Citation Nr: 21011646 Decision Date: 03/02/21 Archive Date: 03/02/21 DOCKET NO. 11-23 878 DATE: March 2, 2021 ORDER Entitlement to service connection for a bilateral foot disorder to include as residuals of a cold weather injury, claimed as cold weather injury feet (frostbite), is denied. FINDINGS OF FACT 1. The weight of the medical and other evidence of record is against a finding that the Veteran has a bilateral foot condition, claimed as cold weather injury feet (frostbite), that had its onset in-service or is otherwise related to a disease or injury during military service. 2. A bilateral foot condition, claimed as cold weather injury feet (frostbite), was not manifest to a compensable degree within one year of separation from active duty service and is not otherwise related to military service. CONCLUSION OF LAW The criteria for entitlement to service connection for a bilateral foot disorder to include as residuals of a cold weather injury have not been met. 38 U.S.C. §§ 101, 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 4.104, diagnostic code (DC) 7122. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty in the U.S. Army from January 1978 to January 1981. This matter comes before the Board of Veterans’ Appeals (Board) from an October 2009 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Montgomery, Alabama. The Veteran testified at an April 2014 Board Central Office hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the claims file. The matter was previously remanded in July 2014, August 2018, and August 2020 for further development. The case is now before the Board for further action. Entitlement to service connection for a bilateral foot disorder to include as residuals of a cold weather injury. The Veteran essentially contends that the frigid weather during Basic Training at Fort Knox has caused his current foot conditions. See August 2011 Veteran Correspondence. Duty to Notify and Assist Neither the Veteran nor his representative has raised any issues with the duty to notify or duty to assist. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board...to search the record and address procedural arguments when the veteran fails to raise them before the Board”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). The Board notes that previous remand orders directed that the Veteran provide private medical treatment records previously identified at the April 2014 Board Central Office hearing. See April 2014 Board Central Office hearing transcript. The Board specifically directed, “Request that the Veteran complete VA Form 21-4142 for Dr. C.F., Dr. M.G., and Dr. I.R.M. Make two requests for authorized records, unless it is clear after the first request that a second request would be futile.” See August 2020 Board remand. In August and October 2020, requests were made of the Veteran to “complete and return the enclosed VA Form 21-4142, Authorization to Disclose Information to the Department of Veterans Affairs, and VA Form 21-4142a, General Release for Medical Provider Information to the Department of Veterans Affairs (VA).” See August and October 2020 VA Subsequent Development Letters. To date, no response has been received from the Veteran to these requests. As for VA’s duty to assist the Veteran, medical examinations and medical opinions have been obtained, sufficient to apply the applicable rating criteria and to make a decision on the claim. See 38 C.F.R. §§ 4.14, 4.40, 4.59, 4.104. The Board finds that VA has done everything reasonably possible under 38 C.F.R. § 21.1032(a) to assist the Veteran. A remand or further development of this claim would serve no useful purpose. VA has satisfied its duties to inform and assist the Veteran in this case. See 38 U.S.C. §§ 5103, 5103A; 38 C.F.R. § 21.1032(a). Further, the RO’s efforts have substantially complied with the instructions contained in the August 2020 Board remand. See Stegall v. West, 11 Vet. App. 268 (1998). The entire record was available to the October 2014, September 2017, October 2019, and November 2020 examiners. Further, examinations were performed, and the testing was sufficient to adequately address all potential rating criteria. See October 2014, September 2017, October 2019, and November 2020 VA examination reports. Further development and further assistance by VA are not warranted. Service Connection Generally, to prevail on a claim for service connection on the merits, there must be competent evidence of (1) a current disability, (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury, and (3) medical evidence or other competent evidence of a nexus between the claimed in-service disease or injury and the present disease or injury. See Hickson v. West, 12 Vet. App. 247 (1999); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). An alternative method of establishing the second and third elements of service connection is by establishing continuous symptoms since service. See Barr v. Nicholson, 21 Vet. App. 303, 307 (2007). Continuity of symptomatology may be established if a claimant can demonstrate (1) that a condition was “noted” during service; (2) evidence of post-service continuity of the same symptoms; and (3) medical or, in certain circumstances, lay evidence of a nexus (causal connection) between the present disability and the post-service symptoms. Savage v. Gober, 10 Vet. App. 488 (1997); 38 C.F.R. § 3.303(b). However, the theory of continuity of symptomatology can only be used in cases involving those medical conditions explicitly recognized as “chronic” under 38 C.F.R. § 3.309(a). See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); see also Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006) (“[T]he Board cannot determine that lay evidence lacks credibility merely because it is unaccompanied by contemporaneous medical evidence”). The Board must determine, on a case by case basis, whether the Veteran’s particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011). Although the Veteran is competent to provide a diagnosis of an observable condition such as a headache, varicose veins, or tinnitus, the Veteran is not competent to provide evidence as to more complex medical questions, such as the etiology of residuals of a cold weather injury pathology. See Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). Although the credibility of lay evidence may not be refuted solely by the absence of corroborating medical evidence, it is a factor. Buchanan v. Nicholson, 451 F.3d 1331, 1336 (Fed. Cir. 2006) (lay evidence concerning continuity of symptoms after service, if credible, may be competent, regardless of the lack of contemporaneous medical evidence). Other factors are the lapse of time in recollecting events attested to, prior conflicting statements as opposed to consistency with other statements and evidence, internal consistency, facial plausibility, bias, interest, the length of time between alleged incurrence of disability and the earliest or first corroborating medical or lay evidence thereof, and statements given during treatment (which are usually given greater probative weight, particularly if close in time to the onset thereof). A Veteran is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence on any issue material to the claim. See 38 U.S.C. § 5107 (West 2014); 38 C.F.R. § 3.102 (2016) (providing, in pertinent part, that reasonable doubt will be resolved in favor of the Veteran). When the evidence supports the claim or is in relative equipoise, the claim will be granted. See Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990); see also Wise v. Shinseki, 26 Vet. App. 517, 532 (2014). If the preponderance of the evidence weighs against the claim, it must be denied. See Id.; Alemany v. Brown, 9 Vet. App. 518, 519 (1996). Factual Background In an August 2012 lay statement, the Veteran reported, “While I was [a]ctive [sic] I was [t]reated for cold weather injury.” Service treatment records for the Veteran document, “Eval(uate) feet for frostbite. Physical examination: no cold injury.” See February 1978 Chronological Record of Medical Care. The Veteran was evaluated for a weight problem in March 1979: “Weight 209 lbs Overweight by 33 1/2 pounds...mildly obese.” See March 1979 Chronological Record of Medical Care. In January 1980, the Veteran was provided with weight loss instructions: “Weight - 209 lbs, Recommended weight - 176 - 185 lbs…Weight over (Army Regulations) - 33 lbs...physical measurements of skinfold indicate he is obese...scheduled for weight reduction diet instruction.” See January 1980 Department of the Army Physical Evaluation Memorandum. At a July 1980 follow up visit, the Veteran was again determined to be overweight: “Nutrition Clinic: Caliper measurements done. Determine % body fat to be 23% = 13 lbs excess fat.” See July 1980 Chronological Record of Medical Care. Service treatment records for the Veteran do not contain any additional complaints, treatment, reports of injury, or trauma for residuals of a cold weather injury during the remainder of his military service. At his separation examination, the Veteran did not complain of any residuals of a cold weather injury. His Clinical Evaluation was “Normal,” including “Feet” and “Neurologic.” He was determined to be fit for separation. See September 1980 Report of Medical Examination. The Veteran testified at his April 2014 Board Central Office hearing that “around 1986, 1987” his feet “just got, automatically just started paining [sic].” See April 2014 Board Central Office hearing transcript. While the Veteran did not provide treatment records before 1998 as requested in previous Board remand orders, the first diagnosis of a foot disorder in the record appears as gout. See March 1998 Dr. P., M.D., P.A. Treatment Notes (“pain, gout left foot”). A March 1998 X-ray revealed, “Examination demonstrates degenerative change about the first metatarsophalangeal joint (MPJ) associated with mild soft tissue swelling. No underlying fracture or malalignment is seen. Impression: No acute injury.” See March 1998 Radiology Imaging Associates Imaging Consult. An April 1998 examination noted, “[P]ainful area around his left bunion which has been present for three weeks…treated by his (Primary Care Physician) for gout…Circulation and other pedal examination are within normal limits…X-ray examination reveals a bunion with a dorsal spur and evidence of osteoarthritic changes.” See April 1998 District Heights Foot & Ankle Center Initial History and Physical Examination. The Veteran received an X-ray of his left foot from VA in July 1998. The impression was “none.” See July 1998 VA Radiology Report. In a September 1998 letter, the Veteran’s physician indicated, “(Veteran) on long-term disability from March 6, 1998 through September 28, 1998…He was suffering from severe pain of the left foot, [sic] his diagnosis was severe gouty arthritis.” See September 1998 Dr. P., M.D., P.A. Letter. A March 2001 X-ray demonstrated, “Degenerative change is present at their first (MPJ) with an associated hallux valgus deformity and bunion. Osteopenic changes are present throughout the foot mostly involving the great toe. No acute osseous or soft tissue abnormalities are seen.” See March 2001 Radiology Imaging Associates Imaging Consultation. A December 2005 cardiology consult with the Veteran produced a normal neurological examination and reported, “Weight 240 pounds…healthy, active [sic] middle aged man with diet controlled [sic] diabetes.” See December 2005 Cardiology Associates Consult. In January and June 2009 examinations, the Veteran recorded: “Neurological and vascular examination was within normal limits bilaterally…X-rays taken revealed a mild bunion deformity with large dorsal spurring on the 1st metatarsal head and base of the proximal phalanx. Impression: Hallux limitus left foot. 1st MPJ Capsulitis left foot. Chronic Gout.” See January and June 2009 Family Foot & Ankle Associates Notes. The Veteran provided a buddy statement in June 2009 from his employer. The statement included, “(Veteran) has missed numerous days and hours of work…from what has been explained to me as Gouty Arthritis in his feet.” See June 2009 VA Form 21-4138, Statement in Support of Claim. In an August 2009 evaluation, the Veteran continued to record a normal neurological examination. See August 2009 VA Primary Care Initial Evaluation Note. An August 2010 examination documented: “(Veteran) is doing better in regards to his right ankle…right ankle has no erythema. There is some mild soft tissue swelling anteromedially and anterolaterally. There is no fluctuance…no anterior drawer. No tenderness…No lymphadenopathy…question is whether or not he had a gouty flare up or potentially some degenerative changes that were mild in nature that started bothering him.” See August 2010 Capital Orthopaedic Specialists Service Note. At a July 2009 VA examination for feet, the Veteran stated that he developed pain and swelling in both of his feet and toes in 1998 and was diagnosed with gout. See July 2009 VA examination report. An X-ray was taken pursuant to the examination, which revealed “Normal both feet.” See July 2009 VA Radiology Report. A November 2009 VA appointment for the Veteran recorded: “Assessment / Plan: Diabetes. Hypertension, blood pressure not controlled. Lipids, last LDL 125. Overweight, has gained 11 pounds since last visit, patient strongly encouraged to diet and exercise. Gout, last attack about 9 months ago, stable at present.” See November 2009 VA Primary Care Note. The Veteran reported in June 2014 that he “has not had a gouty attack in 7 years and is currently not on a gout regiment.” See June 2014 VA Podiatry Outpatient Note. A VA examination for foot disorders was performed in October 2014. The claim file was reviewed, and the examiner determined that the claimed condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event or illness. The rationale included, “There is no supporting medical evidence or link between the service treatment records in February 1978 for frostbite that is connected to the Veteran’s current diagnosis of gout. The diagnosis of gout made in 2009 is unrelated with no link to past medical documentation of frostbite.” See October 2014 VA examination report. An October 2016 examination note documented: “Has a history of gout but normally gets in his big toe and has not had an attack in 5 plus years…Examination without swelling / erythema / warmth, no concern for septic joint, although not clearly gout either….You presented today complaining of left ankle pain for several days, without known injury. Your examination was overall reassuring and did not suggest any evidence of infected joint. You had an X-ray that showed no acute reason for your pain but did show some degenerative changes consistent with arthritis. We suspect your pain is related to your history of gout, and as such will be treated with anti-inflammatory medications.” See October 2016 VA Emergency Department Note. In a September 2017 VA Medical Expert Opinion, the Veteran was diagnosed with “Gouty arthropathy bilaterally, Posterior tibial tendon dysfunction left, Dorsal calcaneal spurs bilaterally.” The expert examiner concluded, “Upon review of the full record of the Veteran as a podiatric specialist, the diagnosed foot disabilities of gouty arthropathy, posterior tibial tendon dysfunction and dorsal calcaneal spurs in my opinion are not related to the Veteran’s military service. These conditions are not related to cold weather exposure.” Rationale for the expert opinion included, “I did not find evidence in the medical literature correlating frostbite with the conditions that are the diagnosed foot disabilities of the Veteran.” See September 2017 VA Medical Expert Opinion and Addendums. The following literature was cited by the September 2017 expert: “The Problem of Frostbite in Civilian Medical Practice.” Hermann, G et al. Surg Clin North Am. 1963 April; 43: 519-536. “A new treatment for frostbite sequeiae; Botulinum toxin.” Norheim, A et al. Int J Circumpolar Health. 2017; 76(1): 1273677. “Cold damage to the extremities: Frostbite and non-freezing cold injuries.” Imray, D et al. Postgraduate Medical Journal. 85. 481-8. 10.1136/pgmj.2008.068635. “2012 American College of Rheumatology guidelines for management of gout. “Part 1: Systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia.” Khanna, D et al. Arthritis Care Res (Hoboken). 2012 October; 64(10): 1431-1446. “Posterior tibial tendon dysfunction: a review.” Durrant, B et al. J Am Podiatr Med Assoc. 2011 Mar – Apr; 101(2): 176-86. “The Diagnosis and Treatment of Heel Pain: A Clinical Practice Guideline – Revision 2010.” Thomas, J et al. The Journal of Foot and Ankle Surgery, Volume 49, Issue 3, S1 – S19.” See September 2017 VA Medical Expert Opinion and Addendums. A December 2017 emergency department physician advised: “I have reviewed the results of the testing you recently had done here at the VAMC...The Uric Acid test result was slightly elevated at 9.1 and the normal range is [3 - 9.0]. Most of the time, a high uric acid level occurs when your kidneys don’t eliminate uric acid efficiently. Things that may cause this slow-down in the removal of uric acid include rich foods, being overweight, having diabetes, taking certain diuretics (sometimes called water pills) and drinking too much alcohol. High levels of uric acid in the blood can cause solid crystals to form within joints. This causes a painful condition called gout.” See December 2017 VA Emergency Department Note. The Veteran participated in Cold Injury Residuals and Foot Conditions examinations in October 2019. The examiner considered the statements of the Veteran, including the report, “[H]e was outside training and…he developed frostbite.” The Veteran reported no pain, flare-ups, or functional loss. There were no pertinent physical findings, including no signs or symptoms in the ears, nose, hands, or feet. The examiner concluded, “The findings are less likely than not sequelae of cold injury…not indicative of cold injury in the feet.” The rationale in formulating the opinion included, “Onset…was well after service and cannot be attributed to any in-service event.” See October 2019 VA examination report. An additional examination was completed in November 2020. The examiner reviewed the Veteran’s claim file and his medical history. The examiner concluded, “The claimed condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness.” In formulating his opinion, the examining physician reasoned: “None of the (bilateral gouty arthropathy dorsal calcaneal spurs, achilles enthesopathy, degenerative arthritis) conditions are due to cold injury and have never been linked to cold injury objectively in the record or any medical literature. The gout is due to uric acid deposits causing joint damage (arthropathy). The Achilles enthesopathy, degenerative arthritis and calcaneal spurs are all age and activity-related degenerative changes seen in most elderly patients. I found no objective evidence the cold injury caused any of these conditions.” See November 2020 VA examination report. Analysis The Veteran has presented conflicting statements regarding the nature of an in-service injury. He stated in an August 2011 lay statement, “I was examine [sic] by (US Army Doctor), MD and signed off (no foot trouble).” See August 2011 Veteran Correspondence. In an August 2012 lay statement, it was reported by the Veteran, “I was treated for cold weather injury.” See August 2012 VA Form 21-4138, Statement in Support of Claim. At the October 2019 VA examination, the Veteran stated that he “developed frost bite and was sent to sick bay.” See October 2019 VA examination report. Regarding continuity of symptoms, the Veteran reported to his July 2009 examiner that he “developed pain and swelling in both feet and toes in 1998.” See July 2009 VA examination report. The Veteran reported “around 1986, 1987” his feet “just started paining” at his April 2014 Board Central Office hearing. See April 2014 Board Central Office hearing transcript. This evidences shows the conditions started more than one year after service separation, and that the were no continuous symptoms or complaints of same since service. While lay evidence can be sufficient on its own to establish any element of a claim for service connection, the lack of internal consistency in the Veteran’s statements, reporting “no foot trouble” in August 2011, a “cold weather injury” in August 2012, and “frostbite” in October 2019, along with the lack of consistency between the Veteran’s statements with other evidence, including service medical records documenting “no cold injury” in February 1978 and “Normal” clinical evaluation in September 1980, present issues of credibility regarding an in-service event. See Caluza v. Brown, 7 Vet. App. 498 (1995). Contemporaneous medical evidence has greater probative value than the Veteran’s reports of history. See Curry v. Brown, 7 Vet. App. 59 (1994). The Veteran stated in August 2012 that he was “treated for a cold weather injury,” and he stated in October 2019 he “developed frost bite.” February 1978 treatment records reflect “no cold injury.” The September 1980 separation physical evidence reflects a “Normal” clinical evaluation for “Feet” and “Neurological.” The Veteran’s diagnoses of gouty arthropathy and degenerative arthritis are included on the list of presumptive diseases enumerated in 38 C.F.R. § 3.309(a). However, the first recorded complaints of “pain,” as documented in Dr. P.M.D., P.A., VA treatment, and VA examination records is 1998, decades after the reported injury. Assuming arguendo that the Veteran’s reported pain “around 1986, 1987” is taken as a starting point for the manifestation of symptoms, the Veteran still does not meet the requirements for presumptive service connection, either by diagnosis in-service, within the prescribed time limits after service, or through continuity of symptomatology from service. Therefore, he is not entitled to the presumption of an in-service incurrence, aggravation in-service, or nexus to service. Notwithstanding the conflicting reports of an in-service injury, direct service connection would still fail for lack of the element of a nexus between the current diagnosed conditions and an in-service event. The Veteran has provided lay evidence, through personal and buddy statements, regarding his feet conditions. The latter statement refers to current symptoms only. Since the Veteran is not competent to provide evidence as to more complex medical questions, including etiology and pathology, evidence of service connection lies in the October 2014, September 2017, October 2019, and November 2020 VA examinations. See Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). The VA examination reports consistently deny a known connection between cold weather injuries and the conditions diagnosed in the Veteran. As explained by the VA Podiatry Medical Expert after the September 2017 examination: “Gout is not the result of or not related to service of the Veteran, including the instance of treatment for frostbite in February 1978 of the right and left foot. Posterior tibial tendon dysfunction is not the result of or not related to service of the Veteran, including the instance of treatment for frostbite in February 1978 of the (right and) left foot. Dorsal calcaneal spurs are not the result of or not related to service of the Veteran, including the instance of treatment for frostbite in February 1978 of the right and left foot.” The September 2017 VA Podiatry Medical Expert provided a list of published materials to support his conclusion following a review of the pertinent evidence. While the Board found that this opinion lacked consideration of a February 1978 treatment note, this was addressed in the later VA examination report of November 2020. Finally, a December 2017 VA Emergency Department physician explained to the Veteran that “being overweight, having diabetes” are “[t]hings that may cause this slow-down in the removal of uric acid” that “causes a painful condition called gout.” See December 2017 VA Emergency Department Note. The Veteran was noted to be “obese” in-service at “209 lbs” in January 1980, “240 pounds” at his cardiology consult in December 2005, and “[o]verweight” at a November 2009 VA Primary Care visit. Diabetes was noted in the Veteran at the December 2005 cardiology consult and again in November 2009 at the VA Primary Care visit. The evidence provides an explanation for the Veteran’s current disorder that is more likely the cause of his foot conditions and unrelated to service. Conclusion The October 2014, September 2017 (including its addendums), October 2019, and November 2020 opinions from the VA examiners are the most probative evidence of record on the question of diagnosis and nexus to service. The opinions were based on an extensive review of all of the evidence, including lay statements from the Veteran, were supported by a detailed rationale, provided data to support any conclusions, and they provided a clear and reasoned analysis, the source of the most probative value in a medical opinion. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). The October 2014, September 2017 (and its addendums), October 2019, and November 2020 VA examiner opinions are consistent with one another and with the evidence of record. Determining the origins of residuals of a cold weather injury is complex, so supporting medical evidence is required, not just mere lay opinion. When considering whether lay evidence is competent, the Board must determine, on a case-by-case basis, whether the Veteran’s particular disability is the type of disability for which lay evidence may be competent. See Kahana v. Shinseki, 24 Vet. App. 428 (2011). See also King v. Shinseki, 700 F.3d 1339, 1345 (Fed. Cir. 2012) (indicating lay evidence must demonstrate some competence and affirming the Court’s conclusion that the Board did not improperly discount the weight of a lay opinion in finding a medical expert’s opinion more probative on the issue of medical causation). The VA examiner opinions provide compelling evidence against the Veteran’s claim for service connection. The Veteran contends that his claimed disability exists and is related to his active service. This opinion is of no probative value, because he lacks the medical expertise needed to diagnose residuals of a cold weather injury or to attribute it to active military service. There is no competent, credible evidence to refute the October 2014, September 2017 (including its addendums), October 2019, and November 2020 VA examiner opinions. The weight of the probative evidence of record is against a finding that the Veteran has a diagnosis of residuals of a cold weather injury that is causally or etiologically related to any disease, injury, or incident, in-service. Consequently, service connection is not warranted. As the preponderance of the evidence is against the claim for service connection for residuals of a cold weather injury, this claim must be denied. The Board acknowledges that the Veteran may sincerely believe his previous and current diagnoses of foot conditions warrant service connection. However, without the appropriate medical training and expertise, which he has not demonstrated, he is not competent to provide an opinion regarding the etiology of his foot conditions. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir 2007); see also Jones v. West, 12 Vet. App. 383, 385 (1999) (holding that where the determinative issue is one of medical causation or diagnosis, only those with specialized medical knowledge, training, or experience are competent to provide evidence on the issue). In reaching this conclusion, the Board has considered the overall disability picture demonstrated by the record to arrive at the appropriate evaluation in this case. A preponderance of the evidence is against a finding that the Veteran is entitled to service connection for residuals of a cold weather injury under 38 C.F.R. § 4.104, DC 7122, for the relevant appeal period. The Board has considered the applicability of the benefit-of-the-doubt doctrine; however, in the absence of any competent, credible, and probative evidence relating the Veteran’s current disorder to service, that doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). MARJORIE A. AUER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. Small, Attorney Advisor 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.