Citation Nr: 20053333 Decision Date: 08/12/20 Archive Date: 08/12/20 DOCKET NO. 12-21 467 DATE: August 12, 2020 ORDER Entitlement to service connection for a left ankle disorder is denied. Entitlement to service connection for left flat foot (pes planus), to include as secondary to a service-connected left foot hallux valgus, is denied. Entitlement to service connection for sinusitis, diagnosed as allergic rhinitis, is denied. Entitlement to a non-initial rating in excess of 10 percent for post-operative left foot hallux valgus, excluding a temporary total disability rating from April 24, 2007 to September 1, 2007, is denied. Entitlement to a non-initial compensable rating for hemorrhoids is denied. Entitlement to a non-initial rating in excess of 10 percent for a left knee disorder is denied. Entitlement to a non-initial rating in excess of 10 percent for a right knee disorder is denied. FINDINGS OF FACT 1. The record contains clear and unmistakable evidence that the Veteran’s left ankle disorder pre-existed entrance to service and that there was no increase in severity of the pre-existing left ankle in service beyond the natural progression of the disorder. 2. The Veteran’s left foot pes planus did not manifest during service, is not etiologically related to any incident of active military service, and is not caused or aggravated by a service-connected disability. 3. The preponderance of the evidence is against finding that the Veteran has allergic rhinitis due to a disease or injury in service. 4. The Veteran’s service-connected left foot hallux valgus is assigned a 10 percent rating, which is the maximum schedular rating authorized for post-operative left foot hallux valgus under Diagnostic Code 5280 for unilateral hallux valgus. 5. For the entire period on appeal, the Veteran’s service-connected hemorrhoids are manifested by external tags, moderate external hemorrhoids, mild tender external hemorrhoids, and pain; there is no evidence of frequent recurrences or persistent bleeding with secondary anemia or fissures. 6. The Veteran’s left knee disorder is manifested by subjective complaints of pain and limitation of motion to, at worst, extension to 5 degrees and flexion to 100 degrees. 7. The Veteran’s right knee disorder is manifested by subjective complaints of pain, slight instability, and limitation of motion to, at worst, extension to 5 degrees and flexion to 100 degrees. CONCLUSIONS OF LAW 1. The criteria for service connection for a left ankle disorder are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for left foot pes planus due to service or service-connected disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 3. The criteria for service connection for allergic rhinitis are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 4. The criteria for a rating in excess of 10 percent for left foot hallux valgus have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.71a, Diagnostic Code 5280. 5. The criteria for a non-initial compensable rating for hemorrhoids have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.3, 4.7, 4.114, Diagnostic Code 7336. 6. The criteria for a disability rating in excess of 10 percent for the Veteran’s service-connected left knee disorder are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5256, 5257, 5258, 5259, 5260, 5261, 5262, 5263. 7. The criteria for a disability rating in excess of 10 percent for the Veteran’s service-connected right knee disorder are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5256, 5257, 5258, 5259, 5260, 5261, 5262, 5263. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Marine Corps from January 1988 to May 1993. The Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge in April 2018. A transcript of that hearing has been associated with the claims file. The issues of entitlement to service connection for a left ankle disorder, bilateral feet disorder, right foot disorder, and sinusitis and the issues of entitlement to an increased rating for a bilateral knee disorder, left foot hallux valgus, and hemorrhoids were remanded by the Board in September 2018 for further development and have since been returned to the Board for appellate review. In an April 2020 rating decision, the Agency of Original Jurisdiction (AOJ) granted service connection for right foot hallux valgus, right knee instability, and right knee extension. The AOJ also granted an increased rating for right foot plantar fascia with the addition of right foot pes planus. As there is a full grant of benefit sought for entitlement to service connection for a right foot disorder and right foot pes planus, these issues are no longer on appeal. As a result of the grant of service connection for right foot pes planus, the issue of bilateral pes planus has been recharacterized as entitlement to service connection for left foot pes planus. See Clemons v. Shinseki, 23 Vet. App. 1 (2009) (noting that when a claimant makes a claim, he is seeking service connection for symptoms regardless of how those symptoms are diagnosed or labeled). Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). To establish a right to compensation for a present disability, a Veteran must show: (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 - the so-called “nexus” requirement. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Service connection may be granted for any disease initially diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). In addition, service connection for certain chronic diseases, including arthritis, may be established on a presumptive basis by showing that the condition manifested to a degree of 10 percent or more within one year from the date of separation from service. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.307, 3.309(a); Fountain v. McDonald, 27 Vet. App. 258, 271-72 (2015). Although the disease need not be diagnosed within the presumption period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309(a). For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. If chronicity in service is not established, a showing of continuity of symptoms after discharge may support the claim. 38 C.F.R. §§ 3.303(b), 3.309; Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Secondary service connection is warranted where a disability is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Briefly, the threshold legal requirements for a successful secondary service connection claim are: (1) evidence of a current disability for which secondary service connection is sought; (2) a disability for which service connection has been established; and (3) competent evidence of a nexus between the two. Wallin v. West, 11 Vet. App. 509 (1998). When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. When all of the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the appellant prevailing in either event, or whether a fair preponderance of the evidence is against the claim, in which case the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). 1. Entitlement to service connection for a left ankle disorder is denied. The Veteran asserts that he is entitled to service connection for a left ankle disorder on the basis of aggravation of a pre-existing disorder. However, as outlined below, the evidence of record demonstrates that the Veteran’s pre-existing left ankle disorder, which was noted at service entry, was clearly and unmistakably not aggravated by service. As such, service connection cannot be established. Under ordinary circumstances for veterans of active military wartime service or peacetime service on or after January 1, 1947, for purposes of 38 U.S.C. §§ 1110, 1131, and 1137, every veteran shall be taken to have been in sound condition when examined, accepted, and enrolled for service, except as to defects, infirmities, or disorders noted at the time of the examination, acceptance, and enrollment, or where clear and unmistakable evidence demonstrates that the injury or disease existed before acceptance and enrollment and was not aggravated by such service. 38 U.S.C. § 1111. The presumption of soundness may only be rebutted by clear and unmistakable evidence that the Veteran’s disability was both preexisting and not aggravated by service. Wagner v. Principi, 370 F.3d 1089 (Fed. Cir. 2004); 38 C.F.R. § 3.304 (b). This statutory provision is referred to as the ‘presumption of soundness.’ Horn v. Shinseki, 25 Vet. App. 231, 234 (2012). In VAOGCPREC 3-2003, VA’s General Counsel reinforced that the presumption of soundness is rebutted only where clear and unmistakable evidence shows both that the condition existed prior to service and that it was not aggravated by service. The General Counsel concluded that 38 U.S.C. § 1111 requires VA to bear the burden of showing the absence of aggravation in order to rebut the presumption of sound condition. See Wagner v. Principi, 370 F.3d 1089 (Fed. Cir. 2004). Therefore, where there is evidence showing that a disorder manifested or was incurred in service, and this disorder is not noted on the Veteran’s entrance examination report, this presumption of soundness operates to shield the Veteran from any finding that the unnoted disease or injury preexisted service. See Gilbert v. Shinseki, 26 Vet. App. 48, 52-53 (2012); see also 38 C.F.R. § 3.304 (b) (‘Only such conditions as are recorded in examination reports are considered as noted.’). This presumption is only rebutted where the evidence clearly and unmistakably shows that the Veteran’s disability (1) existed before acceptance and enrollment into service and (2) was not aggravated by service. See Wagner, 370 F.3d at 1096; Bagby v. Derwinski, 1 Vet. App. 225 (1991). The two parts of this rebuttal standard are referred to as the ‘preexistence prong’ and the ‘aggravation prong.’ Horn, 25 Vet. App. at 234. The aggravation prong may be met 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 preexisting condition. Wagner, 370 F.3d at 1096; see also 38 U.S.C. § 1153. If this burden is met, then the Veteran is not entitled to service-connected benefits, and, conversely, where the presumption is not rebutted, the Veteran’s claim is one for service connection, and not aggravation. Wagner, 370 F.3d at 1096. Accordingly, no deduction for the degree of disability existing at the time of entrance shall be made if a rating is awarded. 38 C.F.R. § 3.322 (‘In cases involving aggravation by active service, the rating will reflect only the degree of disability over and above the degree of disability existing at the time of entrance into active service’). On the August 1987 enlistment examination, the medical provider noted the Veteran had a left ankle injury prior to service. On the August 1987 enlistment evaluation, the medical provider assed the Veteran to have had two or three prior left ankle sprains that resulted in being casted for six to eight weeks prior to service. The medical provider assessed that the injury has recovered and there is no recurrence of sprain. With an explicit finding of a left ankle disorder on enlistment, the presumption of soundness does not attach, as the disability was noted at entrance to service. Therefore, the only benefit that can be awarded for a left ankle disorder is service connection on the basis of aggravation of preexisting left ankle disorder. 38 U.S.C. § 1153; 38 C.F.R. § 3.306 (b). With regard to the ‘aggravation prong’, the Board finds that there is clear and unmistakable evidence that the Veteran’s preexisting left ankle disorder was not aggravated during military service beyond its natural progression. In a January 1987 service treatment record (STR), the Veteran stated he fell and twisted his left ankle playing basketball. The medical provider diagnosed the Veteran with a left ankle sprain. The imaging showed an abnormal varus stress view of the ankle. In an August 1987 examination, the medical provider noted that the Veteran had a swollen and torn ligament in the left ankle that was treated in by orthopedics in February 1987. On a May 1989 examination, the medical provider noted the Veteran had a history of hospitalization for a torn ligament in the left ankle. A January 1990 STR imaging showed the left foot/ankle has several abnormal areas. In a January 1990 follow up, the medical provider observed the Veteran to have a slight limp favoring his left side. In a February 2007 private treatment record, the medical provider noted the Veteran has a history of significant torn ligaments in the bilateral ankles. In an October 2008 private treatment record, the Veteran complained of left ankle pain. He stated he has history of left foot trauma that occurred while assisting a fellow officer in service. He stated he has generalized pain and discomfort since the injury. In a February 2009 VA treatment record, the Veteran reported chronic pain in the ankles. In a January 2010 statement in support of claim, the Veteran stated that he injured his ankles in 1998 during active service. He stated his ankles have been swollen since his injury. In a March 2010 correspondence, the Veteran stated that he had a bilateral ankle injury that was aggravated while in service. On a September 2010 VA ankle examination, the Veteran stated that his ankles pop occasionally. He stated that he experiences chronic soreness in the bilateral ankles and climbing stairs and ladders and prolonged walking aggravates the ankles. On examination, the examiner did not observe any deformity of either ankle. Imaging of both ankles show minimal deformity and degenerative changes that are most likely secondary to old trauma. The September 2010 VA examiner opined that the Veteran’s left ankle disorder is not service connected and is not aggravated by service. The examiner reasoned that there is no evidence of complaint, treatment, or evaluation for the left ankle in service. Also, the examiner stated the Veteran had a pre-existing injury, that is less likely than not aggravated by service. The examiner also found that the left ankle disorder is not secondary to the Veteran’s right ankle disorder. On the July 2012 substantive appeal, the Veteran stated that he injured his left ankle in service and was treated with ice and pain medication. He stated that he continues to have symptoms in the left ankle and the left ankle was aggravated by service. At the April 2018 Board hearing, the Veteran testified that a doctor stated his service-connected left foot disorder would cause problems with his ankles because he may tend to shift compensation from side to side. Board Hearing Transcript (T.) at 9. The Veteran also stated that he began to experience pain in his ankles during service when he went on walks with full back packs. T. at 11. The Veteran stated that he currently experiences pain and grinding in the left ankle. T. at 19. On the June 2019 VA examination, the examiner diagnosed the Veteran with left ankle degenerative changes of the tibiotalar joint with prior medial and lateral malleoli trauma, changes at the achilles tendon, and deformity of the anterior tibial epiphysis. The Veteran reported that he experienced left ankle pain with popping and puffiness with constant pain. The VA examiner stated that the Veteran’s left ankle disorder clearly and unmistakably existed prior to service. The examiner reasoned that civilian records prior to service showed that the Veteran sustained a left ankle injury in January 1987. The examiner stated that such structural injuries, although initially clinically healed, have residual structural impairment and lead to greater susceptibility to re-injury over time. The June 2019 VA examiner also opined that the clear and unmistakable evidence demonstrates that the Veteran’s left ankle disorder was not aggravated by service. The examiner reasoned that there is no evidence of left ankle injury during active duty service. The examiner stated the STRs are silent for any chronic left ankle complaints. In addition, the examiner stated that almost a decade after separation from service, when treated for right foot pain in December 2002, the Veteran stated he was physically “very active and works out every day at 4 am.” The examiner found that this is further evidence that the left ankle disorder was not aggravated during service. In addition, the examiner stated that there is no evidence that the left ankle disorder was aggravated beyond its natural progression by his service-connected lower extremity disorder because the natural history of the ankle disorder is progression over time. The June 2019 VA examiner also opined that the Veteran’s left ankle disorder is less likely than not caused by service. The examiner reasoned that the STRs are silent for any left ankle injury or complaints. Thus, it is less likely than not that the Veteran’s current left ankle disorder was incurred in or had its onset in service or is otherwise medically related to in-service injury or disease. In light of the negative medical opinion, the June 2019 VA examiner stated that although years after service the Veteran gave a history of service incurred “torn ligaments in both ankles,” the evidence in the STR does not show a left ankle injury during service. Also, the examiner acknowledged that a January 1990 bone scan incidentally mentioned an uptake in the left foot when the Veteran was treated for right foot pain but concluded that this left ankle uptake is likely due to residual of the Veteran’s injury prior to service, because there were no complaints of left ankle pain at the time of the treatment. And the examiner noted that in February 1990, the Veteran denied pain or trouble with the left foot or ankle. Given the foregoing, the Board finds that the evidence of record clearly and unmistakably shows that the Veteran’s left ankle was not aggravated by his active duty service. Wagner, 370 F.3d at 1096; Horn, 25 Vet. App. at 234. There is no basis to allow the Veteran’s claim for service connection for his preexisting left ankle disorder. Both the facts and the medical evidence, overall, provide highly significant evidence against the claim that meets this high standard. Consideration has been given to the Veteran’s assertion that his left ankle disorder was aggravated by his active service. 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, a left ankle disability, this 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). Although the Board readily acknowledges that the Veteran is competent to report left ankle pain, there is no indication that he is competent to provide an opinion that the reported ankle pain problem represented an aggravation of his left ankle disorder (as opposed to the natural waxing and waning of the condition). The Veteran has not been shown to possess the requisite medical training, expertise, or credentials needed to render a diagnosis or a competent opinion as to medical causation for the above-cited disabilities. Nothing in the record demonstrates that the Veteran has received any special training or acquired any medical expertise in evaluating ankle disorders. See King v. Shinseki, 700 F.3d 1339, 1345 (Fed. Cir. 2012). Accordingly, this lay evidence does not constitute competent medical evidence and lacks probative value. In sum, the competent evidence clearly and unmistakably shows that the Veteran’s pre-existing left ankle disorder was clearly and unmistakably not aggravated by his period of active duty. The benefit-of-the-doubt rule is not for application. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. The claim for service connection for a left ankle disorder must be denied. 2. Entitlement to service connection for left foot pes planus, to include as secondary to service-connected left foot hallux valgus, is denied. The Veteran asserts that he is entitled to service connection for left foot pes planus on a direct and secondary basis. However, as outlined below, the preponderance of the evidence of record demonstrates that the Veteran’s left foot pes planus did not manifest during, within the year following, as a result of active service, or as caused or aggravated by service-connected left foot hallux valgus. As such, service connection cannot be established on a direct or secondary basis. In a September 2007 private treatment record, the medical provider indicated the Veteran had flat foot reconstruction. On the November 2007 VA examination, the examiner stated there is pes planus. The examiner did not provide a medical opinion for the pes planus. In a February 2009 VA treatment record, the Veteran complained of chronic pain in the feet. In an October 2016 VA treatment record, the Veteran complained of constant painful tingling of the bottom of the feet. The Veteran stated he is not able to stand for long periods of time. At the April 2018 Board hearing, the Veteran testified that his doctor stated that his left foot disorder could contribute to flat feet. T. at 10. In service, he stated that he went on walks with full back packs. T. at 11. And as a result, he stated that he started to experience a lot of pain in his knees, feet, and ankles. Id. He stated that he complained about pain in the feet to treatment providers in service. Id. The Veteran stated he currently has shoe inserts for his flat feet. T. at 12. The Veteran asserts that a doctor found that his flat feet were related to service. Id. In a July 2019 VA foot examination, the examiner found the Veteran to have arthritis and pes planus of the bilateral feet. The Veteran stated he has pain in the arches of both feet. The Veteran stated he wears shoe inserts that provide partial pain relief. The Veteran stated he has flare-ups in the bilateral feet that are severe and occur daily after work. The July 2019 examiner opined that the Veteran’s left foot pes planus is more likely than not related to the left ankle disorder that had its onset prior to service and progressed over the years. The examiner also opined that the Veteran’s bilateral pes planus is less likely than not caused by service, to include long walks with full backpacks. The examiner acknowledged that this is contrary to the Veteran’s lay statements and contentions but stated, however, if the bilateral pes planus was due to the Veteran’s contention there would be evidence of pes planus during active service, and there is none. The examiner found that the Veteran’s bilateral pes planus is less likely than not caused or aggravated by service-connected left foot hallux valgus, explaining that it is instead caused by the left ankle disorder. Also, the examiner stated that the bilateral pes planus is not aggravated by the left foot hallux valgus because there is no scientific or objective basis for such an aggravation. Based on the foregoing, the Board concludes that there is no evidence that the Veteran’s left foot pes planus was manifested in service or to a compensable degree in the first year following his separation from service. Consequently, service connection for left foot pes planus on the basis that such became manifest in service and persisted, or on a presumptive basis (as a chronic disease under 38 U.S.C. § 1112), is not warranted. There is also no evidence that the Veteran’s left foot pes planus is otherwise related to service. The Veteran’s post-service treatment records are silent for an opinion relating his left foot pes planus to service. The only competent evidence in the record that addresses this question is the July 2019 VA medical opinion, which stated that the Veteran’s left foot pes planus was not related to his service. As there is no other evidence to the contrary, and the July 2019 VA medical opinion was based on a full review of the record as well as an interview and examination of the Veteran, the Board finds it persuasive. Further, the Veteran’s own statements relating his left foot pes planus to service are not competent evidence, as he is a layperson and lacks the training to provide adequate opinion regarding medical etiology. Specifically, the Veteran lacks the training to opine whether pes planus is related to an incident in service. See Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007) (Whether lay evidence is competent and sufficient in a particular case is a fact issue to be addressed by the Board rather than a legal issue to be addressed by the Veterans Court). Also, pes planus is a disease of the musculoskeletal system, and the record does not show that the Veteran has training or education in this medical field; therefore, lay evidence of the etiology is not competent nexus evidence as it is not capable of lay observation. See Barr v. Nicholson, 21 Vet. App. 303, 307-08 (2007); Layno v. Brown, 6 Vet. App. 465, 469-70. Thus, the Veteran is not competent or qualified, as a layperson, to render an opinion on medical causation. The Veteran also asserts that his left foot pes planus is caused or aggravated by his service-connected hallux valgus. However, this assertion is not supported by the record. The only competent evidence in the record that address this question is the July 2019 VA examiner’s medical opinion, which stated that the Veteran’s left foot pes planus is caused by his left ankle disorder, but not caused or aggravated by the service-connected left foot hallux valgus. The examiner provided a rationale based on a review of the medical evidence and the claims file. The Board finds the July 2019 VA medical opinion persuasive. There is no medical evidence to the contrary. While the Veteran believes his left foot pes planus is caused or aggravated by service-connected disabilities, he is not competent to provide a nexus opinion in this case. The issue is medically complex, as it requires knowledge of the musculoskeletal system. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the July 2019 VA medical opinion. In light of the foregoing, the Board concludes that the preponderance of the evidence is against the Veteran’s claim of entitlement to service connection for left foot pes planus. Accordingly, it must be denied. 3. Entitlement to service connection for sinusitis, diagnosed as allergic rhinitis, is denied. The Veteran asserts that he is entitled to service connection for allergic rhinitis on a direct basis. However, as outlined below, the preponderance of the evidence of record demonstrates that the Veteran’s rhinitis did not manifest during service or as a result of active service. As such, service connection cannot be established on a direct basis. In October 1989, the Veteran complained of a cough, congestion, and headaches. The medical provider assessed the Veteran to have mild bilateral bronchitis. In a June 1999 private treatment record, the Veteran was observed to have tender sinuses and the medical provider assessed the Veteran to have sinusitis. In a July 2017 private treatment record, the Veteran complained of cough, sinus pain, and muscle aches. The medical provider diagnosed the Veteran with sinusitis, bronchospasm, and rhinitis. At the April 2018 Board hearing, the Veteran testified that he began to have upper respiratory infections during his service in Korea. T. at 15. The Veteran stated he continued to have the upper respiratory symptoms since service. T. at 16. On the July 2019 VA sinusitis examination, the examiner diagnosed the Veteran with allergic rhinitis. The Veteran reported a history of nasal congestion, rhinorrhea, and sinus pressure. He stated symptoms are year-round. The examiner opined that the Veteran’s rhinitis is less likely than not caused by service. The examiner reasoned that the STRs are negative for complaints of, symptoms consistent with, treatment for, or a diagnosis of an allergic rhinitis or sinusitis disorder. The examiner stated that his disorder was first diagnosed several years after separation from service. The examiner noted the October 1989 STR showing treatment for acute bronchitis but stated the bronchitis was most likely acute and transient that resolved without chronicity. Based on the foregoing, the Board finds that the preponderance of the evidence does not support a finding that the Veteran’s allergic rhinitis was manifested in service or to a compensable degree in the first year following his separation from service. Consequently, service connection for rhinitis on the basis that such became manifest in service and persisted, or on a presumptive basis (as a chronic disease under 38 U.S.C. § 1112), is not warranted. Notably, the Veteran has not submitted competent evidence to show that he has suffered from rhinitis continuously since service. See 38 C.F.R. § 3.303(b); Savage v. Gober, 10 Vet. App. 488, 495-96 (1997). There is also no evidence that the Veteran’s rhinitis is otherwise related to service. The Veteran’s post-service private treatment records are silent for an opinion relating his rhinitis to service. The only competent evidence in the record that addresses this question is the July 2019 VA medical opinion, which stated that the Veteran’s rhinitis was not related to his service. As there is no other evidence to the contrary, and the July 2019 VA medical opinion was based on a full review of the record as well as an interview and examination of the Veteran, the Board finds it persuasive. Further, the Veteran’s own statements relating his rhinitis to service are not competent evidence, as he is a layperson and lacks the training to provide adequate opinion regarding medical etiology. Specifically, the Veteran lacks the training to opine whether rhinitis, in the absence of credible evidence of continuity, as here, is related to an incident in service. See Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007) (Whether lay evidence is competent and sufficient in a particular case is a fact issue to be addressed by the Board rather than a legal issue to be addressed by the Veterans Court). Also, rhinitis is a disease that affects the respiratory system, and the record does not show that the Veteran has training or education in this medical field; therefore, lay evidence of the etiology is not competent nexus evidence as it is not capable of lay observation. See Barr v. Nicholson, 21 Vet. App. 303, 307-08 (2007); Layno v. Brown, 6 Vet. App. 465, 469-70. Thus, the Veteran is not competent or qualified, as a layperson, to render an opinion on medical causation. In light of the foregoing, the Board concludes that the preponderance of the evidence is against the Veteran’s claim of entitlement to service connection for allergic rhinitis. Accordingly, it must be denied. Increased Rating Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Schedule), found in 38 C.F.R. Part 4. The Schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When reasonable doubt arises as to the degree of disability, such doubt will be resolved in the Veteran’s favor. 38 C.F.R. § 4.3. In considering the severity of a disability, it is essential to trace the medical history of the Veteran. 38 C.F.R. §§ 4.1, 4.2, 4.41. Consideration of the whole-recorded history is necessary so that a rating may accurately reflect the elements of any disability present. 38 C.F.R. § 4.2; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Although the regulations do not give past medical reports precedence over current findings, the Board is to consider the Veteran’s medical history in determining the applicability of a higher rating for the entire period in which the appeal has been pending. Powell v. West, 13 Vet. App. 31, 34 (1999). Where entitlement to compensation has been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Where VA’s adjudication of the claim for increase is lengthy and factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings, different or “staged” ratings may be assigned for such different periods of time. Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007). When adjudicating an increased rating claim, the relevant time period for consideration is the time period one year before the claim was filed. Hart, 21 Vet. App. at 509. 4. Entitlement to a non-initial rating in excess of 10 percent for post-operative left foot hallux valgus, excluding a temporary total disability rating from April 24, 2007 to September 1, 2007, is denied. The Veteran’s service-connected left foot hallux valgus has been assigned a 10 percent rating, which is the maximum schedular rating available for unilateral hallux valgus. 38 C.F.R. § 4.71a, Diagnostic Code 5280. Diagnostic Code 5280 contemplates unilateral hallux valgus and assigns a compensable, 10 percent, rating for severe unilateral hallux valgus, if equivalent to amputation of great toe or unilateral hallux valgus that has been operated on with resection of metatarsal head. 38 C.F.R. § 4.71a. When evaluating disabilities of the musculoskeletal system, 38 C.F.R. § 4.40 allows for consideration of functional loss due to pain and weakness causing additional disability beyond that reflected on range of motion measurements. DeLuca v. Brown, 8 Vet. App. 202, 206-07 (1995). Further, 38 C.F.R. § 4.45 provides that consideration also be given to weakened movement, excess fatigability, and incoordination. On the December 2006 VA foot examination, the Veteran reported that he has pain and aching in his left foot, with obvious bone distortion, which causes inflammation and irritation. He stated he has pain with standing and extensive walking. The Veteran denied flare-ups and fatigability or lack of endurance in the left foot. The Veteran denied any history of claw foot. On examination, the examiner observed the Veteran does not walk with a limp. The examiner observed that the Veteran has full range of motion of his toes and feet. The examiner also observed that the Veteran has a left foot 35 degree hallux valgus deformity and the big toe overlaps the second toe. The examiner stated there is a bunion on the outside of the foot from the valgus deformity. The imaging showed the Veteran to have left foot degenerative joint disease (DJD) and hallux valgus, but no fracture. In an April 2007 private treatment record, the Veteran underwent surgery of the left foot. In a May 2007 follow-up evaluation, the medical provider stated the Veteran is to remain non-weightbearing for two weeks and to remain in a cast for six weeks. On the May 2007 VA foot examination, the Veteran reported that he experienced pain in the left foot. The Veteran stated the pain is caused by physical activity and standing. He stated there is occasional minor swelling in the foot. The Veteran stated he underwent surgery on the left foot in April 2007 and has residual pain and swelling. On examination, the examiner observed the Veteran’s posture to be abnormal and the Veteran used a crutch as a result of recent surgery. The examiner stated that Veteran has hallux valgus of the left foot and the degree of angulation is moderate. Also, the examiner stated the Veteran has limitations with standing and walking, especially on hard surfaces, and difficulty climbing stairs. The examiner was unable to perform range of motion testing because the Veteran had a cast on the left lower leg and foot. In a July 2007 correspondence, the Veteran requested a temporary total disability rating due to April 2007 surgery. The medical provider prescribed in July 2007 that the Veteran is able to return to work in August 2007. In an August 2007 correspondence, the Veteran stated he experiences pain in the left foot. He stated he underwent surgery. On the August 2007 VA joints examination, the Veteran stated that he experiences tingling and pain in the first metatarsal of the left foot as well as in the left great toe. He stated he does not experience flare-ups. He stated his left foot hallux valgus affects his ability to perform chores and walk because of pain. He stated he has difficulty climbing stairs and prolonged sitting causes stiffness in his foot. The August 2007 VA examiner noted that the Veteran had a bunionectomy on the left foot in May 2007. On examination, the examiner observed the Veteran to have a scar over the first metatarsal that is nontender, non-raised, and not adherent to subcutaneous structures. The examiner observed the Veteran to have abnormal range of motion. The examiner indicated the Veteran had significant pain, but no weakness or fatigue with repeat flexion and extension. Also, the examiner observed the Veteran to have tenderness on palpation. The examiner indicated the Veteran walked without a limp. Further, the examiner stated there is no significant measurable hallux valgus because of the surgical procedure. An October 2007 imaging showed that the Veteran has mild hallux valgus deformity, which is significantly improved since prior imaging, and moderative degenerative changes. In a November 2007 VA examination, the Veteran reported pain in his left foot that is crushing, burning, aching, and sharp. The Veteran stated he also has pain and swelling when the foot is at rest and the pain is aggravated by prolonged walking. On examination of the skin, the examiner observed the Veteran to have a level scar on the left big toe with hypopigmentation and no tenderness, disfigurement, ulceration, adherence, instability, tissue loss, inflammation, edema, keloid formation, hyperpigmentation, and abnormal texture. On examination of the left foot, the examiner observed the range of motion to be abnormal with dorsiflexion to five degrees and plantar flexion to 20 degrees. Examiner observed the range of motion of the right foot was normal. The examiner stated the joint function on the left foot is limited by pain, fatigue, weakness, lack of endurance after repetitive use. The examiner stated the left foot hallux valgus has resolved. At the April 2018 Board hearing, the Veteran testified that his left foot disorder warrants a higher rating because the disorder interferes with his ability to wear required shoes for his employment. T. at 8. On the June 2019 VA examination, the Veteran stated that at home and work he finds it difficult to stand or walk for more than 15 minutes due to his foot pain. The June 2019 VA examiner indicated the Veteran has a diagnosis of post-operative left foot hallux valgus. The examiner stated she was unable to test the Veteran’s passive range of motion due to voluntary guarding by the Veteran due to pain. In addition, the examiner observed that the Veteran displayed minimal range of motion of the left great toe due to fusion and pain. The examiner observed hesitancy due to pain in all attempted great toe active motion, passive motion, and pain with weight-bearing and without weight-bearing. The Veteran’s left foot hallux valgus is rated 10 percent under Diagnostic Code 5280. 38 C.F.R. § 4.71a. Under that diagnostic code, a 10 percent rating is assigned for severe unilateral hallux valgus if it is equivalent to amputation of the great toe or if the unilateral hallux valgus is operated with resection of the metatarsal head. The maximum schedular rating available for unilateral hallux valgus is 10 percent. 38 U.S.C. § 1155; C.F.R. § 4.71a. As there is no legal basis upon which to award a higher schedular rating, or separate schedular rating, the appeal must be denied. Sabonis v. Brown, 6 Vet. App. 426 (1994). 5. Entitlement to a non-initial compensable rating for hemorrhoids is denied. The Veteran’s hemorrhoids have been assigned a noncompensable rating pursuant to 38 C.F.R. § 4.114, Diagnostic Code 7336. Under Diagnostic Code 7336, a noncompensable rating is warranted for mild or moderate hemorrhoids. A 10 percent rating is warranted when hemorrhoids are large or thrombotic and irreducible, with excessive redundant tissue evidencing frequent recurrences. A 20 percent rating is warranted when there are hemorrhoids with persistent bleeding and with secondary anemia, or with fissures. 38 C.F.R. § 4.114, Diagnostic Code 7336. In a September 2006 VA treatment record, the Veteran stated he occasionally uses an over the counter medication for hemorrhoids. On examination, the medical provider observed the Veteran to have an external stage two hemorrhoid with a remnant tag outside. On the October 2006 VA rectum examination, the Veteran stated he has frequent recurrence of rectal bleeding when wiping hemorrhoids. On examination, the examiner observed the Veteran to have normochromic skin tags that are non-tender. The examiner stated that the digital examination showed no other masses or lesions. In a June 2007 private treatment record, the Veteran reported painful hemorrhoids with rectal bleeding. The private treatment provider’s impression was a complex hemorrhoid with bleeding. In June 2007, the Veteran underwent a surgical repair of his hemorrhoid. In an August 2007 correspondence, the Veteran stated that he has constant swelling, itching, and burning pain that is temporarily relieved by over the counter medication. He stated that he has a tag that is painful. He stated that he had surgery to remove the hemorrhoidal tissue in June 2007. On the November 2007 VA examination, the Veteran reported anal itching, pain, and a feeling of empty bowel and swelling. He stated he does not have diarrhea or perianal discharge. He stated the hemorrhoids recur frequently. He stated he had surgery in June 2007. He reported that he treats the hemorrhoids with over the counter medication. On examination, the examiner found no evidence of hemorrhoids. The examiner observed small anal skin tags. The examiner stated the condition has resolved and there is no anemia or findings of malnutrition. A January 2010 private treatment record the medical provider found no hemorrhoids. In a January 2011 private treatment record, the medical provider observed the Veteran to have hemorrhoids and recommended treatment with over the counter medication. In a December 2012 statement in support of claim, the Veteran stated that he has undergone surgery for his hemorrhoids and his hemorrhoids have worsened since his last VA examination. In a December 2013 VA hemorrhoids examination, the Veteran reported experiencing daily leakage and occasional bleeding. The examiner found the Veteran to have moderate external hemorrhoids. At the April 2018 Board hearing, the Veteran testified he experiences pain. T. at 6. He stated his doctor stated he had a tag. Id. The Veteran stated he uses an over the counter medication to relieve flare-ups. T at 7. The Veteran testified that he was referred for surgery and underwent the procedure a week prior to the Board hearing. Id. In an April 2018 private treatment record, the Veteran complained of rectal pain. On examination, the medical provider observed a mild tender external hemorrhoid. In an April 2018 private treatment letter, a medical provider stated that the Veteran presents with hemorrhoids that are painful. The Veteran stated the pain lasted for two to three weeks. The Veteran stated the hemorrhoids are easily irritated. On the July 2019 VA hemorrhoids examination, the examiner diagnosed the Veteran with internal and external hemorrhoids. The examiner indicated that the Veteran’s hemorrhoids do not require continuous mediation. The examiner observed the Veteran to have mild hemorrhoids and on examination the examiner observed no external hemorrhoids and found skin tags only. Upon review of the record, the Board finds that a compensable rating is not warranted for the Veteran’s hemorrhoids under Diagnostic Code 7336 throughout the period on appeal. The record demonstrates that the Veteran’s hemorrhoids are, at worst, moderate or mild without objective evidence of thrombotic hemorrhoids, excessive redundant tissue, frequent recurrences, or persistent bleeding with anemia or fissures. There is simply no objective medical evidence of record to establish that the Veteran has experienced thrombotic hemorrhoids, excessive redundant tissue, frequent recurrences, or persistent bleeding with anemia or fissures. Therefore, a compensable rating is not warranted. 6. Entitlement to a non-initial rating in excess of 10 percent for a left knee disorder is denied. 7. Entitlement to a non-initial rating in excess of 10 percent for a right knee disorder is denied. Disability of the musculoskeletal system is primarily the inability, due to damage or infection in the parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. It is essential that the examination on which ratings are based adequately portrays the anatomical damage, and the functional loss, with respect to all these elements. The functional loss may be due to absence of part, or all, of the necessary bones, joints and muscles, or associated structures, or to deformity, adhesions, defective innervation, or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part which becomes painful on use must be regarded as seriously disabled. 38 C.F.R. §§ 4.10, 4.40, 4.45. VA must analyze the evidence of pain, weakened movement, excess fatigability, or incoordination and determine the level of associated functional loss in light of 38 C.F.R. § 4.40, which requires VA to regard as “seriously disabled” any part of the musculoskeletal system that becomes painful on use. DeLuca v. Brown, 8 Vet. App. 202 (1995). The intent of the Rating Schedule is to recognize painful motion with joint or periarticular pathology as productive of disability. It is the intention to recognize actually painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59. The Board is also required to consider the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the Veteran, as well as the entire history of the Veteran’s disability. 38 C.F.R. §§ 4.1, 4.2; Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991). The evaluation of the same disability under several diagnostic codes, known as pyramiding, must be avoided; however, separate ratings may be assigned for distinct disabilities resulting from the same injury so long as the symptomatology for one condition is not duplicative of the symptomatology of the other condition. 38 C.F.R. § 4.14; Esteban v. Brown, 6 Vet. App. 259, 262 (1994). Under Diagnostic Code (DC) 5260, a noncompensable rating is assigned when flexion of the knee is limited to 60 degrees; a 10 percent rating is assigned when flexion is limited to 45 degrees; a 20 percent rating is assigned when flexion is limited to 30 degrees; and a 30 percent rating is assigned when flexion is limited to 15 degrees. Under Diagnostic Code 5261, a noncompensable rating is assigned when extension of the knee is limited to 5 degrees; a 10 percent rating is assigned when extension is limited to 10 degrees; a 20 percent rating is assigned when extension is limited to 15 degrees; a 30 percent rating is assigned when extension is limited to 20 degrees; a 40 percent rating is assigned when extension is limited to 30 degrees; and a 50 percent rating is assigned when extension is limited to 50 degrees. Full range of motion of the knee is from 0 degrees to 140 degrees in extension and flexion. See 38 C.F.R. § 4.71, Plate II. Separate ratings under Diagnostic Code 5260 for limitation of flexion of the leg and Diagnostic Code 5261 for limitation of extension of the leg may be assigned for disability of the same joint. VAOPGCPREC 09-04. Under 38 C.F.R. § 4.71a, Diagnostic Code 5257, which evaluates recurrent subluxation or lateral instability, 10, 20 and 30 percent evaluations are assigned for slight, moderate, and severe recurrent subluxation or lateral instability, respectively. 38 C.F.R. § 4.71a, DC 5257. Several other Diagnostic Codes under 38 C.F.R. § 4.71a pertain to knee disabilities in addition to those above. They include Diagnostic Code 5256 for ankylosis of the knee; Diagnostic Code 5258 for dislocated semilunar knee cartilage with frequent episodes of “locking,” pain, and effusion into the joint; Diagnostic Code 5259 for symptomatic removal of the semilunar knee cartilage; Diagnostic Code 5262 for impairment of the tibia and fibula; and Diagnostic Code 5263 for genu recurvatum (acquired, traumatic, with weakness and insecurity in weight-bearing objectively demonstrated). Under Diagnostic Code 5055, a 30 percent rating is warranted as a minimum rating for knee replacement. With intermediate degrees of residual weakness, pain, or limitation of motion, the condition is rated by analogy to DC 5256, 5261, or 5262. A 60 percent rating is warranted for knee replacement with chronic residuals consisting of severe painful motion or weakness in the affected extremity. A maximum rating of 100 percent is warranted for one year following implantation of prosthesis. 38 C.F.R. § 4.71a, DC 5055. At the outset, the Board notes that the evidence does not support an award for increased ratings for the right knee under Diagnostic Code 5055 for knee replacement (prosthesis); 5256 for ankylosis of the knee; Diagnostic Code 5258 for symptomatic removal of the semilunar knee cartilage with frequent episodes of “locking,” pain and effusion to the joint; Diagnostic Code 5262 for impairment of tibia and fibula; or Diagnostic Code 5263 for genu recurvatum. This is because none of these disabilities have been demonstrated upon VA examinations performed in May 2008 and June 2019 and are not otherwise reflected in the record before the Board at any point during the appeal period. 38 C.F.R. § 4.71a, Diagnostic Codes 5055, 5256, 5258, 5262, 5263. In an August 2007 correspondence, the Veteran filed a claim for increased rating for his bilateral knees. The Veteran stated his knees are progressively worse. He stated that he has constant grinding pain that makes standing, squatting, and kneeling difficult. In a May 2008 VA examination, the Veteran reported pain, weakness, instability, and stiffness. On examination, the examiner observed the Veteran’s posture and gait to be normal. The examiner observed crepitus in the bilateral knees. The examiner observed the Veteran’s range of motion to be 140 degrees flexion in the right and left knee and zero degrees extension in the right and left knee. The examiner observed that the left knee joint function is limited by pain, fatigue, weakness, and lack of endurance after repetitive use. The bilateral knee stability is normal. On diagnostic tests, the examiner observed degenerative changes in the bilateral knees. At the April 2018 Board hearing, the Veteran testified he is having grinding pain in the knees. T. at 3. He stated that when he moves his knees, he can hear a crunching sound. Id. He stated that his knees occasionally give way a couple times a day. T at 3; 5. The Veteran confirmed he has issues squatting, walking, and a decreased range of motion and stated that he experiences swelling and soreness. T. 3-4. In an April 2019 VA treatment record, the medical provider observed tenderness in the bilateral knees with crepitus and no decreased range of motion. On the June 2019 VA examination, the examiner diagnosed the Veteran with right knee instability and indicated a continued diagnosis of bilateral knee patellofemoral pain syndrome and degenerative joint disease. The Veteran reported that he has intermittent pain and he takes prescribed medication to reduce pain. The Veteran also reported swelling during strenuous activity and intermittent instability of the right knee. He stated that squatting worsens the symptoms. The Veteran reported no flare-ups of the left knee and flare-ups in the right knee that occur once every two to three weeks that affect his ability to walk. The Veteran also reported functional loss in the knees that causes difficulty to run, walk, squat, kneel, or climbing the stairs. On examination, the June 2019 examiner observed the Veteran’s right and left knee flexion to be 5 to 100 degrees and extension 100 to 5 degrees. The examiner indicated the Veteran’s range of motion contributes to functional loss by causing decreased capacity for prolonged standing and walking. The examiner observed pain on examination in flexion and extension. The examiner also observed pain on weight bearing and tenderness or pain on palpation as well as crepitus in the bilateral knees. The examiner indicated there is no ankylosis. The examiner observed there to be slight joint instability in the right knee and none in the left knee. Also, the examiner indicated the Veteran has a history of recurrent effusion based on the history given by the Veteran. The examiner specifically noted the Veteran does not have recurrent patellar dislocation, shin splints, stress fractures, chronic exertional compartment syndrome or any other tibial or fibular impairment, or any meniscus condition. Also, the examiner found the non-weight bearing range of motion in passive and active range of motion is the same due to guarding from pain. Upon review of the evidence, the Board finds that the evidence does not support an increased rating higher than 10 percent for the Veteran’s right knee and left knee disorder, respectively, under the limitation of extension and limitation of flexion diagnostic codes. The Board finds that the Veterans right knee and left knee range of motion was never limited to the degrees required for a 20 percent rating in extension (to 15 degrees) or for even a compensable rating in flexion (to 45 degrees). Here the relevant evidence demonstrates that that the right and left knee extension and flexion were limited to, at worst, 5 degrees and 100 degrees, respectively. After reviewing the entirety of the record, the Board finds that the Veteran’s demonstrated range of motion in extension and flexion does not warrant a higher rating under these codes. Therefore, a rating in excess of 10 percent for the period on appeal, based on limitation of motion for the bilateral knees is not warranted. Also, the Board finds that the evidence does not support an increased rating higher than 10 percent for the Veteran’s right knee instability. The Board finds that the Veteran’s right knee instability was not found to be moderate as required for a 20 percent rating. Here, the relevant evidence demonstrates that the right knee instability is slight. After reviewing the entirety of the record, the Board finds that the Veteran’s demonstrated instability does not warrant a higher raring. Therefore, a rating in excess of 10 percent for the period on appeal, based on instability of the right knee is not warranted. The Board also finds that a separate rating of instability for the left knee is not warranted under Diagnostic Code 5257. The Veteran did not report instability of the left knee nor did VA treatment records or VA examinations document observations of instability of the left knee. The Board finds that this medical evidence is probative regarding the instability in the left knee. The Board does not find evidence or recurrent subluxation or lateral instability in the left knee. Therefore, a separate evaluation for instability is not warranted for the left knee under Diagnostic Code 5257. Under DCs 5003 and 5010, absent a compensable level of limited motion, the highest rating available for arthritis of a major joint such as a knee is 10 percent. The Board acknowledges that the medical evidence documents arthritis in the knee and reflects that the Veteran has complained of pain. However, as discussed, there is no evidence to suggest that the Veteran displayed functional losses of his knees tantamount to a compensable level of limited motion at any time during the period on appeal. Thus, even considering the pain on motion noted by the VA examiners and complained of by the Veteran, the Board concludes that his bilateral knee disability was not so disabling as to approximate the level of impairment required for assignment of a higher rating under the limitation of motion criteria during the period on appeal. The Board thus finds that the 10 percent ratings assigned for the right knee and left knee, respectively, during this period sufficiently compensate the Veteran for the extent of his functional loss due to limited movement, pain, weakness, and stiffness. See 38 C.F.R. §§ 4.40, 4.45 (2017); DeLuca. For all the foregoing reasons, there is no basis for a rating in excess of 10 percent for the Veteran’s knee disabilities at any point during the period on appeal. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the doubt doctrine; however, that doctrine is not applicable. See 38 U.S.C. § 5107(b); Gilbert, 1 Vet. App. 49. The claims must be denied. Caroline Fleming Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Thompson, 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.