Citation Nr: 21000849 Decision Date: 01/06/21 Archive Date: 01/06/21 DOCKET NO. 19-09 456 DATE: January 6, 2021 ORDER New and material evidence not having been received, the petition to reopen a claim of entitlement to service connection for hemorrhoids is denied. Entitlement to service connection for a left shoulder disorder is denied. Entitlement to service connection for bilateral metatarsalgia with hallux valgus is denied. Entitlement to service connection for psoriasis with plantar warts is denied. FINDINGS OF FACT 1. In an unappealed August 2013 rating decision, the Veteran was denied entitlement to service connection for hemorrhoids. 2. The evidence associated with the record subsequent to the August 2013 rating decision is cumulative or redundant and does not raise a reasonable possibility of substantiating the claim of entitlement to service connection for hemorrhoids. 3. The Veteran’s left shoulder disorder was not incurred in service, and is not otherwise causally or etiologically related to service. 4. The Veteran’s bilateral metatarsalgia with hallux valgus was not incurred in service, and is not otherwise causally or etiologically related to service. 5. The Veteran’s psoriasis with plantar warts was not incurred in service, and is not otherwise causally or etiologically related to service. CONCLUSIONS OF LAW 1. The August 2013 rating decision denying the claim for service connection for hemorrhoids; new and material evidence has not been received sufficient to reopen a claim of entitlement to service connection for hemorrhoids. 38 U.S.C. §§ 5108, 7104, 7105; 38 C.F.R. § 3.156. 2. The criteria for service connection for a left shoulder disorder have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for service connection for bilateral metatarsalgia with hallux valgus have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 4. The criteria for service connection for psoriasis with plantar warts have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Marine Corps from March 1969 to March 1973, and from February 1981 to February 1984, to include service in the Republic of Vietnam. The Veteran’s awards and decorations for his service include a Vietnam Cross of Gallantry. These matters come to the Board of Veterans’ Appeals (Board) on appeal from a June 2017 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). Jurisdiction of this appeal is currently with the RO in Honolulu, Hawaii. This case was most recently before the Board in September 2020, at which time the appeal was remanded to the Agency of Original Jurisdiction (AOJ) for further development. Specifically, the petition to reopen a claim for service connection for hemorrhoids and entitlement to service connection for a left shoulder disorder were remanded for the issuance of a statement of the case under Manlincon v. West, 12 Vet. App. 238, 240-41 (1999). In addition, the claims for service connection for bilateral metatarsalgia with hallux valgus and psoriasis with plantar warts to obtain an etiology opinion. Such a statement of the case was issued in November 2020 and a substantive appeal was filed in December 2020. A VA etiology opinion was obtained in November 2020. The Board determines that there has been substantial compliance with its previous remand. Stegall v. West, 11 Vet. App. 268 (1998). The case has now been returned to the Board for appellate action. As explained in the September 2020 Board remand, the Veteran appears to assert in his July 2020 substantive appeal that there was clear and unmistakable error (CUE) in the June 2017 rating decision in that the instant claims on appeal were incorrectly decided. However, following the June 2017 rating decision, the Veteran submitted a timely notice of disagreement in June 2017 broadly disagreeing with the June 2017 rating decision. After the March 2019 statement of the case, the Veteran submitted a substantive appeal in July 2020. As such, the June 2017 rating decision is not final and a claim for CUE is not appropriate. Considering the appropriate appeal of the issues at hand, the Board will be reviewing the claims as characterized on the cover page of this decision on a de novo basis. Claim to Reopen As a threshold matter, the Board must determine whether new and material evidence has been submitted to reopen a previously denied claim. See Jackson v. Principi, 265 F.3d 1366 (Fed. Cir. 2001) (reopening after a prior unappealed RO denial) A rating decision becomes final when it has not been appealed within the prescribed time period and when no additional material evidence was received within a year of the decision; the decision is not subject to revision on the same factual basis. 38 U.S.C. § 7105(b); 38 C.F.R. §§ 3.104, 20.302, 20.1103. In order to reopen a claim, there must be added to the record “new and material evidence.” 38 U.S.C. § 5108. New evidence means existing evidence not previously submitted to agency decisionmakers. Material evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can neither be cumulative or redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156. The law provides that new and material evidence necessary to reopen previously and finally disallowed claims must be secured or presented since the time that the claims were finally disallowed on any basis, not only since the time the claims were last disallowed on the merits. See Evans v. Brown, 9 Vet. App. 273, 285 (1996). 38 C.F.R. § 3.156(a), which defines new and material evidence, requires that evidence raise a reasonable possibility of substantiating the claim in order to be considered “new and material,” and defines material evidence as evidence, that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. The Court of Appeals for Veterans Claims (Court) has held that the determination of whether newly submitted evidence raises a reasonable possibility of substantiating the claim should be considered a component of the question of what is new and material evidence, rather than a separate determination to be made after the Board has found that evidence is new and material. See Shade v. Shinseki, 24 Vet. App. 110 (2010). The Court further held that new evidence would raise a reasonable possibility of substantiating the claim if, when considered with the old evidence, it would at least trigger the Secretary’s duty to assist by providing a medical opinion. Id. For the purpose of establishing whether new and material evidence has been submitted, the credibility of the evidence is to be presumed. Justus v. Principi, 3 Vet. App. 510, 513 (1992). When all the evidence is assembled, the Secretary is then 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; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). The Veteran’s claim for service connection for hemorrhoids was originally denied in a rating decision decided in August 2013. Specifically, the rating decision indicated the Veteran’s hemorrhoids were not incurred in nor caused by his active service; nor was there evidence of aggravation of his hemorrhoids during a period of active duty. As a result, his claim was denied. Evidence considered in the August 2013 rating decision includes the Veteran’s service treatment records, post-service VA and private treatment records and VA examination report. In September 2013, the Veteran was advised of the decision and his appellate rights. However, no further communication regarding his claim of entitlement to service connection was received until March 2017, when VA received his instant petition to reopen his claim for entitlement to service connection for hemorrhoids. Therefore, the August 2013 rating decision is final. 38 U.S.C. § 7105(c); 38 C.F.R. §§ 3.104, 20.302, 20.1103. In this regard, the Board has considered the applicability of 38 C.F.R. § 3.156(b), which provides that, when new and material evidence is received prior to the expiration of the appeal period, it will be considered as having been filed in connection with the claim which was pending at the beginning of the appeal period. However, in the instant case, such regulation is inapplicable as no relevant evidence pertaining to the Veteran’s claims for service connection was received prior to the expiration of the appeal period stemming from August 2013 rating decision. See also Long v. Wilkie, 2020 U.S. App. Vet. Claims LEXIS 2371; Bond v. Shinseki, 659 F.3d 1362, 1367 (Fed. Cir. 2011); Roebuck v. Nicholson, 20 Vet. App. 307, 316 (2006); Muehl v. West, 13 Vet. App. 159, 161-62 (1999). Moreover, no additional service records (warranting reconsideration of the claim) have been received at any time. See 38 C.F.R. § 3.156(c). The pertinent evidence that has been received since the August 2013 rating decision includes continuing post-service treatment records. The Board finds that while some of the evidence added to the record is new, as it was not previously considered by VA, it is duplicative and not material as it does not specifically address the reason the claim was previously denied. Specifically, the Veteran has not submitted any new evidence indicating that he has such disability was is etiologically related to his active service. To the extent that the Veteran submitted new statements relating his claimed hemorrhoids, such statements are duplicative or cumulative of statements that were previously submitted. Therefore, the Board finds that new and material evidence has not been presented sufficient to reopen the Veteran’s claim of entitlement to service connection for hemorrhoids. Accordingly, reopening of the claim of entitlement to service connection for hemorrhoids is not warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra.   Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection requires: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); see also Caluza v. Brown, 7 Vet. App. 498 (1995). Service connection may also be granted for any disease diagnosed after discharge when the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Direct service connection may not be granted without evidence of a current disability; in-service incurrence or aggravation of a disease or injury; and a nexus between the claimed in-service disease or injury and the present disease or injury. Id.; see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff’d, 78 F.3d 604 (Fed. Cir. 1996) [(table)]. Where a veteran served for at least 90 days during a period of war or after December 31, 1946, and manifests certain chronic diseases to a degree of 10 percent within one year, from the date of termination of such service, such disease shall be presumed to have been incurred or aggravated in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1110, 1112, 1131; 38 C.F.R. §§ 3.307, 3.309. The Veteran has not been diagnosed with a chronic disease for purposes of presumptive service connection and these provisions are not applicable. Alternatively, when a disease at 38 C.F.R. § 3.309(a) is not shown to be chronic during service or the one-year presumptive period, service connection may also be established by showing continuity of symptomatology after service. See 38 C.F.R. § 3.303(b). However, the use of continuity of symptoms to establish service connection is limited only to those diseases listed at 38 C.F.R. § 3.309(a) and does not apply to other disabilities which might be considered chronic from a medical standpoint. See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Pertinent to a claim for service connection, such a determination requires a finding of a current disability that is related to an injury or disease in service. Watson v. Brown, 4 Vet. App. 309 (1993); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); Rabideau v. Derwinski, 2 Vet. App. 141, 143 (1992). Under applicable regulation, the term “disability” means impairment in earning capacity resulting from diseases and injuries and their residual conditions. 38 C.F.R. § § 4.1; see also Hunt v. Derwinski, 1 Vet. App. 292, 296 (1991); Allen v. Brown, 7 Vet. App. 439 (1995); Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018) (the term “disability” as used in 38 U.S.C. § 1110 “refers to the functional impairment of earning capacity, not the underlying cause of said disability,” and held that “pain alone can serve as a functional impairment and therefore qualify as a disability”). 1. Left Shoulder The Veteran generally asserts that he has a left shoulder disorder that is related to his active service. Specifically, the Veteran seems to assert that his left shoulder disorder was conceded and shown during a period of active service, aggravated during a period of active duty service, and therefore should be service connected. See Correspondence, December 2, 2020. Service treatment records are negative for any complaints, treatments or diagnoses related to a left shoulder disorder. The Veteran’s examinations during service were consistently shown to be normal with respect to his joints. A March 1973 service discharge examination found the Veteran’s shoulder and upper extremities to be normal, and notes one scar in the Veteran’s left arm. Post-service VA and private treatment records show the Veteran had left arm surgery in April 2018, and had a device implanted into his left shoulder. See generally, VA treatment record, February 25, 2019. He has a current left shoulder disorder diagnosis that includes surgical intervention of the left humoral fracture. See, VA treatment record, May 21, 2018. The normal clinical findings throughout service, as well as the absence of any clinical records demonstrating the diagnosis or treatment for many years after service is probative evidence against the claim for service connection for the left shoulder disorder. Maxson v. Gober, 230 F.3d 1330 (Fed. Cir. 2000). Moreover, no competent, credible evidence has been received showing a nexus between the claimed left shoulder disorder and active service. The only evidence of the claimed left shoulder disorder during active service are the Veteran’s own statements. As a layman, the Veteran is generally not competent by training or experience to provide an etiology between the current claimed left shoulder disorder and service. The issues are medically complex and require specialized knowledge and experience with several areas of medical expertise, including orthopedics, as well as the ability to interpret laboratory and radiographic studies. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007) The Board notes that the Veteran has not been afforded a VA examination addressing his claimed left shoulder disorder. However, the Board finds that such an examination is not required VA must provide a medical examination and medical opinion when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, and (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran’s service or with another service-connected disability, but (4) insufficient competent medical evidence on file for the VA to make a decision on the claim. See McLendon v. Nicholson, 20 Vet. App. 79, 81-82 (2006). Here, there is no evidence a left shoulder disorder until many decades after the Veteran’s separation from service. Further, the Veteran has not identified any in-service disease or injury to which his left shoulder disorder can be linked. While the Veteran himself has advanced such a theory, a mere conclusory generalized lay statement that service event or illness caused the claimant’s current condition is insufficient to require the Secretary to provide an examination. See Waters v. Shinseki, 601 F.3d 1274, 1278 (2010). The Court has held that VA is not required to provide a medical examination when there is not credible evidence of an event, injury, or disease in service. See Bardwell v. Shinseki, 24 Vet. App. 36 (2010). Therefore, the Board finds that a VA examination and/or etiology opinion is not necessary to decide the claim for service connection for a left shoulder disorder. The Board also considered the lay statements made by the Veteran in support of his claim, to include the contentions that his left shoulder condition was conceded and shown during a period of active service, aggravated during a period of active duty service, and therefore should be service connected. However, he has not reported being diagnosed with a left shoulder disorder during active service. Simply having symptoms of pain does not constitute a diagnosis of a left shoulder disorder, as this condition has a specifically defined set of clinical criteria which must be met. Moreover, lay witnesses are competent to provide testimony or statements relating to symptoms or facts of events that the lay witness observed and is within the realm of his or her personal knowledge, but not competent to establish that which would require specialized knowledge or training, such as medical expertise. Layno v. Brown, 6 Vet. App. 465, 469-70 (1994). Lay evidence may also be competent to establish medical etiology or nexus. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009). However, “VA must consider lay evidence but may give it whatever weight it concludes the evidence is entitled to” and a mere conclusory generalized lay statement that service event or illness caused the claimant’s current condition is insufficient to require the Secretary to provide an examination. Waters v. Shinseki, 601 F.3d 1274, 1278 (2010). In the instant case, the Board finds that the question regarding the potential relationship between the Veteran’s left shoulder disorder and any instance of his service to be complex in nature. Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). Specifically, while the Veteran is competent to describe his current left shoulder symptoms, such as pain, the Board accords their statements regarding the etiology of such a disorder little probative value as he is not competent to opine on such a complex medical question. Specifically, where the determinative issue is one of medical causation, only those with specialized medical knowledge, training, or experience are competent to provide evidence on the issue. See Jones v. Brown, 7 Vet. App. 134, 137 (1994). In this regard, the question of causation involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship, and requires the administration and interpretation of diagnostic testing such as a sleep study. In the instant case, there is no suggestion that the Veteran has had any medical training. As such, the question of etiology in this case may not be competently addressed by lay evidence, and the opinions of the Veteran are nonprobative evidence. As discussed, to the extent that the Veteran contends that the left shoulder disorder existed in service, the Board finds that contemporaneous medical evidence showing no such disorder at separation to be of greater probative value. In reaching this decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, the preponderance of the evidence is against the Veteran’s claim for service connection for left shoulder disorder. As such, that doctrine is not applicable in the instant appeal, and his claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. 2. Bilateral Metatarsalgia with Hallux Valgus and Psoriasis with Plantar Warts The Veteran generally asserts that he has bilateral metatarsalgia with hallux valgus and psoriasis with plantar warts that are related to his active service. Specifically, the Veteran seems to assert that his bilateral metatarsalgia with hallux valgus and psoriasis with plantar warts existed during service, were caused or aggravated by military service, and that he was presumed sound upon entry into active service. See Correspondence, December 2, 2020. Service treatment records show the Veteran complained of foot trouble, and had a left heel plantar wart or “blister” during active service. See Service Treatment Record (STR), May 1, 1982; see also STR December 8, 1969. Post-service VA and private treatment records show the Veteran has multiple diagnoses that include plaque psoriasis, plantar warts, bilateral metatarsalgia, and bilateral hallux valgus. See VA treatment record, September 28, 2011 (indicating the Veteran reported a skin disorder began during active service, and he believed it was related to herbicide agent exposure); see VA treatment record, December 17, 2015 (showing a diagnosis of plaque psoriasis since the 1980s); see also VA treatment record, December 28, 2012 (showing a diagnosis of psoriasis); see generally VA examination report, April 27, 2017. The Veteran was afforded a VA examination for his bilateral metatarsalgia with hallux valgus and psoriasis with plantar warts in April 2017. At this time, the examiner diagnosed plantar warts, metatarsalgia, and hallux valgus. The Veteran reported that he developed chronic plaque psoriasis in the 1980s, and developed a plantar wart on his left foot. With regard to his bilateral metatarsalgia and hallux valgus, the Veteran reported that the onset was in 2006, that he did not report a specific foot trauma and that he gradually developed pain at the ball of his foot that was described as sharp needle-like pain at the balls of his feet. The VA examiner opined that there was a lack of medical literature to support that the Veteran’s skin condition of plantar warts contributed to a biomechanical foot condition; and as such, the Veteran’s bilateral metatarsalgia and hallux valgus was less likely than not incurred in or caused by the treatment for plantar wars during active service. The Board found this opinion to be inadequate to decide the claims in its September 2020 decision. The Veteran was afforded VA examinations for his bilateral metatarsalgia with hallux valgus and psoriasis with plantar warts in November 2020. With regard to his bilateral metatarsalgia and hallux valgus, the examiner diagnosed bilateral pes planus. The Veteran reported that he was first treated for a left plantar wart in December 1969 during active service, that the warts had resolved, that a toe fracture had healed and his bilateral pes planus was ongoing. With regard to the Veteran’s psoriasis with plantar warts, the examiner diagnosed psoriasis. The Veteran reported that he first noted plaques on his scalp in 1995 and that the plaques on his scalp resolved but now had the plaques on his hand, elbows, and tailbones. The examiner also noted that the Veteran previously had plantar warts that resolved in 2017 and were not observed on examination. The November 2020 VA examiner opined that the Veteran’s bilateral metatarsalgia with hallux valgus and psoriasis with plantar warts were less likely than not as a result of his active service. In this regard, the examiner noted that there were no medical records to support a diagnosis of hallux valgus during service, that on examination there were no plantar warts or hallux valgus noted and that the Veteran also denied foot pain and stated that his foot pain resolved when the plantar warts resolved. The examiner noted current psoriatic lesions noted on the bilateral hands, elbows, and tailbone. Moreover, the examiner noted that the Veteran’s pes planus was likely congenital, and therefore less likely than not due to his service. Further, the examiner noted that the wart in the service was in 1969 and only located on the left foot, and not present during separation; therefore, the warts present in 2017 were likely a new infection. Additionally, the examiner noted there was absolutely no evidence of warts at the time of the examination, no diagnosis of metatarsalgia, and no diagnosis of hallux valgus at this time; and that there was no military medical record evidence of psoriasis during the Veteran’s active service, and that the diagnosis of psoriasis was not noted until 2011. Therefore, there was no nexus established, and the claims were less likely than not related to his service. With regard to any conflicting medical evidence, the November 2020 VA examiner opined that it was less likely than not that any psoriasis with plantar warts had its onset during any period of service or was otherwise related to such service. In this regard, the examiner noted the Veteran did not currently have plantar warts and the Veteran stated the condition resolved in 2017 with home treatment. The examiner further noted that the Veteran stated that the foot pain and metatarsalgia resolved with the resolution of his warts, that the Veteran reported he first noticed plaque psoriasis on his scalp around 1995, that the diagnosis for psoriasis was made in October 2011 and there was no history of psoriasis found in the Veteran’s military service medical records. The examiner noted that the Veteran was diagnosed with a plantar wart of the left foot in December 1969, without any further mention in the medical records, and there was no current wart noted on the examination. The examiner also opined that it was less likely than not that the Veteran’s bilateral foot disorder had its onset during any period of service or was otherwise related to such service. In that regard, the examiner noted the Veteran did not have hallux valgus on examination, had mild pes planus, with onset that was unclear but was most likely congenital. The examiner noted that there was no mention in the medical records of pes planus, although the Veteran reported he had flat feet as long as he could remember; and that the metatarsalgia resolved with the resolution of his plantar warts. Finally, the examiner noted there were no medical records linking the warts in the military to the warts diagnosed in 2017, which had now resolved. The Board affords significant probative value to this November 2020 VA opinion, which assesses the nature of the Veteran’s bilateral metatarsalgia with hallux valgus, pes planus, psoriasis, and plantar warts against his military service, service treatment records, post-service treatment records, and statements thereon. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008) (holding that the probative value of a medical opinion comes from the “factually accurate, fully articulated, sound reasoning for the conclusion”). There is no contrary opinion of record. The Board also considered the lay statements made by the Veteran in support of his claims, to include the contentions that his bilateral metatarsalgia with hallux valgus and psoriasis with plantar warts existed during service, were caused or aggravated by military service, and that he was presumed sound upon entry into active service. However, he has not reported being diagnosed with bilateral metatarsalgia with hallux valgus and psoriasis with plantar warts during active service. Simply having symptoms does not constitute diagnoses of bilateral metatarsalgia with hallux valgus and psoriasis with plantar warts, as these conditions have a specifically defined set of clinical criteria which must be met. Moreover, lay witnesses are competent to provide testimony or statements relating to symptoms or facts of events that the lay witness observed and is within the realm of his or her personal knowledge, but not competent to establish that which would require specialized knowledge or training, such as medical expertise. Layno v. Brown, 6 Vet. App. 465, 469-70 (1994). Lay evidence may also be competent to establish medical etiology or nexus. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009). However, “VA must consider lay evidence but may give it whatever weight it concludes the evidence is entitled to” and a mere conclusory generalized lay statement that service event or illness caused the claimant’s current condition is insufficient to require the Secretary to provide an examination. Waters v. Shinseki, 601 F.3d 1274, 1278 (2010). In the instant case, the Board finds that the question regarding the potential relationship between the Veteran’s bilateral metatarsalgia with hallux valgus and psoriasis with plantar warts and any instance of his service to be complex in nature. Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). Specifically, while the Veteran is competent to describe his current symptoms, such as dry skin and pain, the Board accords their statements regarding the etiology of such disorders little probative value as he is not competent to opine on such a complex medical question. Specifically, where the determinative issue is one of medical causation, only those with specialized medical knowledge, training, or experience are competent to provide evidence on the issue. See Jones v. Brown, 7 Vet. App. 134, 137 (1994). In this regard, the question of causation involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship, and requires the administration and interpretation of diagnostic testing such as a sleep study. In the instant case, there is no suggestion that the Veteran has had any medical training. As such, the question of etiology in this case may not be competently addressed by lay evidence, and the opinions of the Veteran are nonprobative evidence. As discussed, to the extent that the Veteran contends that the bilateral metatarsalgia with hallux valgus and psoriasis with plantar warts existed in service, the Board finds that contemporaneous medical evidence showing no such disorders at separation to be of greater probative value. The Board finds that the only probative medical evidence of record, the findings and opinions of the November 2020 VA examiner, to be of greater probative value than the Veteran’s lay contentions. In reaching this decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, the preponderance of the evidence is against the Veteran’s claims for service connection for bilateral metatarsalgia with hallux valgus and psoriasis with plantar warts. As such, that doctrine is not applicable in the instant appeal, and his claims must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. KRISTY L. ZADORA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Mariah N. Sim, 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.