Citation Nr: 21022113 Decision Date: 04/14/21 Archive Date: 04/14/21 DOCKET NO. 15-34 599 DATE: April 14, 2021 ORDER Entitlement to service connection for a lower back disability, to include degenerative disc disease, is denied. Entitlement to service connection for complex regional pain syndrome, to include reflex sympathetic dystrophy, in the left leg is denied. Entitlement to service connection for complex regional pain syndrome, to include reflex sympathetic dystrophy, in the right leg is denied. Entitlement to service connection for a left ankle disability is denied. Entitlement to service connection for a right ankle disability is denied. Entitlement to service connection for left flat foot is denied. Entitlement to service connection for right flat foot is denied. FINDINGS OF FACT 1. The weight of the evidence is against finding that a lower back disability, to include degenerative disc disease, manifested during active service or within a year of separation from service, or that it is otherwise the result of a disease or injury during active service. 2. The weight of the evidence is against finding that complex regional pain syndrome, to include reflex sympathetic dystrophy, in the left leg is due to lower back disability, or that it manifested during active service or within a year of separation from service, or that it is otherwise the result of a disease or injury during active service. 3. The weight of the evidence is against finding that complex regional pain syndrome, to include reflex sympathetic dystrophy, in the right leg is due to lower back disability, or that it manifested during active service or within a year of separation from service, or that it is otherwise the result of a disease or injury during active service. 4. A current left ankle disability has not been demonstrated. 5. The weight of the evidence is against finding that a right ankle disability manifested during active service or within a year of separation from service, or that it is otherwise the result of a disease or injury during active service. 6. The weight of the evidence is against finding that left flat foot is manifested during active service or within a year of separation from service, or that it is otherwise the result of a disease or injury during active service. 7. The weight of the evidence is against finding that right flat foot is manifested during active service or within a year of separation from service, or that it is otherwise the result of a disease or injury during active service. CONCLUSIONS OF LAW 1. The criteria for service connection for lower back disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.309. 2. The criteria for service connection for complex regional pain syndrome, to include reflex sympathetic dystrophy, in the left leg have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 3. The criteria for service connection for complex regional pain syndrome, to include reflex sympathetic dystrophy, in the right leg have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 4. The criteria for service connection for left ankle disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 5. The criteria for service connection for right ankle disability have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 6. The criteria for service connection for left flat foot disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 7. The criteria for service connection for right flat foot disability 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 in the Army National Guard from July 1984 to March 1988, to include active duty for training from October 1984 to January 1985. These matters are before the Board of Veterans’ Appeals (Board) on appeal from a November 2011 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO), which denied service connection for degenerative disc disease in the lumbar spine; denied service connection for bilateral reflex sympathic dystrophy; denied service connection for flat feet; and denied service connection for ankle condition. The appellant timely appealed the rating decision with a notice of disagreement received by VA in September 2012. After the RO issued a statement of the case in September 2015, the appeal was perfected with the timely filing of a substantive appeal in the same month. The appellant testified before the undersigned Veterans Law Judge at a September 2016 hearing at the RO in Little Rock, Arkansas. A hearing transcript has been associated with the claims file and reviewed. In October 2018 and again in September 2020, the Board remanded these matters for further development. Such has been completed and these matters are returned to the Board for further consideration. Service Connection Establishing service connection generally requires (1) medical evidence of 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 of a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); 38 C.F.R. § 3.303. Service connection may also be granted for a disease first diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). Under 38 C.F.R. § 3.303 (b), an alternative method of establishing the second and third Shedden/Caluza element is through a demonstration of continuity of symptomatology. Barr v. Nicholson, 21 Vet. App. 303 (2007); see Savage v. Gober, 10 Vet. App. 488, 495-97 (1997). 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 symptomatology; and (3) medical or, in certain circumstances, lay evidence of a nexus between the present disability and the post-service symptomatology. Savage, 10 Vet. App. at 495-96. For veterans who have served 90 days or more on or after December 31, 1946, certain chronic diseases, such as degenerative arthritis, or certain neurological diseases is presumed to have been incurred in service if such manifested to a compensable degree within one year of separation from service. 38 U.S.C. §§ 1101, 1112, 1133; 38 C.F.R. §§ 3.307 (a), 3.309(a). A nexus between a current disability and an in-service injury or event may be established by evidence of continuity of symptomatology, if the condition is a chronic disease enumerated under 38 U.S.C. § 1101. Walker v. Shinseki, 708 F.3d 1331, 1338-40 (Fed. Cir. 2013). With chronic diseases shown as such in service, or within the presumptive period after service, so as to permit a finding of service connection, subsequent manifestation of the same chronic disease at any later date, however remote, are service connected unless clearly attributable to intercurrent causes. 38 C.F.R. § 3.303 (b). Service connection may be granted for a disability that is proximately due to, or aggravated by, service-connected disease or injury. 38 C.F.R. § 3.310. 1. Lumbar Spine Disorder The Veteran claims to have first hurt his back when he fell while on an obstacle course in basic training at Fort Benning, Georgia. At that time he was treated by a doctor. He has reported having had continuous problems with his back ever since but waited until he had insurance to receive medical treatment around the late 1980s. He has been prescribed medication to manage pain and discomfort. See Hearing Transcript Testimony, received 9/21/2016 pages 3-6. Service treatment records showed normal musculoskeletal findings, including for the back, on the July 1984 enlistment examination; he denied all orthopedic issues including back pain in the accompanying report of medical history. A November 1984 ETS examination was normal. In December 1984 he complained of lower back pain for 3 days. On examination there was no edema or swelling and he had full range of motion. Post-service, the Veteran received private treatment in 1993 for back issues following reported work related injuries to the back per records addressing his Workers Compensation claim. A March 1993 Workers Compensation record disclosed the employer’s first report of injury or illness. A July 1994 needle EMG/Nerve Conduction Study (NCS) report included the physician’s notation that he had previously seen the Veteran for an independent medical examination (IME) after he alleged an injury on March 18, 1993 and had reported having reinjured his back in October 20, 1993. Diagnostic studies from June 1993 included an X-ray report showing evidence of transitional vertebrae with extra articulation of the transverse spinal process at L5-S1. This report noted complaints of persistent lumbar spine pain at the L5/S1 level with an opinion that his symptoms are most likely a result of the inflammatory process and mechanical dysfunction at this level from aggravation and his pre-existing congenital abnormality. Workers Compensation notes from May 1993 and June 1993 reflect complaints of pain at the L5-S1 lumbar region. Physical examination was within normal limits, including neurologically and the June 1993 note describing no paresthesias or sensory abnormalities. A June 1993 MRI of the lumbar spine was within normal limits with the report unable to account for his current symptom complex and physical exam noted to be completely normal. In August 1993 the Veteran underwent an independent medical examination (IME) for workers compensation with a history given of injury on March 18, 1993. He was lifting some containers of cafeteria food and strained lower back. He developed diffuse pain initially centered around L5-S1 but has spread to upper and lower thoracic. Sensation was intact in his lower extremities and he had not noticed specific weakness. It did not seem to radiate into his lower extremities. He also reported that on April 22, 1993 he felt another popping sensation in the lower back when picking up some cheese. The assessment from the IME was that he had a work injury on March 18, 1993 and the doctor thought that he most likely had a lumbar strain. He had a non-focal neurological exam. A December 1993 myelogram of the lumbar spine diagnosed lumbalgia. He was noted to have ongoing complaints of back pain with lower extremity involvement, including his right leg and buttock in April 1994, and numbness both legs reported in June 1994. The results from the July 1994 EMG/NCS report was within normal limits with no evidence of radiculopathies or neuropathic processes. In July 1995 the Veteran was diagnosed via lumbar X-ray with a prominent right transverse process, producing some sclerotic changes related to the right ileum, right adjacent ileum and sacroiliac joint. The clinical significance of this was uncertain. A September 1999 radiology report shows mild. disc space narrowing at L5-S1 which may be congenital or acquired. There was questionable narrowing at L4-5 which is more apt to be acquired. Posterior elements, disc spaces elsewhere and vertebral bodies appeared intact and normal. Neurological symptoms potentially linked to the lumbar spine were addressed in private records from September 1999 through November 1999. The records from September and October 1999 reported a nine-year history of back pain and numbness/burning pain in his legs. The September 1999 evaluation described the symptoms of intermittent numbness and pain to anterior thighs down to the knee bilaterally for past 9 years. The Veteran described his symptoms as being related to his job 9 years ago when he was catering food to schools and carrying large quantities of food. Examination of the back was essentially negative, and he was assessed with numbness and pain to anterior thighs bilaterally. The October 1999 orthopedic evaluation noted that he had recently undergone EMG/NCV testing with a report of generalized sensory motor polyneuropathy of the primary demyelinating type with no electrophysiologic evidence for lumbosacral radiculopathy. The assessment was sensory motor polyneuropathy, primary demyelinating type. An orthopedist’s opinion from October 1999 was that the Veteran’s current symptoms were not related to his October 1993 lumbosacral strain, which was opined to have resolved. November 1999 private neurology notes reflect the Veteran’s report that his back pain began in 1993 when he was working for the school system and lifting heavy objects. He reported having developed low back pain without radiation and the same time having developed numbness and tingling in feet which gradually spread to legs and hands/arms. Examination of the lumbosacral spine was noted to show a good range of motion and negative straight leg raise. The November 1999 neurological clinic report confirmed that EMG/NCV was consistent with a polyneuropathy with no evidence of radiculopathy. An August 2010 MRI of the lumbar spine yielded an impression of disc bulge and some borderline narrowing at L4-L5; no focal herniation. A June 2011 record noted the Veteran to complain of constant back pain that radiates to the bilateral lower extremity down to the feet, described as burning, sharp and stabbing. He was assessed with RSD unspecified, ICD, ankle fusion, neuritis peripheral and chronic pain syndrome. Social Security records reference back pain and neurological symptoms of the lower extremities from 2010 through 2012. These include a November 2010 note showing treatment for low back pain and leg pain, with the pain described as constant, hot, burning and sharp, which radiated down the bilateral lower extremities with numbness in the legs and feet. He reported severe burning pain in his feet. He was assessed with reflexive dystrophy and chronic pain syndrome. Low back pain and leg pain was also reported in February 2011, and peripheral neuropathy and back pain was treated in November 2011 and January 2012. Records from November 2011 noted complaints of a numb area in the dorsum of the ankle and hindfoot. He also had lumbar tenderness and diffuse muscular tenderness without warmth or associated erythema. He was assessed with peripheral neuropathy and back pain. In January 2012 the problem list included peripheral neuropathy, with the Veteran been seen for pain in back and right leg. Examination disclosed lumbar tenderness, diffuse muscular tenderness without warmth or associated erythema. A right ankle scar and slight diffuse swelling over ankle was noted. He was assessed with peripheral neuropathy and back pain. Treatment records from February 2013, April 2013, May 2013, and June 2013 discloses treatment for persistent low back pain, or “backache” including with Lortab, and findings including osteoarthritis in April 2013. Treatment records from late 2013 through 2015 disclose repeated treatment for persistent low back pain with symptoms that include tenderness, muscle spasm, and some of the records include radiation of symptoms down both lower extremities including in October 2013, November 2013, December 2013, January 2014, February 2014, March 2014, April 2014, July 2014, November 2014, March 2015. These records repeatedly assessed him with lumbar disc degeneration. A February 2016 record described low back pain without radiation. Treatment records dated from 2017 through 2019 show ongoing treatment for chronic low back pain. In June 2017 leg pain was diagnosed. In June 2018 he was seen for muscle cramps with chronic back pain also noted. In September 2018 he was seen with a history of chronic back pain with exacerbation of his pain, for which he took gabapentin. His pain was typical of flareups with right sided pain radiating to legs. Past medical history was significant for arthritis, chronic ankle pain, and chronic back pain. On examination, pain could be reproduced on palpation along paraspinal muscles on the right side. He was assessed with chronic bilateral low back pain with right sided sciatica. In April 2019 he was diagnosed with chronic low back pain with right sided sciatica. The report of a September 2019 VA examination diagnosed lumbosacral strain and additionally diagnosed radiculopathy of the lower extremities. The history of onset was given of increased pain carrying heavy equipment as a mortarman. He reported that he was treated by infirmary and had been placed on light duty. Symptoms had increased over the past few years. Current symptoms were pain with driving, walking, standing, and lifting. He treated with pain management and took Gabapentin. Physical examination included findings of functional limitations (painful walking and standing), limited range of motion, as well as findings of radiculopathy with radicular pain and numbness described as mild. No findings of arthritis on X ray were shown. Following examination, the examiner opined that the claimed condition was at least as likely as not (50 percent or greater probability) incurred in or caused by the claimed in-service injury, event, or illness. The rationale, that has been deemed inadequate by the VA, was that the Veteran had no issues related to the claimed back (thoracolumbar) prior to military service. Onset of the condition was during service, and documented in the Service Medical Records. The examiner stated that there is evidence of current, chronic and continuous treatment and care and that nexus has been established. Because the rationale for the favorable opinion in the September 2019 VA examination was not based on adequate rationale, a new opinion was obtained. In a February 2020 VA examination addendum it was opined that the Veteran’s lower back disability was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The rationale noted that the December 1984 treatment record included no objective findings noted on examination and the back condition was acute only. There were no further back complaints until 1993, which was a result from civilian work-related injury from picking up food containers, and he was diagnosed with lumbar strain. Records were noted to disclose complaints of pain in lower back and numbness to legs determined to have started around 1990. X-ray findings in 1999 indicate mild disc space narrowing. The Veteran continued to have chronic back pain since this time which is noted in medical records. The examiner, who also reviewed the Veteran’s lay statement of back symptoms beginning in active duty (erroneously said to be in 2011), opined that there is no evidence to support ongoing care for back complaints from 1984 to back complaints from civilian work-related injury in 1993. A nexus has not been established. The February 2020 examiner further opined that records less likely than not show that any lower back disability manifested within one year of the Veteran’s separation from service. Again, the rationale pointed out that the back complaints treated in December 1984 were acute, with no objective findings on examination. There were no further back complaints until 1993 which was a result from civilian work-related injury from picking up food containers and was diagnosed with lumbar strain. An October 2020 addendum examination included a comprehensive review of the record and contained an opinion that the Veteran’s claimed back disability was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. In the rationale, the examiner confirmed review of all available medical records and all lay statements. While the lay statement conveys a back injury while on obstacle course, the examiner noted that there are no documented signs/symptoms/complaints consistent with a low back condition other than the December 17, 1984 complaint. The examiner stated that while lay statements provide important information they do not, in and of themselves, provide evidence of a diagnosis. The December 17, 1984 note showed lower back pain times 3 days. The assessment was lower back which was acute only during service. While the lay statement notes continuity of care post service, the claims file was further silent for continued care and treatment of a low back condition until a post-service work related injury 1993. The examiner found that a nexus is not established. The low back condition of December1984 was acute and only during service. The etiology of the current back condition is at least as likely as not related to the post-service work related injury of March 1993 and April 1993. The examiner pointed out that the lumbar MRI of August 23, 2010 is a more specific testing for the spine and showed disc bulge and some borderline narrowing L4-L5, however it did not support a congenital condition. Additionally, the October 2020 VA examiner’s addendum was issued to clarify whether any congenital back disability is shown, and if so, to specify whether it is a defect or disease. If a defect, the examiner was to clarify whether there was there additional disability to the defect during service due to aggravation by a superimposed disease or injury. If a disease, the examiner was to clarify whether it at least as likely as not that it worsened beyond its natural progression during active service. The examiner provided a contradictory opinion, stating that the claimed condition, which clearly and unmistakably existed prior to service, was clearly and unmistakably not aggravated beyond its natural progression by an in-service injury, event, or illness. In the rationale the examiner pointed to the August 2020 MRI showing a disc bulge and some borderline narrowing L4-L5. No focal herniation was shown, and it did not support a congenital low back condition, therefore aggravation not warranted. Despite the October 2020 examiner stating that a pre-existing condition was present, the rationale found no congenital condition confirmed; thus, it must be concluded that no pre-existing congenital condition was shown. Thus, it appears the wording in the opinion of a back disorder “clearly and unmistakably existing prior to service” was made in error, and the examiner in fact confirmed that there is no pre-existing congenital disease or disorder of the lumbar spine. There is also not shown to be any other pre-existing lumbar spine disorder or disease shown in the records. Therefore, it is not necessary to address the presumption of soundness or aggravation of a pre-existing condition, including congenital, in addressing this matter. The question for the Board is whether the Veteran has a current disability that was incurred in or aggravated by service. The Board concludes that, while the Veteran has a current disability diagnosed in the September 2019 VA examination as lumbosacral strain and radiculopathy of the lower extremities in light of Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018), the preponderance of the evidence is against finding that the Veteran’s lumbar spine disability was incurred or aggravated by service. Indeed, there is no showing of a congenital deformity pre-existing service. Again, the addendums to the VA examination in February 2020 and October 2020 explained that there was not shown to be a congenital deformity per the findings from the lumbar spine MRI of August 2010, which were found to show more accurate findings of the lumbar spine disability than the X-ray findings from 1993 that suggested a congenital deformity. The VA examiner in addendums in February 2020, with further clarification in October 2020, opined that the Veteran’s lumbar spine disability that was treated in service was acute and transitory and the current lumbar spine disability is instead more likely due to the post-service work injury in 1993. The rationale was adequate and supported by the medical and lay evidence, which was comprehensively reviewed, and which confirmed treatment for lumbar spine issues following a work-related injury in 1993. Although the September 2019 VA examination that diagnosed lumbar strain gave a positive nexus opinion, this opinion was not supported by adequate rationale which necessitated the addendum opinions that were subsequently unfavorable and supported by adequate rationale. The medical evidence of record is otherwise not shown to directly contradict this opinion. The Veteran believes his lumbar spine disability is proximately due to or the result of his active service. However, the Veteran in this case is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires knowledge of relationships, pathology and interpretation of complicated diagnostic medical testing. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the skills or medical training to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the VA examiner’s addendum opinions of February 2020 and October 2020 rendered by a trained medical professional based on appropriate diagnostic testing and reasonably drawn conclusions with supportive rationale. For the above reasons, the preponderance of the evidence is against the claim and service connection is denied. 2. Reflex sympathetic dystrophy, in the left leg The Veteran claims to have had leg problems ever since he was in the National Guard and incurred injury while on active duty for training. Although he ambiguously expressed a desire to withdraw the leg claim at his September 2016 hearing, he indicated he treated with a doctor in the late 1980s for leg problems along with his back. See Hearing Transcript Testimony, received 9/21/2016 at page 2, 6. Service treatment records showed normal musculoskeletal findings, including the extremities on the July 1984 enlistment examination and the Veteran denied all orthopedic issues including foot trouble in the accompanying report of medical history. The service treatment records disclosed no treatment for any issues impacting the left leg. A November 1984 ETS examination was normal including the lower extremities. Post-service treatment records show neurological symptoms impacting his lower extremities in conjunction with low back pain beginning around April 1994, as noted in the records treating his lumbar spine symptoms. As previously noted, the results from the July 1994 EMG/NCS report were within normal limits and there was no evidence of radiculopathies or neuropathic processes. Later, a November 1999 neurological clinic report confirmed that EMG/NCV was consistent with a polyneuropathy, with no evidence of radiculopathy. Subsequently the treatment records showed a diagnosis of reflexive dystrophy and chronic pain syndrome in November 2010, with subsequent records in November 2011 and January 2012 diagnosing him with peripheral neuropathy. Treatment records from 2013 through 2019 are noted to include treatment for persistent low back pain with symptoms that included radiation of pain down both lower extremities. In addition to neurological symptoms treated in conjunction with his lumbar spine disorder, he is noted to have had issues with numbness associated with his right lower extremity following a fracture of the right ankle with subsequent surgery in December 2009, including in records from June 2010 which noted complaints of pain, burning, numbness was noted to be restricted to the right foot following his right ankle surgery. A July 2010 record noted tingling in both feet and pain the right foot, with a history of a plate in the right foot. Other records from July 2010 focused on symptoms of numbness and tingling related to his right ankle surgery. An August 2010 EMG yielded an impression of probable nerve root compromise at L5-S1 based on needle exam changes in L5-S1 innervated muscles proximal to his ankle trauma. Edema precludes good recording of sensory nerve action potentials and compound muscle action potentials, but this did not appear to be a peripheral neuropathy clinically more in line of CRPS. A September 2010 record addressing complaints of right leg pain with symptoms including the toes burning, radiation, with right lower extremity numbness, and tingling of the right foot. Findings of the neurological examination were normal. The impression was right foot reflexive sympathetic dystrophy (RSD). No such impression or findings were made for the left foot. Later, an April 2011 record which followed up for symptoms following right ankle surgery noted findings from an August 2010 EMG which showed borderline peroneal and tibial motor studies with majority of compromise at L5-S1. Following examination, the impression was of right ankle hardware pain and superficial peroneal nerve impingement with mild contracture and low back pain. Again, the records addressing the right foot and ankle symptoms are not noted to include any significant left foot neurological findings. The report of a September 2019 VA examination diagnosed bilateral sympathetic reflex of the lower extremities. Regarding onset, in 1994 there was slow increased pain and numbness after working and standing for long periods of time. He also had decreased range of motion and was seen for treatment. The course since onset was increased back pain that is still under treatment presently, with flareups of increased pain numbness that that goes down both legs which caused increased difficulty walking and standing 2-3 times a week. He was had issues with standing and locomotion due to numbness and pain and must use a cane. He reported an interference with sitting in which the leg goes numb with sitting or driving, requiring he change positions frequently. Examination included the knee and also muscle strength testing showing 4/5 muscle strength of the bilateral lower extremities on knee flexion and extension. Following examination, the examiner opined that the claimed condition was at least as likely as not incurred in or caused by the claimed in-service injury, event, or illness. The rationale, which has been deemed inadequate by the VA, was that the Veteran had no issues related to the claimed lower extremity dystrophy prior to military service. Onset of the condition was during service, described as documented in the service treatment records.(STRs) The examiner opined that there is evidence of current, chronic and continuous treatment and care and that a nexus has been established. Because the rationale for the favorable opinion in the September 2019 VA examination was not based on adequate rationale, it was deemed necessary to obtain a new opinion. The report of a February 2020 VA addendum opinion included a comprehensive review of the record and gave an opinion that the claimed neurological condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner reasoned that the Veteran’s low back disability treated in December 1984 was acute only and recited the rationale in the unfavorable opinion regarding the lumbar spine etiology. In doing so, the examiner pointed to the post service work related back injury and the subsequent findings of a 1999 ENG/NVC, which indicated generalized sensorimotor polyneuropathy of the primary demyelinating type. No electrophysiologic evidence of lumbosacral radiculopathy was shown. The examiner noted that the Veteran provided lay statement in 2011 indicating legs problems starting while active duty, but there was no evidence of record to support claim. Since 1999, Veteran continues to have complaints to bilateral lower extremities along with ongoing treatment regarding symptoms. The examiner noted that there is a 14 year gap in medical records of Veterans complaints to both legs from active duty service, so a nexus has not been established. The examiner also was unable to find any available treatment record by ortho or pain management specialists that diagnoses RSD or complex regional pain syndrome. Regardless, based on above, no nexus was found to exist. The question for the Board is whether the Veteran has a current disability that was incurred in or aggravated by service. The Board concludes that, while the Veteran has a current disability diagnosed in the September 2019 VA examination as bilateral sympathetic reflex of the lower extremities affecting the left lower extremity in light of Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018), the preponderance of the evidence is against finding that the Veteran has a neurological disability of the left lower extremity that was incurred or aggravated by service. Additionally, the preponderance of the evidence is against a finding that there is any neurological disability impacting the left lower extremity that is proximately due to or the result of, or aggravated beyond its natural progression by service-connected disability. 38 U.S.C. §§ 1110, 1131; Allen v. Brown, 7 Vet. App. 439 (1995) (en banc); 38 C.F.R. § 3.310(a). The VA examiner in addendums from February 2020, with further clarification in October 2020, opined that the left leg neurological disorder was not incurred in or aggravated in service. The rationale supporting such opinion was adequate and supported by the medical and lay evidence which was comprehensively reviewed. Although the September 2019 VA examination gave a positive nexus opinion, this opinion was not supported by adequate rationale which necessitated the addendum opinions which were subsequently unfavorable and supported by adequate rationale. The medical evidence of record is otherwise not shown to directly contradict this opinion. The addendum opinions also opined that the Veteran’s lumbar spine disability was not incurred in or aggravated in service as discussed above, and thus while the records do include findings of radicular symptoms impacting the left lower extremity, this cannot be established as secondary to the lumbar spine disorder. Furthermore, the evidence does not support a finding that neurological disorder impacting the left leg is secondary to any disabilities of the left or right ankles. As will be discussed further, the evidence is not shown to support a finding of service connection for disabilities either the left or right ankle. Thus, any neurological manifestations shown to be associated with disabilities of the ankles is not warranted service connection on a secondary basis. The Veteran believes his left leg neurological disorder is proximately due to or the result of his active service. The Veteran in this case is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires knowledge of relationships, pathology and interpretation of complicated diagnostic medical testing. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the skills or medical training to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the VA examiner’s addendum opinions of February 2020 and October 2020 rendered by a trained medical professional based on appropriate diagnostic testing and reasonably drawn conclusions with supportive rationale. For the above reasons, the preponderance of the evidence is against the claim and service connection is denied. 3. Reflex sympathetic dystrophy, in the right leg The Veteran claims to have had leg problems ever since he was in the National Guard and incurred injury while on active duty for training. Although he ambiguously expressed a desire to withdraw the leg claim at his September 2016 hearing, he indicated he treated with a doctor in the late 1980s for leg problems along with his back. See Hearing Transcript Testimony, received 9/21/2016 at page 2, 6. Service treatment records showed normal musculoskeletal findings including the extremities on the July 1984 enlistment examination and he denied all orthopedic issues including foot trouble in the accompanying report of medical history. The service treatment records disclosed no treatment for any issues impacting the right leg. A November 1984 ETS examination was normal including the lower extremities. Post-service treatment records are noted to show neurological symptoms impacting his lower extremities in conjunction with low back pain beginning around April 1994 as noted in the records treating his lumbar spine symptoms discussed above As previously noted in the factual background addressing his lumbar spine disorder, the results from the July 1994 EMG/NCS report was within normal limits with no evidence of radiculopathies or neuropathic processes. Later, a November 1999 neurological clinic report confirmed that EMG/NCV was consistent with a polyneuropathy with no evidence of radiculopathy. Subsequently the treatment records showed a diagnosis of reflexive dystrophy and chronic pain syndrome in November 2010, with subsequent records in November 2011 and January 2012 diagnosing him with peripheral neuropathy. Treatment records from 2013 through 2019 are noted to include treatment for persistent low back pain with symptoms that included radiation of pain down both lower extremities. In addition to neurological symptoms treated in conjunction with his lumbar spine disorder, he is noted to have had issues with numbness associated with his right lower extremity following a fracture of the right ankle with subsequent surgery in December 2009, including in records from June 2010 which noted complaints of pain, burning, numbness was noted to be restricted to the right foot following his right ankle surgery. A July 2010 record noted tingling in both feet and pain the right foot, with a history of a plate in the right foot. Other orthopedic records from July 2010 focused on right ankle and foot numbness and tingling status post ORIF of the right ankle. An August 2010 EMG yielded an impression of probable nerve root compromise at L5-S1 based on needle exam changes in L5-S1 innervated muscles proximal to his ankle trauma. Edema precludes good recording of sensory nerve action potentials and compound muscle action potentials, but this does not appear to be a peripheral neuropathy clinically more in line of CRPS. A September 2010 record addressing complaints of right leg pain with symptoms including the toes burning, radiation, with right lower extremity numbness, and tingling of the right foot. Findings of the neurological examination were normal. The impression was right foot reflexive sympathetic dystrophy (RSD). Later, an April 2011 record which followed up for symptoms following his right ankle surgery was noted to report findings from an August 2010 EMG which showed borderline peroneal and tibial motor studies with majority of compromise at L5-S1. Following examination, the impression was of right ankle hardware pain and superficial peroneal nerve impingement with mild contracture and low back pain. A June 2011 letter from the Veteran’s orthopedic surgeon gave a history of the Veteran’s sustaining an unstable fracture of his lateral malleolus and undergoing open reduction and internal fixation surgery in December 2009. The letter described ongoing symptoms including moderate swelling postoperatively as well as numbness on the dorsum of the foot and toes which settled into his fourth and fifth toes. The letter described his biggest problem as the dysesthesias in his foot and toes with the doctor believing that the symptoms were from irritation of the superficial peroneal nerve. The Veteran underwent conservative treatment, including medications of Neurontin and Lyrica with side effects resulting in discontinued use. Other treatment options were rejected by the Veteran including surgical exploration of the superficial peroneal nerve. The report of a September 2019 VA examination diagnosed bilateral sympathetic reflex of the lower extremities. The details of onset were that in 1994, there was slow increased pain and numbness after working and standing for long periods of time. He also had decreased range of motion and was seen for treatment. The course since onset was increased back pain that is still under treatment presently, with flareups of increased pain numbness that that goes down both legs which caused increased difficulty walking and standing 2-3 times a week. He was noted to have issues with standing and locomotion due to numbness and pain and must use a cane. He reported an interference with sitting in which the leg goes numb with sitting or driving, requiring he change positions frequently. Examination included knee exam and also muscle strength testing showing 4/5 muscle strength of the bilateral lower extremities on knee flexion and extension. Following examination, the examiner gave an opinion that the claimed condition was at least as likely as not (50 percent or greater probability)incurred in or caused by the claimed in-service injury, event, or illness. The rationale, which has been deemed inadequate by the VA, was that the Veteran had no issues related to the claimed lower extremity dystrophy prior to military service. Onset of the condition was during service, described as documented in the service treatment records.(STRs) The examiner opined that there is evidence of current, chronic and continuous treatment and care and that a nexus has been established. Because the rationale for the favorable opinion in the September 2019 VA examination was not based on adequate rationale, it was determined to be necessary to obtain a new opinion. The report of a February 2020 VA addendum opinion included a comprehensive review of the record and gave an opinion that the claimed neurological condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The rationale pointed to the fact that the Veteran’s low back disability treated in December 1984 was acute only and recited the rationale in the unfavorable opinion regarding the lumbar spine etiology. The examiner pointed to the post service work related back injury and the subsequent findings of a 1999 ENG/NVC which indicated generalized sensorimotor polyneuropathy of the primary demyelinating type. No electrophysiologic evidence of lumbosacral radiculopathy was shown. The examiner noted that the Veteran provided lay statement in 2011 indicating legs problems starting while active duty, but there was no evidence of record to support claim. Since 1999, Veteran continues to have complaints to bilateral lower extremities along with ongoing treatment regarding symptoms. The examiner noted that there is a 14-year gap in medical records of Veterans complaints to both legs from active duty service, so a nexus has not been established. The examiner also was unable to find any available treatment record by ortho or pain management specialists that diagnoses RSD or complex regional pain syndrome. Regardless based on above, no nexus was found to exist. The question for the Board is whether the Veteran has a current disability that was incurred in or aggravated by service. The Board concludes that, while the Veteran has a current disability diagnosed in the September 2019 VA examination as bilateral sympathetic reflex of the lower extremities affecting the right lower extremity in light of Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018), the preponderance of the evidence is against finding that the Veteran has a neurological disability of the right lower extremity that was incurred or aggravated by service. Additionally, the preponderance of the evidence is against a finding that there is any neurological disability impacting the right lower extremity that is proximately due to or the result of, or aggravated beyond its natural progression by service-connected disability. 38 U.S.C. §§ 1110, 1131; Allen v. Brown, 7 Vet. App. 439 (1995) (en banc); 38 C.F.R. § 3.310(a). The VA examiner in addendums from February 2020, with further clarification in October 2020, opined that the right leg neurological disorder was not incurred in or aggravated in service. The rationale supporting such opinion was adequate and supported by the medical and lay evidence which was comprehensively reviewed. Although the September 2019 VA examination gave a positive nexus opinion, this opinion was not supported by adequate rationale which necessitated the addendum opinions which were subsequently unfavorable and supported by adequate rationale. The medical evidence of record is otherwise not shown to directly contradict this opinion. The addendum opinions also opined that the Veteran’s lumbar spine disability was not incurred in or aggravated in service as discussed above, and thus while the records do include findings of radicular symptoms impacting the right lower extremity, this cannot be established as secondary to the lumbar spine disorder. Furthermore, the evidence does not support a finding that neurological disorder impacting the right leg is secondary to any service-connected disabilities of the left or right ankles. Although the medical evidence does show that the Veteran has neurological manifestations of the right lower extremity shown to be residuals of his right ankle surgery, as will be discussed further, the evidence is not shown to support a finding of service connection for disabilities either the left or right ankle. Thus, any neurological manifestations shown to be associated with disabilities of the ankles is not warranted service connection on a secondary basis. The Veteran believes his right leg neurological disorder is proximately due to or the result of his active service. The Veteran in this case is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires knowledge of relationships, pathology and interpretation of complicated diagnostic medical testing. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the skills or medical training to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the VA examiner’s addendum opinions of February 2020 and October 2020 rendered by a trained medical professional based on appropriate diagnostic testing and reasonably drawn conclusions with supportive rationale. For the above reasons, the preponderance of the evidence is against the claim and service connection is denied. 4. Left ankle disability The Veteran contends that service connection is warranted for a left ankle disability. Although he did not testify regarding the left ankle at his September 2016 hearing, he did provide a lay statement in his August 2011 claim that ankle problems were related to active service, without specifically mentioning which ankle he was referring to. Service treatment records showed normal musculoskeletal findings including the extremities on the July 1984 enlistment examination and he denied all orthopedic issues including foot trouble in the accompanying report of medical history. A November 1984 ETS examination was normal including the lower extremities and feet. On August 7, 1986 he was seen for a swollen ankle. A doctor’s note ordered no walking or standing for one week. An August 15, 1986 treatment record diagnosed a sprained foot, said to have happened in the line of duty, and treated with an Ace bandage, Parafon Forte, and no walking. Post-service treatment records focus on right ankle problems following a December 2009 injury in which he sustained a right lateral malleolus fracture that was surgically repaired. None of the post-service records showed any complaints or diagnosis of any chronic disorder pertaining to his left ankle. Although a July 2010 private orthopedic record noted left ankle and foot pain, the rest of this orthopedic record addressed right ankle complaints following the surgery of the right lateral malleolus, with no left ankle diagnosis given. . There is also noted to be a November 2011 record describing a scar and slight swelling of the left ankle with range of motion slightly limited; however, it is noted that this ankle is not the one which had surgery resulting in a scar and swelling, and the findings are similar to those documenting the post-surgical scarring and symptoms of the right ankle. In September 2019 the Veteran underwent a VA examination which diagnosed a chronic recurrent lateral collateral ligament sprain on the right diagnosed in 1984 and residuals of right ankle fracture repair. The examiner provided an opinion linking the right ankle disability to service. However, no left ankle disorder was diagnosed in this examination report. The report of a February 2020 VA addendum opinion included a comprehensive review of the record and concluded that the claimed ankle condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner noted that the Veteran complained of a right swollen ankle on August 7, 1986; however, this was noted to be after active duty service which is from 10/8/1984 to 01/18/1985. The swollen ankle in 1986 was an acute condition and there were no further complaints to right ankle since 2009, which is from a separate and unrelated medical condition. The Veteran provided lay statement in 2011 that ankle problems were related to active duty service. There is no evidence of record to support Veterans lay statement. Per medical records, the Veteran fell at home in December 2009 which resulted in a right ankle fracture. On December 16, 2009, the Veteran had surgery to right ankle related to fracture. He has had ongoing complaints of pain to right ankle since surgery. The examiner noted that there was an error in medical records indicating left ankle scar due to surgery, but there is no evidence of surgery to left ankle throughout medical reports, this is noted to be an error, there is only evidence of right ankle procedure and scar. The examiner opined that the Veteran does not have a left musculoskeletal ankle condition. A nexus has not been established. The examiner further gave an opinion that records less likely show that any ankle disability manifested within one year of the Veteran’s separation from active service (i.e. by January 1986). Again, it was noted that the swollen right ankle in August 1986 was an acute condition and there were no further complaints to right ankle until 2009, which is from a separate and unrelated medical condition. The examiner reiterated that the Veteran does not have a left musculoskeletal ankle condition and that records showing a left ankle surgical scar was in error. A nexus has not been established. The report of an October 2020 addendum opinion is noted to focus entirely on the etiology of the Veteran’s right ankle disorder and did not again included any findings or opinion regarding the left ankle. The question for the Board is whether the Veteran has a current disability that was incurred in or aggravated by service or is proximately due to or the result of, or aggravated beyond its natural progress by service-connected disability. The evidence reviewed does not show a current diagnosis of any disability of the left ankle. Rather, the evidence overwhelmingly addresses residuals of an injury to the right ankle with surgery following a fracture in December 2009. The Veteran has further not described any disability to the left ankle, but rather has focused on the well documented right ankle disability. No left ankle disability was diagnosed in the September 2019 VA examination, which also disclosed no functional impairment of the left ankle. Although left ankle pain was reported in July 2010, no actual left ankle disability, including functional impairment, was disclosed in this orthopedic record and although a November 2011 record gave a history of left ankle surgical scar, the rest of the records disclose that only the right ankle had surgery. Additionally, the VA examiner in addendum from February 2020 determined that any such findings regarding the left ankle were in error. The Board finds that the evidence shows a lack of a current disability including during the pendency of this claim. The Board notes that this differs from the situation in McLain v. Nicholson, 21 Vet. App. 319 (2007), which holds that the “current disability” requirement for service connection is met if disability is shown at any time during the claims period. Thus, given the lack of a current diagnosis of a left ankle disability, an essential element for the claim of service connection is not met. Shedden, 381 F.3d at 1167; Brammer, 3 Vet. App. at 225. As the preponderance of the evidence is against the claim, reasonable doubt does not arise, and the claim is denied. 38 U.S.C. § 5107 (b). 5. Right ankle disability The Veteran claims to have first hurt his right ankle when he twisted it in basic training at Fort Benning, GA. He has been limping from this ankle injury ever since. The Veteran further alleged that he suffered a broken right ankle in 2009 resulting from the original ankle injury on active duty. He indicated he needed surgery on the ankle around 2011 or 2012. See Hearing Transcript received 9/21/2016 page 11-17. Service treatment records showed normal musculoskeletal findings including the extremities on the July 1984 enlistment examination and he denied all orthopedic issues including foot trouble in the accompanying report of medical history. A November 1984 ETS examination was normal including the lower extremities and feet. On August 7, 1986 he was seen for a swollen ankle; with the doctor’s note says no walking or standing for one week. An August 15, 1986 treatment record diagnosed a sprained foot, said to have happened in the line of duty, and treated with an Ace bandage, Parafon Forte, and no walking. Post-service treatment records show that the Veteran injured his right ankle in December 2009, with a December 13, 2009 record disclosing that he fell in mud and popped his right ankle. The initial impression was displaced fracture, lateral malleolus R ankle and ruptured deltoid. The initial diagnosis was a right lateral malleolus fracture, and rupture deltoid. Later in December 2009, he underwent open reduction surgery of internal fixation of the right lateral malleolus of the right ankle for the diagnosed fractured lateral malleolus of the right ankle. Following such surgery, he continued with ongoing treatment for right ankle symptoms repeatedly shown to include neurological manifestations. These include a June 2010 record which disclosed right foot complaints of burning, numbness, pain and swelling. Pain onset was after ankle surgery in December 2009. The impression was pain in his limb/foot/toe. The physician recommended the Veteran needed to return to the doctor who did the surgery. A July 2010 record addressing peripheral neuropathy noted complaints of tingling and pain of the right foot with a history of a “plate” in his right foot and he thought he did something wrong. An April 2011 record indicated that the Veteran was seen for right ankle injury with a noted history of twisting his ankle in December 2009 with fracture and open reduction surgery. He was also noted to have EMG of 8/10 showing borderline peroneal and tibial motor studies with majority of compromise at L5-S1. Following exam there was an impression of right ankle hardware pain and superficial peroneal nerve impingement with mild contracture and LBP. A June 2011 letter from the Veteran’s orthopedic surgeon gave a history of the Veteran’s sustaining an unstable fracture of his lateral malleolus and undergoing open reduction and internal fixation surgery in December 2009, with ongoing symptoms from the surgery resulting in irritation of the superficial peroneal nerve. The Veteran continued with treatment for right ankle issues in January 2012 with complaints including the right leg, with findings of right ankle scar and slight diffuse swelling over the ankle. In May 2013 he was seen for refills of Lortab for complaints of pain in the back and right ankle. In June 2018 and September 2018 he was noted to have chronic ankle pain with past surgical history of ankle surgery noted. In September 2019 the Veteran underwent a VA examination, which diagnosed a chronic recurrent lateral collateral ligament sprain on the right diagnosed in 1984 and residuals of right ankle fracture repair. Historically, was reported that he fractured his right ankle during basic training, which was treated as a sprain with elevation. This was reportedly found as an old fracture that required ORIF surgery of the ankle fracture in 2011. His current symptoms were of residual pain with weight bearing or climbing stairs or steps. He had a history of only surgical repair as treatment. He had residuals of pain with walking and swelling. Following examination of the right ankle, the examiner gave an opinion that the claimed right ankle condition was at least as likely as not incurred in or caused by the claimed in-service injury, event, or illness. The rationale provided was that he had no issues related to the claimed ankle prior to military service. Onset of the condition was during service, as documented in the Service Treatment Records. The examiner stated that there is evidence of current, chronic and continuous treatment and care. A nexus has been established. The examiner noted that records document surgical repair after fracture were noted and the records do indicate follow up in 2011 for medication refill of Neurontin. The report of a February 2020 VA addendum opinion included a comprehensive review of the record and contained an opinion that the claimed ankle condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner noted that the Veteran complained of a right swollen ankle on August 7, 1986; however, this was noted after active duty service which is from 10/8/1984 to 01/18/1985. The swollen ankle in 1986 was an acute condition and there were no further complaints to right ankle since 2009, which is from a separate and unrelated medical condition. The Veteran provided lay statement in 2011 that ankle problems were related to active duty service. There is no evidence of record to support Veterans lay statement. Per medical records, the Veteran fell at home in December 2009, which resulted in a right ankle fracture. On December 16, 2009, Veteran had surgery to right ankle related to fracture. He has had ongoing complaints of pain in the right ankle since surgery. The examiner noted that there was an error in medical records indicating left ankle scar due to surgery, but there is no evidence of surgery to left ankle throughout medical reports. This was noted to be an error, there is only evidence of right ankle procedure and scar. The examiner opined that the Veteran does not have a left musculoskeletal ankle condition. A nexus has not been established. The examiner further opined that records less likely show that any ankle disability manifested within one year of the Veteran’s separation from active service (i.e. by January 1986). Again, it was noted that the swollen right ankle in August 1986 was an acute condition and there were no further complaints to right ankle until 2009, which is from a separate and unrelated medical condition. The examiner reiterated that the Veteran does not have a left musculoskeletal ankle condition and that records showing a left ankle surgical scar was in error. A nexus has not been established. The report of an October 2020 addendum opinion again included a comprehensive review of the records to include consideration of previously overlooked treatment record in November 1984 during ACDUTRA showing foot problems with corns and contracted digits and his contention at the September 2016 Board hearing that he twisted his ankle in service and had symptoms with limping after service. It was noted that the treatment for a sprained foot and swollen ankle in August 1986 was not during a period of ACDUTRA or other form of active service; the ACDUTRA period ended in January 1985. The examiner gave an opinion that the claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. In the rationale which considered service dates from October 8, 1984 to January 18, 1985, the examiner confirmed review of the entire claims file, including lay statements. While the lay statement conveys that he twisted his ankle in service, the examiner found no documented signs/symptoms/complaints consistent with a diagnosis of an ankle condition found during service. While lay statements provide important information they do not, in and of themselves, provide evidence of a diagnosis. Specialty separation examination in November 1984 performed by podiatrist showed contracted digits 2-5 bilateral; soft corn left fourth interspace; tinea pedis plantar aspect left foot and none of these exam findings caused the ankle condition. The August 7, 1986 Individual sick slip showing ankle swollen was post service, acute and unrelated to service. The veteran sustained a post service right lateral malleolus fracture in December 2009 treated with ORIF. The April 20, 2011 orthopedic note showed right ankle twisting injury 12/16/2009 status post ORIF right lateral malleolus fracture with an assessment-right ankle hardware pain and superficial peroneal nerve impingement with mild contracture. Therefore, it is less likely than not related to AD service. A nexus is not established. The question for the Board is whether the Veteran has a current disability that was incurred in or aggravated by service. The Board concludes that while the Veteran has a current disability diagnosed in the September 2019 VA examination as chronic recurrent lateral collateral ligament sprain on the right diagnosed in 1984 and residuals of right ankle fracture repair in light of Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018), the preponderance of the evidence is against finding that the Veteran’s right ankle disability was incurred or aggravated by service. The VA examiner in addendums from February 2020, with further clarification in October 2020, opined that the Veteran’s right ankle disability that was treated in service was acute and transitory and the current right ankle disability is instead more likely due to the post service fracture resulting in ORIF surgery in December 2009. The rationale was adequate and supported by the medical and lay evidence, which was comprehensively reviewed, and which confirmed treatment for persistent symptoms affecting the right ankle following the fracture and surgery to reduce the fracture in December 2009. Although the September 2019 VA examination gave a positive nexus opinion, this opinion was not supported by adequate rationale which necessitated the addendum opinions which were subsequently unfavorable and supported by adequate rationale. The medical evidence of record is otherwise not shown to directly contradict this opinion. The Veteran believes his right ankle disability is proximately due to or the result of his active service. The Veteran in this case is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires knowledge of relationships, pathology and interpretation of complicated diagnostic medical testing. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the skills or medical training to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the VA examiner’s addendum opinions of February 2020 and October 2020 rendered by a trained medical professional based on appropriate diagnostic testing and reasonably drawn conclusions with supportive rationale. For the above reasons, the preponderance of the evidence is against the claim and service connection is denied. 6. Pes planus (flat foot) of the left and right feet The Veteran contends that service connection is warranted for a left flat foot and right flat foot disability. Although he did not testify regarding the left and right flat foot disability at his September 2016 hearing, he did claim in August 2010 that foot problems occurred in service. Because the flat foot factual background is the same for the left foot and right foot the Board shall address these disorders together. Service treatment records showed normal musculoskeletal findings including the extremities and feet on the July 1984 enlistment examination and he denied all orthopedic issues including foot trouble in the accompanying report of medical history. In November 1984, the Veteran was seen for complaints of “corns” of the 4th Metatarsal and fingers. Physical exam was positive for contracted digits 2-5 bilaterally and “HD’s” (Heloma durum hard corn) 2-5 bilat, HM 4th interface L (soft corn) and Tinea plantar aspect of foot. The Veteran was assessed with HD’s 2ndary to contracted digits, HM 4th interface, tinea pedis. A November 1984 ETS examination was normal including the feet. On August 7, 1986 he was seen for a swollen ankle; the doctor’s note ordered no walking or standing for one week. An August 15, 1986 treatment record diagnosed a sprained foot, said to have happened in the line of duty, and treated with an Ace bandage, Parafon Forte, and no walking. The report of a July 2010 private orthopedic evaluation by Dr. D, signed in August 2010, addressing pain and numbness of his right ankle post ORIF surgery is noted to include incidental findings of a bilateral pes planus deformity, although he was able to reconstitute his arch. The rest of this examination focused on residual issues with the right ankle status post ORIF surgery. Otherwise, the post-service records addressed other medical issues besides pes planus, to include extensive findings and examinations related to the Veteran’s post service right ankle fracture as discussed in the records addressing his right ankle problems and did not include any findings regarding the feet pertinent to this matter. The report of a September 2019 VA examination diagnosed flat foot (pes planus) bilaterally, with a date of diagnosis in 1986. The rest of the examination addressed the severity of this pes planus. No other foot disorders were diagnosed. Following examination, the examiner gave an opinion that the claimed foot disorder was less likely than not incurred in or caused by the inservice injury, event or illness. The rationale provided noted that during service, his condition was acute only. There was no evidence of chronicity of care. A nexus has not been established. The examiner opined that records were silent on any treatment of flat feet during or after service. The report of a February 2020 VA addendum opinion included a comprehensive review of the record and gave an opinion that the claimed pes planus condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. In the rationale, the examiner pointed out that flat foot was not diagnosed or treated during active duty service from October 8, 1984 to January 18, 1985. The Veteran claimed flatfoot in 2010 and provided lay statement that this occurred in service. The examiner noted that there is no evidence of record to support the Veteran’s lay statements. Service treatment records were silent for a flat foot condition. The Veteran did complain of sprain foot condition on August 15, 1986; however, this is was acute and has no relation to claim for flat foot condition. Diagnosis of flat feet was rendered on day of examination; however, there is a 25-year gap from initial claim of flat foot in relation to active duty and 35-year gap from diagnosis rendered on day of examination on 9/5/2019. A nexus has not been established. The report of an October 2020 addendum opinion again included a comprehensive review of the records and provided an opinion that the claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. In the rationale the examiner noted that a specialty separation examination in service performed by a podiatrist did not show evidence of pes planus. The physical examination shows contracted digits 2-5 bilateral; soft corn left fourth interspace; tinea pedis plantar aspect left foot and none of these exam findings cause pes planus. Therefore, it is less likely than not that the flat foot is related to active service. The August 15, 1986 individual sick slip for sprain foot, shows a post service foot sprain which was acute and is not related to active service. An August 2010 orthopedic note shows pes planus deformity both feet, 25 years post service. The literature supports risk factors for acquired pes planus are obesity, foot/ankle trauma, posterior tibial dysfunction and diabetes mellitus. A December 12, 2009 ER note shows weight 242 lbs. height from separation exam 73 inches calculated BMI 31.9, which is considered obese and the veteran underwent a right ankle ORIF for a right lateral malleolus fracture 12/16/2009. It is equally plausible the flatfoot is related to these post service conditions. A nexus is not established. The question for the Board is whether the Veteran has a current disability that was incurred in or aggravated by service. The Board concludes that, while the Veteran has a current disability diagnosed in the September 2019 VA examination as bilateral pes planus in light of Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018), the preponderance of the evidence is against finding that the Veteran’s pes planus disabilities of the left foot and right foot were incurred or aggravated by service. The VA examiner in addendums from February 2020, with further clarification in October 2020, opined that the Veteran’s pes planus disability did not begin in service and that the current pes planus disability is instead more likely due to the post service risk factors including obesity, which the Veteran was noted to meet the criteria for. The rationale was adequate and supported by the medical and lay evidence, which was comprehensively reviewed. The medical evidence of record is otherwise not shown to directly contradict this opinion. The Veteran believes his pes planus disability of the left foot and right foot is proximately due to or the result of his active service. The Veteran in this case is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires knowledge of relationships, pathology and interpretation of complicated diagnostic medical testing. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the skills or medical training to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the VA examiner’s addendum opinions of February 2020 and October 2020 rendered by a trained medical professional based on appropriate diagnostic testing and reasonably drawn conclusions with supportive rationale. For the above reasons, the preponderance of the evidence is against the claim and service connection is denied. Eric S. Leboff Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Eckart 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.