomies in general and stress incontinence in general, but did not provide a positive nexus opinion as to direct or secondary service connection for a bladder disorder Upon foot conditions examination, the clinician provided a diagnosis of left foot hallux valgus and bilateral plantar fasciitis. Upon consideration of the Veteran’s subjective accounts and applicable medical history, the clinician reported mild symptoms of left foot hallux valgus as a 1999 surgical procedure to the right fifth toe in 1999. There was no objective evidence of pain in either foot upon examination; however, the Veteran subjectively endorsed bilateral pain upon use. Indicated functional limitations upon repeated use in time and flareups was reported as the Veteran’s inability to walk for prolonged periods. However, the clinician did not opine that the Veteran’s two diagnosed foot disorders functionally impacted her ability to perform any type of occupational task. X-ray imaging disclosed the presence of degenerative arthritis in the feet. The clinician opined that the Veteran’s claimed condition was less likely than not incurred in or caused by the Veteran’s claimed in-service injury, event, or illness. As a rationale for this negative nexus opinion, the clinician indicated that spurring of the feet and toes is usually due to pressure from shoes. The Veteran had bone spurs of the right 5th metatarsal toe significant enough for partial surgery resection; however, this occurred 30 years after discharge. Moreover, pain of the magnitude requiring such surgery would result in an obvious limp and a patient would most probably seek treatment, medical care, or rest while in service. Such is not disclosed in the evidence. And, as the Veteran did not complain of pain or footwear-induced symptoms in active duty service, it is less likely than not that the Veteran’s bone spurs of the heel and toes; hallux valgus; degenerative arthritis; or plantar fasciitis were due to either footwear or lifting during service. The Veteran and her lay informants contend that a bilateral foot disorder, to include bone spurs; residuals of a hysterectomy; and a bladder disorder were incurred in, aggravated by, or otherwise attributable to, service. However, as lay persons, these parties lack the specialized medical training and expertise in the fields of podiatry, gynecology, and/or urology to render diagnoses, etiological opinions, or theories of medical proximate causation. See Jandreau, Routen, Bostain, all supra. As already noted, competent medical evidence is evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions. Competent medical evidence may also include statements conveying sound medical principles found in medical treatises. It also includes statements contained in authoritative writings, such as medical and scientific articles and research reports or analyses. 38 C.F.R. § 3.159(a)(1). Therefore, this lay evidence warrants less probative weight. The Board assigns significant probative to the VA examinations and opinions, as discussed above. In each instance a medical clinician or physician reviewed the claims file; considered the Veteran’s subjective endorsements; and conducted an evaluation. Moreover, each respective examiner rendered an opinion based in evidence (or lack thereof) and medical information. The Board takes notice of the August 2019 latest battery of VA examinations. As to the respective etiologies of bilateral foot disorder, to include bone spurs, and residuals of hysterectomy, the clinician provided a negative nexus opinion as to direct service connection. As to bladder disorder, the clinician provided a negative nexus opinion, as discussed above. The Board also places weight on the private clinical records from 1997 through 2003 that show symptoms and treatment for early menopause, urinary frequency and incontinence, and low sex drive prior to the hysterectomy. The Veteran is competent to report that a physician told her that the gynecological disorders, prolapsed uterus, and hysterectomy were caused by heavy lifting. A record of this opinion could not be recovered and was not mentioned in the private records that referred to a consultation with this physician. The report of this opinion warrants less weight because the basis for it other than a general report of lifting associated with military duties is not of record. Lifting as required by duties as a postal clerk after active service from 1985 to 2003 was not discussed by the Veteran. Here, the present disability prong of service connection for bilateral foot disorder, to include bone spurs; residuals of hysterectomy (FDAD); and bladder disorder are present. However, the weight of evidence fails to establish in-service incurrences. See Shedden, supra. The Veteran argues that these current disorders were incurred in service. As the service treatment records for both active duty and National Guard training could not be recovered, the Board acknowledges the Veteran’s report of wearing boots and heavy lifting and that she sought treatment for foot pain in service. However, the Veteran was able to continue her duties as a soldier and supply specialist throughout all periods of service and successfully completed the May 1997 physical readiness testing. Establishing service connection on a presumptive basis for bilateral foot disorder, to include bone spurs, is also not possible here. While August 2019 clinician indicated x-ray evidence of degenerative arthritis of the feet, this degenerative arthritis was not diagnosed within one year from the Veteran’s separation from service, foreclosing a grant of service connection on a presumptive basis. See 38 C.F.R. §§ 3.307(a), 3.309(a). And, as a matter of law, secondary service connection cannot be established upon a non-service-connected disability. Hence, the Veteran’s contention concerning a bladder disorder as secondary to residuals of a hysterectomy (or for that matter the hysterectomy itself) is unsupportable. See Sabonis v. Brown, 6 Vet. App. 426 (1994). Here, the Veteran sincerely believes that that a bilateral foot disorder, to include bone spurs; residuals of a hysterectomy; and a bladder disorder were incurred in, aggravated by, or otherwise attributable to, service. However, the weight of competent evidence fails to support the Veteran’s beliefs. (continued next page) The preponderance of the evidence is against the Veteran’s three service connection claims; there are no doubts to be resolved. See 38 U.S.C. § 5107(b); Gilbert, supra. J.W. FRANCIS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. J. Komins, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.