Citation Nr: 21065430 Decision Date: 10/26/21 Archive Date: 10/26/21 DOCKET NO. 17-37 132 DATE: October 26, 2021 ORDER Entitlement to an increased evaluation in excess of 10 percent prior to January 30, 2020 and in excess of 20 percent thereafter for a lateral collateral ligament strain with myositis ossificans (right ankle disorder) is denied. Entitlement to service connection for right ear hearing loss is denied. Entitlement to service connection for a right knee disorder, to include as secondary to a service connected right ankle disorder is denied. FINDINGS OF FACT 1. Prior to January 30, 2020, the Veteran's right ankle disorder is manifested by no more than moderate limited motion of the ankle. 2. On/after January 30, 2020, the Veteran's right ankle disorder is manifested by no more than marked limitation of motion of the ankle. 3. The evidence of the record does not support a finding that the Veteran's right ear hearing loss began during active service or is otherwise related to an in-service injury or disease. There is no indication that right ear hearing loss manifested to a compensable degree during the one-year period following the Veteran's discharge from service. 4. The evidence of the record does not support a finding that the Veteran's right knee disorder began during active service or is otherwise related to an in-service injury or disease. There is no indication that arthritis of the right knee manifested to a compensable degree during the one-year period following the Veteran's discharge from service. CONCLUSIONS OF LAW 1. The criteria for an increased evaluation in excess of 10 percent prior to January 30, 2020 for a right ankle disorder and in excess of 20 percent thereafter are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.17a Diagnostic Code 5201-5271 2. The criteria for service connection for right ear hearing loss are not met. 38 U.S.C. §§ 1101, 1110, 1112, 1113; 38 C.F.R. §§ 3.303, 3.307, 3.309. 3. The criteria for service connection for a right knee disorder are not met. 38 U.S.C. §§ 1101, 1110, 1112, 1113; 38 C.F.R. §§ 3.303, 3.307 3.309, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1968 to January 1970. This matter comes before the Board of Veterans' Appeals (BVA or Board) on appeal from a June 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In January 2020, the Board remanded these claims for further development, which has since been substantially completed. See Dyment v. West, 13 Vet. App. 141, 146-47 (1999) (remand not required under Stegall v. West, 11 Vet. App. 268 (1998), where Board's remand instructions were substantially complied with), aff'd, Dyment v. Principi, 287 F.3d 1377 (2002). The Veteran filed service connection claims for right ear hearing loss and a right knee disorder along with an increased evaluation claim for a right ankle disorder in July 2013. In the June 2014 rating decision on appeal, the RO denied service connection for a right ear and knee disorder. The RO also continued 10 percent evaluation for the Veteran's right ankle disorder. The Veteran appealed the rating decision. During the appeal period, in a June 2020 rating decision, the RO increased the Veteran's evaluation for his right ankle disorder to 20 percent effective January 30, 2020. The Veteran's claim was last adjudicated in a June 2020 supplemental statement of the case. The Veteran continues to assert entitlement to service connection for his right ear and right knee disorder along with a higher evaluation for his right ankle disorder. Laws and Regulations Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits. VA shall consider all information lay and medical evidence of record in a case and when there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107 (2012); 38C.F.R. §3.102 (2020); Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on its merits, a preponderance of the evidence must be against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996). For the purposes of applying the laws administered by VA, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000,3000, or 4000 Hertz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385 (2020). For Veterans with 90 days or more of active service during a war period or after December 31, 1946, certain chronic diseases may be presumed to have been incurred in service if they manifest to a compensable degree within one year of separation from service. 38 U.S.C. §§ 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309; Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Hearing loss and arthritis is on the list of diseases presumed to have been incurred in-service and receives a one-year presumption. Service connection may also be granted for a disability that is proximately due to, the result of, or aggravated by a service-connected disability. 38 C.F.R. § 3.310. In such an instance, the Veteran may be compensated for the degree of disability over and above the degree of disability existing prior to the aggravation. 38 C.F.R. § 3.310 (b); see Allen v. Brown, 7 Vet. App. 439, 448 (1995). Increased Ratings Disability evaluations are determined by the application of the facts presented to VA's Schedule for Rating Disabilities (Rating Schedule) at 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and the 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. Reasonable doubt will be resolved in the Veteran's favor. 38 C.F.R. § 4.3. A Veteran's entire history is to be considered when making disability evaluations. See generally 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Where an increase in the level of a service-connected disability is at issue, the primary concern is the present level of disability. Francisco v. Brown, 7 Vet. App. 55 (1994). Staged ratings are appropriate when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. See Fenderson v. West, 12 Vet. App. 119, 126 (1999). Disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. Functional loss may be due to the absence or deformity of structures or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by the visible behavior in undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. § 4.40. In Mitchell v. Shinseki, 25 Vet. App. 32 (2011), the Court held that, although pain may cause a functional loss, "pain itself does not rise to the level of functional loss as contemplated by VA regulations applicable to the musculoskeletal system." Rather, pain may result in functional loss, but only if it limits the ability "to perform the normal working movements of the body with normal excursion, strength, speed, coordination, or endurance." Id. With respect to joints, in particular, the factors of disability reside in reductions of normal excursion of movements in different planes. Inquiry will be directed to more or less than normal movement, weakened movement, excess fatigability, incoordination, pain on movement, swelling, deformity or atrophy of disuse. 38 C.F.R. § 4.45. The intent of the Rating Schedule is 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. In Burton v. Shinseki, 25 Vet. App. 1, 5 (2011), the Court found that, when 38 C.F.R. § 4.59 is raised by the claimant or reasonably raised by the record, even in non-arthritis contexts, the Board should address its applicability. Prior to February 7, 2021, under diagnostic Code 5271, the maximum evaluation of 20 degrees is assigned for an ankle limited of motion which is marked. A 10 percent evaluation is assigned for ankle limited motion which is moderate. On/after February 7, 2021, an evaluation of 20 percent is assigned for marked limitation of motion less than 5 degrees dorsiflexion or less than 10 degrees plantar flexion. An evaluation of 10 percent is assigned for a moderate limitation of motion less than 15 degrees dorsiflexion or less than 30 degrees plantar flexion 38 C.F.R. § 4.71a, Diagnostic Code 5271. Also, for consideration, under Diagnostic code 5270, a 20 percent evaluation will be assigned for plantar flexion less than 30 degrees. A 30 percent evaluation will be assigned for ankle ankylosis in plantar flexion between 30 degrees and 40 degrees, or dorsiflexion between 0 degrees and 10 degrees. A 40 percent evaluation will be assigned for ankle ankylosis in plantar flexion at more than 40 degrees, or in dorsiflexion between 0 degrees and 10 degrees. C.F.R. § 4.71a, Diagnostic Code 5270. 1. Entitlement to an increased evaluation in excess of 10 percent prior to January 30, 2020 and in excess of 20 percent thereafter for a right ankle disorder As indicated in a January 2020 VA ankle examination, the clinical records in this case establish that the Veteran has had an ongoing right ankle disorder since his initial diagnosis. The Veteran's contention is that his initial evaluation for a right ankle disorder warrants an evaluation in excess of 10 percent prior to January 30, 2020 and in excess of 20 percent thereafter. In a June 2004 private ankle examination, the examiner diagnosed the Veteran with right ankle pain with heterotopic ossification in the medial malleolar deltoid region. The examiner noted no edema or swelling but did diagnose mild tenderness over the posterior along the tibial tendon extending to the intersection of the navicular. Weakness to resisted inversion was noted at 4 of 5 giving way to secondary pain. Pain was also noted on extreme dorsiflexion over the medial aspect of the ankle. MRI findings revealed extremely large bony exostosis of the medial malleolus with some degenerative changes in the medial gutter. Mild midfoot changes were also noted. A course of Cortisone steroid injections was prescribed. In a February 2014 VA ankle examination, the examiner diagnosed the Veteran with palpitation over lateral ligaments of the right ankle and heterotopic ossification of the right ankle in the medial malleolar area. The Veteran reported limping during flare-ups of the right ankle occurring one time a week lasting three to four days at a time. The Veteran also reported the regular use of a cane during flare-ups. Flexion of the right ankle was noted at 45 degrees or greater with no objective evidence of painful motion. Dorsiflexion was noted at 5 degrees. Functional impairment was noted with pain on movement of the right ankle noted with repetitive use. Pain on palpitation was also noted with plantar flexion of the right ankle noted at 5/5 with no evidence of right ankle ankylosis. Diagnostic imaging of the right ankle revealed abnormal findings. Regarding functional and occupational impairment, the examiner noted that the Veteran's right ankle impacts his ability to work. The examiner noted that the Veteran's right ankle disorder could impact the Veteran's safety at work. Lastly, the examiner was unable to objectively provide an objective opinion as to whether pain, weakness, fatigability, or incoordination limit the Veteran's ability during flare-ups of his right ankle without mere speculation. In an April 2017 VA ankle examination, the examiner diagnosed the Veteran with chronic right ankle sprains and heterotopic ossification of the right ankle of the medial malleolar. The Veteran reported flare-ups with increased pain when he twisted his ankle and functional impairment resulting in difficulty walking, lifting, climbing stairs, or carrying groceries. Range of motion testing reveals dorsiflexion of the right ankle at 5 degrees with planter flexion at 45 degrees with pain causing functional loss noted at 10 degrees dorsiflexion. Weight bearing pain was also noted with evidence of localized tenderness and pain on palpitation with no objective evidence of crepitus or ankylosis. Non-weight bearing pain was noted as negative. Additional functional loss on repetitive testing was also noted as negative. Joint instability of the right ankle was noted with the use of a brace regularly as an assistive device. The examiner was not able to objective provide an opinion without resulting to mere speculation as to whether pain, weakness, fatigability, or incoordination could significantly limit functional ability during flare-ups. Diagnostic imaging did not reveal any arthritic findings. Regarding functional and occupational impairment, the examiner note that the Veteran's right ankle impacts his ability to work. The examiner noted that the Veteran's right ankle disorder impacts his ability to climb ladders, stairs, or carry material of 100 lbs. by himself. After a thorough review of the record, the Board concludes that the current evidence does not provide a basis for granting a 10 percent rating percent prior to January 30, 2020 for the Veteran's right ankle. As determined by the examiner prior to January 30, 2020, there are no findings of marked limitation of motion. Although weight bearing pain and localized tenderness with pain on palpitation was noted, there were no findings of crepitus or ankylosis diagnosed to warrant the assignment of a 20 percent evaluation under diagnostic code Diagnostic Code 5270. The Board finds that, there is no evidence of marked limited motion to warrant a 20 percent evaluation prior to January 30, 2020. On/after January 30, 2020, in a January 2020 VA right ankle examination, the examiner diagnosed the Veteran with lateral collateral ligament sprain, chronic tendonitis of the right ankle, and myositis ossificans of the right ankle. The Veteran reported flare-ups of the right ankle usually occurring once or twice a week lasting approximately two to three days with functional impairment resulting in difficulty walking, climbing stairs, or carry groceries. Dorsiflexion was noted at 5 degrees with planter flexion noted at 40 degrees with no evidence of weightbearing pain, ankylosis, or crepitus. Pain on palpitation was noted with evidence of localized tenderness. The examiner also diagnosed flare-ups of the right ankle with pain, weakness, fatigability, or incoordination significantly limiting functional ability. Joint instability of the right ankle was noted with no evidence of laxity. The use of an assistive brace and cane regularly was noted for the Veteran's right ankle disorder. Diagnostic imaging studies revealed no degenerative arthritis of the right ankle. In a June 2020 VA addendum opinion, the examiner was asked to clarify the range of motion of the ankle joint and determine if there is ankylosis. The examiner explained that during range of motion testing, the Veteran was able to dorsiflexion his right ankle from 0 to 5 degrees bilaterally. The Veteran was also able to perform three repetitions of dorsiflexion and plantar flexion on the right ankle; however, after three repetitions of motion, he was unable to perform dorsiflexion of the right ankle beyond 0 degrees. The Veteran was still able to perform dorsiflexion from 0 to 5 degrees bilaterally and plantar flexion 40 degrees on the right side and 30 degrees on the left side. Thus, there is no ankylosis diagnosed. The Board has reviewed and carefully considered the Veteran's lay statements asserting that the severity of his right ankle disorder has increased. Lay people are competent to report on matters observed or within their personal knowledge. See Layno v. Brown, 6 Vet. App. 465, 470 (1994). Therefore, the Veteran is competent to provide statements of symptoms which are observable to his senses. However, the Board must emphasize that the Veteran is not competent to interpret accurately clinical findings pertaining to a right ankle disorder, as this requires highly specialized knowledge and training. 38 C.F.R. § 3.159 (a)(1). See also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). After a thorough review of the record, the Board concludes that the current evidence does not provide a basis for granting a 30 percent rating for the Veteran's right ankle disorder. As determined by the January 2020 VA examination, there were no findings of ankle ankylosis in plantar flexion between 30 degrees and 40 degrees, or dorsiflexion between 0 degrees and 10 degrees to warrant the assignment of a 30 percent evaluation under diagnostic code Diagnostic Code 5270. The Board finds that, there is no evidence of ankle ankylosis in plantar flexion between 30 degrees and 40 degrees, or dorsiflexion between 0 degrees and 10 degrees to warrant the assignment of a 30 percent evaluation. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board's consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). The Board finds that based on the evidence of the claims file, the 10 percent evaluation prior to January 30, 2020 and the 20 percent evaluation thereafter currently assigned better approximates the trajectory of the Veteran's current right ankle disorder. As the Board reviewed the Veteran's records and determined that they do not support an increased disability rating in excess of 10 percent prior to January 30, 2020 and in excess of 20 percent thereafter for this disorder, the evidence for this period preponderates against an increase so reasonable doubt provisions are inapplicable. 38 C.F.R. § 3.102 2. Entitlement to service connection for right ear hearing loss As indicated in a September 2021 Appellate Brief, the Veteran contends that his right ear hearing loss is related to his hazardous noise exposure in-service. As indicated in an April 2017 VA hearing loss examination, the clinical records in this case establish that the Veteran has had ongoing sensorineural right ear hearing loss since his initial diagnosis. The Board acknowledges that the Veteran is currently service connected for left ear hearing loss, tinnitus, and a traumatic brain injury as a result of an in-service explosion which resulted in acoustic and head trauma. Since the Veteran is competent to report what he experiences personally, the Board concedes in-service hazardous noise exposure based on the Veteran's report for the purpose of determining the etiology of the claimed condition. The more dispositive question is whether the onset of the Veteran's right ear hearing loss is related to his noise exposure in-service. Service treatment records (STRs) are bare for any complaints, diagnosis, or treatments for right ear hearing loss in-service. At a January 1970 separation examination, the Veteran did not report, nor was he diagnosed with any right ear trouble, ear drum perforation or scarring, or running ears at the close of his tour of duty. The evidence of record does not indicate that the Veteran's right ear hearing loss manifested to a compensable degree within one year since separation. In a February 2014 VA hearing loss examination, pure tone thresholds, in decibels were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 20 20 25 40 45 Maryland speech audiometry test revealed speech recognition ability of 100 percent in the right ear. The examiner diagnosed the Veteran with sensorineural hearing loss of the right ear. The examiner opined that it is less likely than not that the Veteran's hearing loss incurred in or was caused by the claimed in-service event, injury, or disease. The examiner explained that the Veteran's STRs revealed normal hearing in the right ear with no significant threshold shifts at his separation examination. The examiner also noted that the Veteran's employment after separation from service as an iron worker installing sliding as the possible etiology of the Veteran's right ear hearing loss. In an April 2017 VA hearing loss examination, pure tone thresholds, in decibels were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 20 20 25 45 50 Maryland speech audiometry test revealed speech recognition ability of 96 percent in the right ear. The examiner diagnosed the Veteran with sensorineural hearing loss of the right ear. In a January 2020 VA addendum opinion, the examiner opined that it is not at least as likely as not that the Veteran's right ear hearing loss has its onset in-service or within a year of discharge from service. The examiner explained that there is no significant threshold shifts from pre-induction to discharge from service. The examiner also explained that medical literature does not support a finding that permanent noise-induced hearing loss with a delayed onset can develop much later after the cessation of noise exposure. The Board also reviewed the Veteran's lay statements that his right ear hearing loss disorder is related to his time in-service. Lay people are competent to report on matters observed or within their personal knowledge. See Layno v. Brown, 6 Vet. App. 465, 470 (1994). Therefore, the Veteran is competent to provide statements of symptoms which are observable to his senses and there is no reason to doubt his credibility. However, the Board must emphasize that the Veteran is not competent to interpret accurately clinical findings pertaining to a right ear hearing loss disorder as this requires highly specialized knowledge and training. 38 C.F.R. § 3.159 (a)(1) (2018). See also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). The summarize, STRs reveal that that at the Veteran's separation examination, his right ear hearing was diagnosed as normal. The Veteran did not report any hearing loss during service or at separation. In-fact, it was not until many years after separation from service that the Veteran was treated for hearing loss. See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (the passage of many years between discharge from active service and the medical documentation of a claimed disability is evidence against a claim of service connection). This premise is further evidenced by the fact that the Veteran's did not apply for compensation and pension for his service-related hearing loss until many years after separation from service. While the Veteran has reported that his right ear hearing loss has been present since service, this is not found to be probative considering the other evidence of the record. It has been determined by the recent examiner that the Veteran's hearing loss is not the result of noise exposure in-service. The examiner determined that medical literature does not support a finding that permanent noise-induced hearing loss with a delayed onset can develop much later after the cessation of noise exposure. Moreover, there is no evidence at his separation examination of a significant right ear threshold change. Lastly, the examiner opined that it is not at least as likely as not that the Veteran's right ear hearing loss has its onset in-service or within a year of discharge from service. While the Veteran's representative cited medical literature in the informal hearing presentation, there was no explanation of how that literature supported this Veteran's claim in light of the above facts. As the claims file lacks evidence of a nexus between the Veteran's hearing and his time in-service, the Board finds that the onset of the Veteran's right ear hearing loss is less likely than not related to an injury, event, or occurrence in-service. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board's consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). Based on this evidence, the Board finds service connection is not warranted. The Board has considered the benefit-of-the-doubt doctrine; however, the Board does not perceive an approximate balance of positive and negative evidence. The preponderance of the evidence is against the claim, the doctrine is not applicable, and the claim must be denied. 38 U.S.C. § 5107 (b); 38 C.F.R. § 4.3. 3. Entitlement to service connection for a right knee disorder As indicated in a September 2021 Appellate Brief, the Veteran contends that his diagnosed osteoarthritis of the right knee is proximately related to falls resulting from instability associated with his service-connected right ankle disorder. As indicated in a January 2020 VA knee examination, the clinical records in this case establish that the Veteran has had an ongoing right knee disorder since his initial diagnosis. Since the Veteran is competent to report what he experiences personally, the Board concedes that the Veteran's right knee pain has progressively increased since his separation from service based on the Veteran's report for the purpose of determining etiology of the claimed condition. The more dispositive question is whether the onset of the Veteran's right knee disorder is related to or aggravated by his service connected right ankle disorder. STRs reveal that the Veteran received treatment in January 1969 for a twisted right ankle. X-ray findings were negative for an ankle fracture or any right knee residuals. The Veteran's STRs are also are bare for any complaints, diagnosis, or treatments in-service for any residuals right knee disorder associated with the Veteran's right ankle injury. At a January 1970 separation examination, the Veteran did not report, nor was he diagnosed with any right knee pain, soreness, joint or bone deformity, or arthritis. The evidence of record does not indicate that the Veteran's right knee arthritis manifested to a compensable degree within one year since separation. In a February 2014 VA knee examination, the examiner diagnosed the Veteran with osteoarthritis of the right knee. The Veteran reported flare-ups of the right knee directly related to the twisting of his right ankle which occurs numerous times over the years. The examiner opined that the Veteran's right knee is less likely than not related to incurred in or caused by the claimed in-service injury, event, or illness. The examiner explained that although there is documented evidence in the record that the Veteran consistently complained about his right ankle instability since 2004, there is no objective evidence since his discharge from military service to support the Veteran's report that his right ankle instability caused the onset of arthritis problems in his right knee. The examiner also noted that in 2004 the Veteran underwent a left knee replacement procedure which likely caused him to place more stress on his right knee over the years. The examiner also noted the Veteran's weight gain as well as his post-service employment as an iron worker along with the natural aging process as contributing factors to the onset of his right knee disorder. In a January 2020 VA knee examination, the examiner diagnosed the Veteran with right knee tendinosis and joint knee osteoarthritis. The Veteran also underwent a right knee total joint replacement in 2017. The examiner opined that it is less likely than not that the Veteran's right knee disorder was caused by the service connected right ankle injury. The examiner explained that there are many potential non-service connected variables that may have aggravated the Veteran's right knee disorder over many years. The examiner also noted the Veteran's weight gain, physical post-service occupation, and the natural aging process as contributing to the onset of the Veteran's right knee disorder. Moreover, the examiner noted a lack of documentation in the record of complaints for the Veteran's right ankle instability aggravating the Veteran's right knee disorder. The Board also reviewed the Veteran's lay statements asserting that the onset of his right knee disorder is related to his service connected right ankle disorder. Lay people are competent to report on matters observed or within their personal knowledge. See Layno v. Brown, 6 Vet. App. 465, 470 (1994). Therefore, the Veteran is competent to provide statements of symptoms which are observable to his senses. However, the Board must emphasize that the Veteran is not competent to interpret accurately clinical findings pertaining to a right knee disorder as this requires highly specialized knowledge and training. 38 C.F.R. § 3.159 (a)(1) (2018). See also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). To summarize, the Veteran's STRs reveal no complaints, diagnosis, or treatments for any right knee disorders related to his service or his service-connected right ankle disorder. Furthermore, there is no indication of any complaints or treatments for any right knee disorder related to service for many years post-service. See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (the passage of many years between discharge from active service and the medical documentation of a claimed disability is evidence against a claim of service connection). This premise is further evidenced by the fact that the Veteran did not file a compensation claim for his service-related right knee disorder until many years after discharge. Moreover, it is not shown that the right ankle disorder was so severe as to alter the Veteran's gait or otherwise create excessive stress on the right knee. As such, the foregoing summary of the treatment record reveals no possibility for service connection for a right knee disorder on a primary or secondary basis. Although the Veteran contends that the onset of his right knee disorder is related to his service connected right ankle disorder, there is no in-service treatment for right knee problems, or for many years after discharge. Moreover, the Veteran was not diagnosed, nor did he report any right knee problems at various VA outpatient examinations post-service. Furthermore, the Board acknowledges the most recent January 2020 VA examiner opinion. The examiner opined that the Veteran's right knee disorder is less likely than not proximately due to or the result of the Veteran's service connected right ankle disorder. The examiner explained that a cause and effect relationship between an ankle disorder and arthritis of the right knee joint has not been established to date by preponderance of the evidence. The examiner explained that there are many potential non-service connected variables that may have aggravated the Veteran's right knee disorder over many years. The examiner also noted the Veteran's weight gain, physical post-service occupation, and the natural aging process as contributing to the onset of the Veteran's right knee disorder. Moreover, the examiner noted a lack of documentation in the record of complaints for the Veteran's right ankle instability aggravating the Veteran's right knee disorder. Thus, a nexus has not been established. There is no persuasive clinical opinion to the contrary. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board's consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). (Continued on the next page) As the claims file lacks evidence of a right knee disorder secondary to the Veteran's service connected right ankle disorder, the Board finds that the evidence of the record indicates that the onset of the Veteran's right knee disorder is less likely than not related to his service connected right ankle disorder. As a pathology for a right knee disorder has not been shown to be related to the Veteran's service connected right ankle disorder, the Board finds that the clinical evidence does not support the Veteran's contentions. Based on this evidence, the Board finds service connection is not warranted. The Board has considered the benefit-of-the-doubt doctrine; however, the Board does not perceive an approximate balance of positive and negative evidence. The preponderance of the evidence is against the claim, the doctrine is not applicable, and the claim must be denied. 38 U.S.C. § 5107 (b) (2012); 38 C.F.R. § 3.102. Emily Tamlyn Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Elliot Harris 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.