Citation Nr: 21026932 Decision Date: 05/04/21 Archive Date: 05/04/21 DOCKET NO. 14-01 518 DATE: May 4, 2021 ORDER Entitlement to service connection for sleep apnea is denied. Entitlement to service connection for headaches is denied. Entitlement to service connection for a cervical spine disability is denied. Entitlement to service connection for a lumbar spine disability is denied. Entitlement to service connection for a right upper extremity disability is denied. Entitlement to service connection for a right lower extremity disability is denied. Entitlement to service connection for a left lower extremity disability is denied. Entitlement to service connection for a right hip disability is denied. Entitlement to service connection for a left hip disability is denied. Entitlement to service connection for a right knee disability is denied. Entitlement to service connection for a left knee disability is denied. Entitlement to service connection for a right ankle disability is denied. Entitlement to service connection for a left ankle disability is denied. Entitlement to an initial disability rating in excess of 10 percent for a post-operative scar resulting from removal of sebaceous cyst is denied. Entitlement to an initial compensable disability rating for degenerative joint disease of the left little finger is denied. Entitlement to an initial disability rating in excess of 30 percent for bilateral pes planus is denied. FINDINGS OF FACT 1. A current diagnosis of sleep apnea was not incurred in service, has not been chronic or continuous since service separation, did not manifest to a compensable degree within a year of service separation, is not due to or aggravated by a service-connected disability, and is not due to or aggravated by a service-connected disability. 2. A current headache disorder was not incurred in service, has not been chronic or continuous since service separation, did not manifest to a compensable degree within a year of service separation, is not due to or aggravated by a service-connected disability, and is not due to or aggravated by a service-connected disability. 3. A current cervical spine disability was not incurred in service, has not been chronic or continuous since service separation, did not manifest to a compensable degree within a year of service separation, is not due to or aggravated by a service-connected disability, and is not due to or aggravated by a service-connected disability. 4. A current lumbosacral spine disability was not incurred in service, has not been chronic or continuous since service separation, did not manifest to a compensable degree within a year of service separation, is not due to or aggravated by a service-connected disability, and is not due to or aggravated by a service-connected disability. 5. A current disability of the right upper extremity was not incurred in service, has not been chronic or continuous since service separation, did not manifest to a compensable degree within a year of service separation, is not due to or aggravated by a service-connected disability, and is not due to or aggravated by a service-connected disability. 6. A current disability of the right lower extremity was not incurred in service, has not been chronic or continuous since service separation, did not manifest to a compensable degree within a year of service separation, is not due to or aggravated by a service-connected disability, and is not due to or aggravated by a service-connected disability. 7. A current disability of the left lower extremity was not incurred in service, has not been chronic or continuous since service separation, did not manifest to a compensable degree within a year of service separation, is not due to or aggravated by a service-connected disability, and is not due to or aggravated by a service-connected disability. 8. A current disability of the right hip was not incurred in service, has not been chronic or continuous since service separation, did not manifest to a compensable degree within a year of service separation, is not due to or aggravated by a service-connected disability, and is not due to or aggravated by a service-connected disability. 9. A current disability of the left hip was not incurred in service, has not been chronic or continuous since service separation, did not manifest to a compensable degree within a year of service separation, is not due to or aggravated by a service-connected disability, and is not due to or aggravated by a service-connected disability. 10. A current disability of the right knee was not incurred in service, has not been chronic or continuous since service separation, did not manifest to a compensable degree within a year of service separation, is not due to or aggravated by a service-connected disability, and is not due to or aggravated by a service-connected disability. 11. A current disability of the left knee was not incurred in service, has not been chronic or continuous since service separation, did not manifest to a compensable degree within a year of service separation, is not due to or aggravated by a service-connected disability, and is not due to or aggravated by a service-connected disability. 12. A current disability of the right ankle was not incurred in service, has not been chronic or continuous since service separation, did not manifest to a compensable degree within a year of service separation, is not due to or aggravated by a service-connected disability, and is not due to or aggravated by a service-connected disability. 13. A current disability of the left ankle was not incurred in service, has not been chronic or continuous since service separation, did not manifest to a compensable degree within a year of service separation, is not due to or aggravated by a service-connected disability, and is not due to or aggravated by a service-connected disability. 14. The Veteran's post-operative scar resulting from removal of a sebaceous cyst results in several small surgical scars which are not deep, do not involve tissue loss, and are less than 39 sq. cm. in size. 15. The Veteran's degenerative joint disease of the left little finger results in at least some motion of the affected finger. 16. The Veteran's bilateral pes planus results in pain and tenderness of the feet, without marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement, or severe spasm of the Achilles tendon on manipulation. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for sleep apnea have not been met. 38 U.S.C. §§ 1101, 1112, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.310. 2. The criteria for entitlement to service connection for headaches have not been met. 38 U.S.C. §§ 1101, 1112, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.310. 3. The criteria for entitlement to service connection for a cervical spine disability have not been met. 38 U.S.C. §§ 1101, 1112, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.310. 4. The criteria for entitlement to service connection for a lumbar spine disability have not been met. 38 U.S.C. §§ 1101, 1112, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.310. 5. The criteria for entitlement to service connection for a right upper extremity disability have not been met. 38 U.S.C. §§ 1101, 1112, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.310. 6. The criteria for entitlement to service connection for a right lower extremity disability have not been met. 38 U.S.C. §§ 1101, 1112, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.310. 7. The criteria for entitlement to service connection for a left lower extremity disability have not been met. 38 U.S.C. §§ 1101, 1112, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.310. 8. The criteria for entitlement to service connection for a right hip disability have not been met. 38 U.S.C. §§ 1101, 1112, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.310. 9. The criteria for entitlement to service connection for a left hip disability have not been met. 38 U.S.C. §§ 1101, 1112, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.310. 10. The criteria for entitlement to service connection for a right knee disability have not been met. 38 U.S.C. §§ 1101, 1112, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.310. 11. The criteria for entitlement to service connection for a left knee disability have not been met. 38 U.S.C. §§ 1101, 1112, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.310. 12. The criteria for entitlement to service connection for a right ankle disability have not been met. 38 U.S.C. §§ 1101, 1112, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.310. 13. The criteria for entitlement to service connection for a left ankle disability have not been met. 38 U.S.C. §§ 1101, 1112, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.310. 14. The criteria for entitlement to an initial disability rating in excess of 10 percent for a post-operative scar resulting from removal of sebaceous cyst have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.118, Diagnostic Codes 7800-04. 15. The criteria for entitlement to an initial compensable disability rating for degenerative joint disease of the left little finger have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5003, 5230. 16. The criteria for entitlement to an initial disability rating in excess of 30 percent for bilateral pes planus have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5276-84. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from November 1980 to November 1983. This matter comes before the Board of Veterans' Appeals (Board) on appeal from December 2010, July 2011, and December 2011 rating decisions of a Regional Office (RO) of the Department of Veterans Affairs (VA). The Veteran testified before a Veterans Law Judge in January 2016. A transcript of that hearing has been associated with the claims file. This Veterans Law Judge is no longer with the Board. The Veteran was offered the opportunity for another hearing before a current Veterans Law Judge, but in a February 2021 telephone call, declined a second Board hearing. These issues were remanded by the Board in May 2018 and November 2019. They have now been returned to the Board for further consideration. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). As a general matter, service connection for a disability requires evidence of: (1) the existence of a current disability; (2) the existence of the disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Where the evidence shows a "chronic disease" in service or "continuity of symptoms" after service, the disease shall be presumed to have been incurred in service. For the showing of "chronic" disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. With chronic disease as such in service, subsequent manifestations of the same chronic disease at any later date, however remote, are service-connected, unless clearly attributable to intercurrent causes. If a condition noted during service is not shown to be chronic, then generally, a showing of "continuity of symptoms" after service is required for service connection. 38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Additionally, where a veteran served ninety days or more of active service, and certain chronic diseases become manifest to a degree of 10 percent or more within one year after the date of separation from such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309(a). While the disease need not be diagnosed within the presumption period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. Id. Finally, service connection may be awarded for any disability which is proximately due to or the result of, or is otherwise aggravated by, a service-connected disease or injury. 38 C.F.R. § 3.310. 1. Entitlement to service connection for sleep apnea The Veteran seeks service connection for sleep apnea. He asserts such a disability first manifested during active duty service. In the alternative, he asserts such a disability is due to or aggravated by a service-connected disability. Considering first the service treatment records, these are negative for any diagnosis of or treatment for a sleep apnea or any other sleep disorder. While a service separation examination is not of record, he was afforded a November 1984 reserve service physical examination and report of medical history. At that time, no respiratory or sleep-related abnormalities were noted by the examiner or reported by the Veteran. On the concurrent report of medical history, the Veteran denied any history of frequent trouble sleeping. Post-service, the Veteran was not diagnosed with and did not seek treatment for sleep apnea or any other sleep-related disorder for many years. Moreover, when he initially filed for service connection for unrelated disabilities in August 2010, he did not report any sleep-related disabilities at that time. The first diagnosis of sleep apnea dates to approximately 2011, more than 25 years after service separation. This lengthy period without complaint or treatment is one piece of evidence that there has not been ongoing symptomatology and weighs heavily against the claim. See Buczynski v. Shinseki, 24 Vet. App. 221, 224 (2011) (the Board may consider a lack of notation of a medical condition or symptoms where such notation would normally be expected). Based on this evidence, the Board must conclude that a current diagnosis of sleep apnea did not have its onset in service and has not been chronic and continuous since service separation. In support of his claim, the Veteran submitted a May 2014 statement from his brother. The Veteran's brother wrote that in September 1982, while on active duty, the Veteran visited him for two weeks. During that time, the Veteran's brother observed the Veteran snoring loudly in his sleep and appearing to stop breathing. Another statement was received in December 2015 from F.W., who served with the Veteran. She wrote that during his active duty service, she observed the Veteran struggling to breathe and snoring in his sleep. A December 2016 VA examination and medical opinion was afforded the Veteran. The claims file was reviewed in conjunction with the examination. After review of the file and examination of the Veteran, the VA examiner opined that the Veteran's current obstructive sleep apnea was less likely than not incurred in or aggravated by active duty service. The examiner noted that the first reports of sleep disturbances within the record dated to many years after service. Regarding the question of secondary service connection, the examiner concluded it was less likely than not any current sleep apnea was due to or aggravated by a service-connected disability, to include bilateral pes planus. The examiner noted that sleep apnea was the result of an upper airway obstruction during sleep and was unrelated to aches and pains of the body. Thus, based on the competent evidence of record, the Board must conclude that service connection on a direct basis is not warranted. The medical evidence of record does not reflect a diagnosis of sleep apnea either during service or for many years thereafter. Additionally, the competent evidence of record is against a nexus between any disease, injury, or other incident of service, and a current sleep disorder. Regarding service connection on a secondary basis, the 2016 VA examiner opined that the Veteran's current obstructive sleep apnea was neither caused nor aggravated by a service-connected disability or disabilities. In the absence of competent evidence to the contrary, service connection for sleep apnea on any basis is not warranted. While the Veteran has submitted lay statements from friends and family confirming difficulty breathing and snoring during service, as well as his own contentions, the Board does not find this lay evidence probative. Laypersons are not capable of making medical conclusions; thus, his statements regarding causation are not competent evidence. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Lay statements may be competent to support a claim for service connection by supporting the occurrence of lay-observable events or the presence of disability or symptoms of disability subject to lay observation. See Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006) (addressing lay evidence as potentially competent to support presence of disability even where not corroborated by contemporaneous medical evidence). However, sleep disorders are complex disorders which require specialized training for a determination as to diagnosis and causation, and they are therefore not susceptible of lay opinions on etiology, and the lay statements therein cannot be accepted as competent medical evidence. The Veteran is also not reporting an expert opinion as told to him, and his lay contentions have not subsequently been confirmed by a competent expert. Regarding the credibility of these lay assertions, the Board notes the Veteran himself denied any trouble sleeping during service and did not report or seek treatment for a sleep disorder during service or for many years thereafter. In conclusion, the preponderance of the evidence is against the award of service connection for sleep apnea on any basis. Such a disability was not incurred in service, has not been chronic or continuous since service separation, did not manifest to a compensable degree within a year of service separation, and is not due to or aggravated by a service-connected disability. A current diagnosis of sleep apnea is also not due to or aggravated by a service-connected disability. As a preponderance of the evidence is against the award of service connection, the benefit of the doubt doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107(b); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001). 2. Entitlement to service connection for headaches The Veteran seeks service connection for headaches. He asserts such a disability first manifested during service, and/or is due to a service-connected disability. Thus, the Veteran contends, service connection for this disability is warranted. Considering first the service treatment records, these are negative for any diagnosis of or treatment for headaches. On a November 1984 reserve service physical examination, the Veteran was without any noted neurological impairment. On a concurrent report of medical history, the Veteran explicitly denied any frequent or severe headaches. Post-service, the Veteran was not diagnosed with and did not seek treatment for headaches for many years. Moreover, when he initially filed for service connection for unrelated disabilities in August 2010, he did not report any headaches at that time. The first diagnosis of headaches dates to approximately 2000, more than 15 years after service separation, according to a 2011 VA examination report. This lengthy period without complaint or treatment is one piece of evidence that there has not been ongoing symptomatology and weighs heavily against the claim. See Buczynski v. Shinseki, 24 Vet. App. 221, 224 (2011) (the Board may consider a lack of notation of a medical condition or symptoms where such notation would normally be expected). Based on this evidence, the Board must conclude that a current diagnosis of headaches did not have its onset in service and has not been chronic and continuous since service separation. According to a September 2011 VA examination report, the Veteran claimed he first began experiencing headaches in 2000, post-service. On VA examination in December 2016, the Veteran reported onset of his headaches in 2011, post-service, following surgical removal of a sebaceous cyst from his scalp. The Veteran has been granted service connection for postoperative residuals of surgical removal of a sebaceous cyst. Regarding the etiology of the Veteran's claimed headaches, the examiner determined it was less likely than not any current headaches were due to or aggravated by his postoperative scar of the scalp. The examiner noted that the Veteran's surgical scar was superficial, without muscle or nerve involvement. The Veteran was also without cranial injury, according to the examiner. Thus, there was no clinical evidence the examiner could find to support the claimed causal nexus between the Veteran's headaches and his surgical scar. Another VA examination and opinion was afforded the Veteran in January 2020. The Veteran was both examined by a VA physician's assistant, and his claims file was reviewed. Upon review of the evidence, the examiner determined it was less likely than not any current headache disorder was due to or aggravated by a surgical scar of the scalp. The examiner could find no medical evidence supporting such a nexus. Thus, based on the competent evidence of record, the Board must conclude that service connection on a direct basis is not warranted. The medical evidence of record does not reflect a diagnosis of or treatment for headaches either during service or for many years thereafter. Additionally, the competent evidence of record is against a nexus between any disease, injury, or other incident of service, and a current headache disorder. Regarding service connection on a secondary basis, the 2016 and 2020 VA examiners both opined that the Veteran's current headaches were neither caused nor aggravated by a service-connected disability or disabilities. In the absence of competent evidence to the contrary, service connection for headaches on any basis is not warranted. While the Veteran has submitted his own lay contentions regarding the etiology of his headaches, the Board does not find this lay evidence probative. Laypersons are not capable of making medical conclusions; thus, his statements regarding causation are not competent evidence. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Lay statements may be competent to support a claim for service connection by supporting the occurrence of lay-observable events or the presence of disability or symptoms of disability subject to lay observation. See Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006) (addressing lay evidence as potentially competent to support presence of disability even where not corroborated by contemporaneous medical evidence). However, neurological disorders are complex disorders which require specialized training for a determination as to diagnosis and causation, and they are therefore not susceptible of lay opinions on etiology, and the lay statements therein cannot be accepted as competent medical evidence. The Veteran is also not reporting an expert opinion as told to him, and his lay contentions have not subsequently been confirmed by a competent expert. Regarding the credibility of these lay assertions, the Board notes the Veteran himself denied frequent or severe headaches during service and did not report or seek treatment for headaches during service or for many years thereafter. In conclusion, the preponderance of the evidence is against the award of service connection for headaches on any basis. Such a disability was not incurred in service, has not been chronic or continuous since service separation, did not manifest to a compensable degree within a year of service separation, and is not due to or aggravated by a service-connected disability. A current diagnosis of a headache disorder is also not due to or aggravated by a service-connected disability. As a preponderance of the evidence is against the award of service connection, the benefit of the doubt doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107(b); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001). 3. Entitlement to service connection for a cervical spine disability The Veteran seeks service connection for a cervical spine disability. He asserts he injured his neck in service, and service connection for a cervical spine disability is therefore warranted. He also asserts a current cervical spine disability is caused or aggravated by a service-connected disability, bilateral pes planus. Considering first the service treatment records, the Veteran sought treatment in August 1981 for pain in the neck region. Physical evaluation was negative for any objective findings. The assessment was of pain on the right side of the neck, and the Veteran was given medication. Thereafter, the Veteran did not seek further treatment for his neck or cervical spine. On a November 1984 post-service reserve periodic examination, the Veteran was without any noted abnormalities of the spine or neck, and on a concurrent report of medical history, he denied any history of arthritis, bursitis, rheumatism, recurrent back pain, or bone, joint, or other deformity. Post-service, the Veteran was not diagnosed with and did not seek treatment for a cervical spine disability for many years. Moreover, when he initially filed for service connection for unrelated disabilities in August 2010, he did not report a neck or cervical spine disability at that time. The first diagnosis of such a disability dates to approximately 2010, more than 25 years after service separation, when degenerative changes of the spine were noted. This lengthy period without complaint or treatment is one piece of evidence that there has not been ongoing symptomatology and weighs heavily against the claim. See Buczynski v. Shinseki, 24 Vet. App. 221, 224 (2011) (the Board may consider a lack of notation of a medical condition or symptoms where such notation would normally be expected). Based on this evidence, the Board must conclude that a current diagnosis of a cervical spine disability did not have its onset in service and has not been chronic and continuous since service separation. The Veteran was afforded a VA medical examination and opinion in December 2011. The claims file was reviewed in conjunction with the examination. After examining the Veteran and reviewing the record, the examiner concluded it was less likely than not any current cervical disability was due to or aggravated by the Veteran's bilateral pes planus. Another VA examination and opinion was obtained in December 2016, and that VA examiner also concluded it was less likely than not any current cervical disability was due to or aggravated by the Veteran's bilateral pes planus. This examiner noted the Veteran did not have leg length discrepancy or other orthopedic finding resulting from his bilateral pes planus which would result in a cervical spine disability. Most recently, a VA medical opinion was afforded the Veteran in January 2020. After reviewing the claims folder, including all available medical records, the examiner determined it was less likely than not that the Veteran's current cervical spine condition is aggravated beyond its natural progression by his bilateral pes planus, as there is no medical record evidence that his cervical spine condition was aggravated beyond its natural progression by his pes planus. Thus, based on the competent evidence of record, the Board must conclude that service connection on a direct basis is not warranted. While the Veteran did report neck pain on one occasion during service, no objective findings of a neck or cervical spine disability were made at that time. The Veteran also did not seek additional treatment for his neck during the remainder of service and denied any disabilities of the neck on subsequent examination in November 1984. Additionally, no competent evidence has been presented of a nexus between any disease, injury, or other incident of service, and a current neck or cervical spine disorder. Regarding service connection on a secondary basis, the 2011, 2016, and 2020 VA examiners all opined that the Veteran's current cervical spine disability was neither caused nor aggravated by a service-connected disability or disabilities. In the absence of competent evidence to the contrary, service connection for a cervical spine disability on any basis is not warranted. While the Veteran has submitted his own lay contentions regarding the etiology of his cervical spine disability, the Board does not find this lay evidence probative. Laypersons are not capable of making medical conclusions; thus, his statements regarding causation are not competent evidence. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Lay statements may be competent to support a claim for service connection by supporting the occurrence of lay-observable events or the presence of disability or symptoms of disability subject to lay observation. See Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006) (addressing lay evidence as potentially competent to support presence of disability even where not corroborated by contemporaneous medical evidence). However, orthopedic disorders are complex disorders which require specialized training for a determination as to diagnosis and causation, and they are therefore not susceptible of lay opinions on etiology, and the lay statements therein cannot be accepted as competent medical evidence. The Veteran is also not reporting an expert opinion as told to him, and his lay contentions have not subsequently been confirmed by a competent expert. Regarding the credibility of these lay assertions, the Board notes the Veteran himself denied recurrent back pain following service in 1984 and did not report or seek treatment for neck pain for many years thereafter. In conclusion, the preponderance of the evidence is against the award of service connection for a cervical spine disability on any basis. Such a disability was not incurred in service, has not been chronic or continuous since service separation, did not manifest to a compensable degree within a year of service separation, and is not due to or aggravated by a service-connected disability. A current diagnosis of a cervical spine disorder is also not due to or aggravated by a service-connected disability. As a preponderance of the evidence is against the award of service connection, the benefit of the doubt doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107(b); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001). 4. Entitlement to service connection for a lumbar spine disability The Veteran seeks service connection for a lumbar spine disability. He asserts he injured his low back in service, and service connection for a lumbosacral spine disability is therefore warranted. He also asserts a current lumbosacral spine disability is caused or aggravated by a service-connected disability, bilateral pes planus. Considering first the service treatment records, these are negative for a diagnosis of or treatment for a low back or lumbosacral spine disability. A service separation examination is not of record, but the Veteran was afforded a November 1984 reserve service physical examination. At that time, he was without any abnormality of the neck or spine. On a November 1984 periodic report of medical history, the Veteran denied any history of recurrent back pain. Post-service, the Veteran was not diagnosed with and did not seek treatment for a lumbosacral spine disability for many years. Moreover, when he initially filed for service connection for unrelated disabilities in August 2010, he did not report a low back or lumbosacral spine disability at that time. The first diagnosis of such a disability dates to approximately 2010, more than 25 years after service separation, when degenerative changes of the spine were noted. This lengthy period without complaint or treatment is one piece of evidence that there has not been ongoing symptomatology and weighs heavily against the claim. See Buczynski v. Shinseki, 24 Vet. App. 221, 224 (2011) (the Board may consider a lack of notation of a medical condition or symptoms where such notation would normally be expected). Based on this evidence, the Board must conclude that a current diagnosis of a lumbosacral spine disability did not have its onset in service and has not been chronic and continuous since service separation. The Veteran was afforded a VA medical examination and opinion in December 2011. The claims file was reviewed in conjunction with the examination. After examining the Veteran and reviewing the record, the examiner concluded it was less likely than not any current lumbosacral disability was due to or aggravated by the Veteran's bilateral pes planus. Another VA examination and opinion was obtained in December 2016, and that VA examiner also concluded it was less likely than not any current lumbosacral disability was due to or aggravated by the Veteran's bilateral pes planus. This examiner noted the Veteran did not have a leg length discrepancy, abnormal gait, or other orthopedic finding resulting from his bilateral pes planus which would result in a lumbosacral spine disability. Most recently, a VA medical opinion was afforded the Veteran in January 2020. After reviewing the claims folder, including all available medical records, the examiner determined it was less likely than not that the Veteran's current lumbosacral spine condition is aggravated beyond its natural progression by his bilateral pes planus, as there is no medical record evidence that his lumbosacral spine condition was aggravated beyond its natural progression by his pes planus. Thus, based on the competent evidence of record, the Board must conclude that service connection on a direct basis is not warranted. The service treatment records are negative for any diagnosis of or treatment for a low back or lumbosacral spine disability, and none was reported by the Veteran or noted by a service examiner in 1984, within a year of service separation. Additionally, no competent evidence has been presented establishing a nexus between any disease, injury, or other incident of service, and a current lumbosacral spine disorder. Regarding service connection on a secondary basis, the 2011, 2016, and 2020 VA examiners all opined that the Veteran's current lumbosacral spine disability was neither caused nor aggravated by a service-connected disability or disabilities. In the absence of competent evidence to the contrary, service connection for a lumbosacral spine disability on any basis is not warranted. While the Veteran has submitted his own lay contentions regarding the etiology of his lumbosacral spine disability, the Board does not find this lay evidence probative. Laypersons are not capable of making medical conclusions; thus, his statements regarding causation are not competent evidence. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Lay statements may be competent to support a claim for service connection by supporting the occurrence of lay-observable events or the presence of disability or symptoms of disability subject to lay observation. See Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006) (addressing lay evidence as potentially competent to support presence of disability even where not corroborated by contemporaneous medical evidence). However, orthopedic disorders are complex disorders which require specialized training for a determination as to diagnosis and causation, and they are therefore not susceptible of lay opinions on etiology, and the lay statements therein cannot be accepted as competent medical evidence. The Veteran is also not reporting an expert opinion as told to him, and his lay contentions have not subsequently been confirmed by a competent expert. Regarding the credibility of these lay assertions, the Board notes the Veteran himself denied recurrent back pain following service in 1984 and did not report or seek treatment for low back pain for many years thereafter. In conclusion, the preponderance of the evidence is against the award of service connection for a lumbosacral spine disability on any basis. Such a disability was not incurred in service, has not been chronic or continuous since service separation, did not manifest to a compensable degree within a year of service separation, and is not due to or aggravated by a service-connected disability. A current diagnosis of a lumbosacral spine disorder is also not due to or aggravated by a service-connected disability. As a preponderance of the evidence is against the award of service connection, the benefit of the doubt doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107(b); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001). 5. Entitlement to service connection for a right upper extremity disability The Veteran seeks service connection for a disability of the right upper extremity. He asserts he injured his right upper extremity as the result of a fall in service. He also asserts a current right upper extremity disability is caused or aggravated by a service-connected disability, bilateral pes planus, or a claimed cervical spine disability. Considering first the service treatment records, these are negative for a diagnosis of or treatment for a disability of the right upper extremity. A service separation examination is not of record, but the Veteran was afforded a November 1984 reserve service physical examination. At that time, he was without any abnormality of the upper extremities. On a November 1984 periodic report of medical history, the Veteran denied any history of arthritis, rheumatism, bursitis, or neuritis. Post-service, the Veteran was not diagnosed with and did not seek treatment for a disability of the right upper extremity for many years. Moreover, when he initially filed for service connection for unrelated disabilities in August 2010, he did not report a disability of the right upper extremity at that time. The first reports of symptoms of the right upper extremity date to approximately 2010, more than 25 years after service separation. While the Veteran was afforded EMG/NCV studies of the right upper extremity in 2010 and 2011, these were negative for any neurological abnormalities. This lengthy period without complaint or treatment is one piece of evidence that there has not been ongoing symptomatology and weighs heavily against the claim. See Buczynski v. Shinseki, 24 Vet. App. 221, 224 (2011) (the Board may consider a lack of notation of a medical condition or symptoms where such notation would normally be expected). Based on this evidence, the Board must conclude that a current diagnosis of a right upper extremity disability did not have its onset in service and has not been chronic and continuous since service separation. A VA medical opinion was afforded the Veteran in January 2020. After reviewing the claims folder, including all available medical records, the examiner diagnosed peripheral neuropathy of the right upper extremity, possibly related to a cervical spine disability. The examiner did not find, however, that the claimed cervical spine disability was due to or aggravated by a service-connected disability. Thus, based on the competent evidence of record, the Board must conclude that service connection on a direct basis is not warranted. The service treatment records are negative for any diagnosis of or treatment for a disability of the right upper extremity, and none was reported by the Veteran or noted by a service examiner in 1984, within a year of service separation. Additionally, no competent evidence has been presented establishing a nexus between any disease, injury, or other incident of service, and a current disorder of the right upper extremity. Regarding service connection on a secondary basis, no competent evidence has been presented of that a service-connected disability either causes or aggravates a disability of the right upper extremity. While the Veteran has asserted that he has a right upper extremity disability resulting from a disability of the cervical spine, service connection for a cervical spine disability has not been granted by VA. In the absence of competent evidence to the contrary, service connection for a right upper extremity disability on any basis is not warranted. While the Veteran has submitted his own lay contentions regarding the etiology of his claimed right upper extremity disability, the Board does not find this lay evidence probative. Laypersons are not capable of making medical conclusions; thus, his statements regarding causation are not competent evidence. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Lay statements may be competent to support a claim for service connection by supporting the occurrence of lay-observable events or the presence of disability or symptoms of disability subject to lay observation. See Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006) (addressing lay evidence as potentially competent to support presence of disability even where not corroborated by contemporaneous medical evidence). However, neurological disorders are complex disorders which require specialized training for a determination as to diagnosis and causation, and they are therefore not susceptible of lay opinions on etiology, and the lay statements therein cannot be accepted as competent medical evidence. The Veteran is also not reporting an expert opinion as told to him, and his lay contentions have not subsequently been confirmed by a competent expert. Regarding the credibility of these lay assertions, the Board notes the Veteran himself denied any neuritis following service in 1984 and did not report or seek treatment for a right upper extremity disease or injury for many years thereafter. In conclusion, the preponderance of the evidence is against the award of service connection for a disability of the right upper extremity on any basis. Such a disability was not incurred in service, has not been chronic or continuous since service separation, did not manifest to a compensable degree within a year of service separation, and is not due to or aggravated by a service-connected disability. A current diagnosis of a right upper extremity disorder is also not due to or aggravated by a service-connected disability. As a preponderance of the evidence is against the award of service connection, the benefit of the doubt doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107(b); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001). 6. Entitlement to service connection for a right lower extremity disability 7. Entitlement to service connection for a left lower extremity disability The Veteran seeks service connection for disabilities of the lower extremities. He asserts he injured his back and neck as the result of a fall in service, with resulting impairment of the lower extremities. He also asserts current bilateral lower extremity disabilities are caused or aggravated by a service-connected disability, bilateral pes planus, or claimed disabilities of the cervical and lumbosacral spine. Considering first the service treatment records, these are negative for a diagnosis of or treatment for a disability of the either lower extremity. A service separation examination is not of record, but the Veteran was afforded a November 1984 reserve service physical examination. At that time, he was without any abnormality of the lower extremities. On a November 1984 periodic report of medical history, the Veteran denied any history of arthritis, rheumatism, bursitis, or neuritis, or any bone or joint deformity. A statement was received in December 2015 from F.W., who served with the Veteran. She wrote that during service, the Veteran reported bilateral pain of the lower extremities following physical training. Post-service, the Veteran was not diagnosed with and did not seek treatment for a disability of either lower extremity for many years. Moreover, when he initially filed for service connection for unrelated disabilities in August 2010, he did not report a disability of either lower extremity at that time. The first reports of symptoms of the either lower extremity date to approximately 2010, more than 25 years after service separation. While the Veteran was afforded EMG/NCV studies of the lower extremities in 2010 and 2011, these were negative for any neurological abnormalities. This lengthy period without complaint or treatment is one piece of evidence that there has not been ongoing symptomatology and weighs heavily against the claim. See Buczynski v. Shinseki, 24 Vet. App. 221, 224 (2011) (the Board may consider a lack of notation of a medical condition or symptoms where such notation would normally be expected). Based on this evidence, the Board must conclude that a current diagnosis of disabilities of the lower extremities did not have their onset in service and have not been chronic and continuous since service separation. A VA medical opinion was afforded the Veteran in January 2020. After reviewing the claims folder, including all available medical records, the examiner diagnosed peripheral neuropathy of the bilateral lower extremities, possibly related to a lumbosacral spine disability. The examiner did not find, however, that the claimed lumbosacral spine disability was due to or aggravated by a service-connected disability. Thus, based on the competent evidence of record, the Board must conclude that service connection on a direct basis is not warranted. The service treatment records are negative for any diagnosis of or treatment for a disability of either lower extremity, and none was reported by the Veteran or noted by a service examiner in 1984, within a year of service separation. Additionally, no competent evidence has been presented establishing a nexus between any disease, injury, or other incident of service, and a current disorder of either lower extremity. Regarding service connection on a secondary basis, no competent evidence has been presented of that a service-connected disability either causes or aggravates a disability of the right or left lower extremity. While the Veteran has asserted that he has disabilities of the bilateral lower extremities resulting from disabilities of the cervical and/or lumbosacral spine, service connection for a spine disability has not been granted by VA. In the absence of competent evidence to the contrary, service connection for disabilities of the bilateral lower extremities on any basis is not warranted. While the Veteran has submitted his own lay contentions and those of a friend regarding the etiology of his claimed bilateral lower extremity disabilities, the Board does not find this lay evidence probative. Laypersons are not capable of making medical conclusions; thus, his statements regarding causation are not competent evidence. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Lay statements may be competent to support a claim for service connection by supporting the occurrence of lay-observable events or the presence of disability or symptoms of disability subject to lay observation. See Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006) (addressing lay evidence as potentially competent to support presence of disability even where not corroborated by contemporaneous medical evidence). However, neurological disorders are complex disorders which require specialized training for a determination as to diagnosis and causation, and they are therefore not susceptible of lay opinions on etiology, and the lay statements therein cannot be accepted as competent medical evidence. The Veteran is also not reporting an expert opinion as told to him, and his lay contentions have not subsequently been confirmed by a competent expert. Regarding the credibility of these lay assertions, the Board notes the Veteran himself denied any neuritis following service in 1984 and did not report or seek treatment for a disease or injury of either lower extremity during service or for many years thereafter. In conclusion, the preponderance of the evidence is against the award of service connection for disabilities of the lower extremities on any basis. Such a disability was not incurred in service, has not been chronic or continuous since service separation, did not manifest to a compensable degree within a year of service separation, and is not due to or aggravated by a service-connected disability. A current diagnosis of a disability of either lower extremity is also not due to or aggravated by a service-connected disability. As a preponderance of the evidence is against the award of service connection, the benefit of the doubt doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107(b); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001). 8. Entitlement to service connection for a right hip disability 9. Entitlement to service connection for a left hip disability The Veteran seeks service connection for bilateral hip disabilities. He asserts a service-connected disability, bilateral pes planus, causes or aggravates bilateral hip disabilities, and service connection is therefore warranted. Considering first the service treatment records, these are negative for a diagnosis of or treatment for a disability of the either hip. A service separation examination is not of record, but the Veteran was afforded a November 1984 reserve service physical examination. At that time, he was without any abnormality of either hip. On a November 1984 periodic report of medical history, the Veteran denied any history of bone, joint, or other deformity. Post-service, the Veteran was not diagnosed with and did not seek treatment for a disability of either hip for many years. Moreover, when he initially filed for service connection for unrelated disabilities in August 2010, he did not report a disability of either hip at that time. The first reports of symptoms of the either lower extremity date to approximately 2010, more than 25 years after service separation. While the Veteran was afforded VA outpatient treatment and examination in 2010 and 2011 regarding is complaints of bilateral hip pain, these examinations were negative for any bilateral hip conditions. Likewise, x-rays displayed no orthopedic disorders of either hip. This lengthy period without complaint or treatment is one piece of evidence that there has not been ongoing symptomatology and weighs heavily against the claim. See Buczynski v. Shinseki, 24 Vet. App. 221, 224 (2011) (the Board may consider a lack of notation of a medical condition or symptoms where such notation would normally be expected). Finally, at his January 2016 hearing before a Veterans Law Judge, the Veteran attributed his bilateral hip disabilities to his service-connected bilateral pes planus, and did not claim an in-service disease, injury, or other event of the bilateral hips. Based on this evidence, the Board must conclude that a current disability of either hip did not have their onset in service and have not been chronic and continuous since service separation. The Veteran was afforded a VA medical examination and opinion in December 2011. The claims file was reviewed in conjunction with the examination. After examining the Veteran and reviewing the record, the examiner concluded it was less likely than not any current bilateral hip disability was due to or aggravated by the Veteran's bilateral pes planus. Rather, the examiner determined any current hip disability was likely related to overuse. A VA medical opinion was afforded the Veteran in January 2020. After reviewing the claims folder, including all available medical records, the examiner found no evidence that the claimed bilateral hip disabilities were due to or aggravated by a service-connected disability, to include bilateral pes planus. Thus, based on the competent evidence of record, the Board must conclude that service connection on a direct basis is not warranted. The service treatment records are negative for any diagnosis of or treatment for a disability of either hip, and none was reported by the Veteran or noted by a service examiner in 1984, within a year of service separation. Additionally, no competent evidence has been presented establishing a nexus between any disease, injury, or other incident of service, and a current disorder of either hip. Regarding service connection on a secondary basis, no competent evidence has been presented of that a service-connected disability either causes or aggravates a disability of the right or left hip. While the Veteran has asserted that he has disabilities of the bilateral lower extremities resulting from disabilities of the cervical and/or lumbosacral spine, service connection for a spine disability has not been granted by VA. In the absence of competent evidence to the contrary, service connection for disabilities of the bilateral hips on any basis is not warranted. While the Veteran has submitted his own lay contentions regarding the etiology of his claimed bilateral hip disabilities, the Board does not find this lay evidence probative. Laypersons are not capable of making medical conclusions; thus, his statements regarding causation are not competent evidence. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Lay statements may be competent to support a claim for service connection by supporting the occurrence of lay-observable events or the presence of disability or symptoms of disability subject to lay observation. See Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006) (addressing lay evidence as potentially competent to support presence of disability even where not corroborated by contemporaneous medical evidence). However, orthopedic disorders are complex disorders which require specialized training for a determination as to diagnosis and causation, and they are therefore not susceptible of lay opinions on etiology, and the lay statements therein cannot be accepted as competent medical evidence. The Veteran is also not reporting an expert opinion as told to him, and his lay contentions have not subsequently been confirmed by a competent expert. Regarding the credibility of these lay assertions, the Board notes the Veteran himself denied any disease, injury, or other impairment of either hip following service in 1984, and did not report or seek treatment for a disease or injury of either hip for many years thereafter. In conclusion, the preponderance of the evidence is against the award of service connection for bilateral hip disabilities on any basis. Such a disability was not incurred in service, has not been chronic or continuous since service separation, did not manifest to a compensable degree within a year of service separation, and is not due to or aggravated by a service-connected disability. A current diagnosis of a disability of either hip is also not due to or aggravated by a service-connected disability. As a preponderance of the evidence is against the award of service connection, the benefit of the doubt doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107(b); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001). 10. Entitlement to service connection for a right knee disability 11. Entitlement to service connection for a left knee disability The Veteran seeks service connection for disabilities of the bilateral knees. He asserts current bilateral knee disabilities are caused or aggravated by a service-connected disability, bilateral pes planus, and service connection is therefore warranted. Considering first the service treatment records, these are negative for a diagnosis of or treatment for a disability of the either knee. A service separation examination is not of record, but the Veteran was afforded a November 1984 reserve service physical examination. At that time, he was without any abnormality of either knee. On a November 1984 periodic report of medical history, the Veteran denied any history of a "trick" or locked knee. A statement was received in December 2015 from F.W., who served with the Veteran. She wrote that during service, the Veteran reported bilateral pain of the lower extremities following physical training. Post-service, the Veteran was not diagnosed with and did not seek treatment for a disability of either knee for many years. Moreover, when he initially filed for service connection for unrelated disabilities in August 2010, he did not report a disability of either knee at that time. The first reports of symptoms of either knee date to approximately 2010, more than 25 years after service separation. While the Veteran was afforded a VA examination in 2011, with x-rays, he was without acute fracture, subluxation, joint space narrowing, or soft tissue injury. This lengthy period without complaint or treatment is one piece of evidence that there has not been ongoing symptomatology and weighs heavily against the claim. See Buczynski v. Shinseki, 24 Vet. App. 221, 224 (2011) (the Board may consider a lack of notation of a medical condition or symptoms where such notation would normally be expected). Based on this evidence, the Board must conclude that a current diagnosis of a disability of either knee did not have their onset in service and have not been chronic and continuous since service separation. The Veteran was afforded a VA medical examination and opinion in December 2011. The claims file was reviewed in conjunction with the examination. After examining the Veteran and reviewing the record, the examiner concluded it was less likely than not any current disability of either knee was due to or aggravated by the Veteran's bilateral pes planus. Another VA examination and opinion was obtained in December 2016, and that VA examiner also concluded it was less likely than not any current bilateral knee disability was due to or aggravated by the Veteran's bilateral pes planus. This examiner noted the Veteran did not have a leg length discrepancy, abnormal gait, or other orthopedic finding resulting from his bilateral pes planus which would result in a disability of either knee. On VA examination in January 2020, the Veteran was diagnosed with bilateral knee strains. The examiner opined that these disabilities had their onset in approximately 2000, based on the Veteran's assertion that his bilateral knee pain began at that time. After reviewing medical records, the examiner opined it is less likely than not that any current knee condition was aggravated beyond its natural progression by the Veteran's bilateral pes planus. The examiner could find no evidence within the record supporting such aggravation. The examiner noted the Veteran's bilateral pes planus was diagnosed in 2016 as mild bilateral pes planus, shown on x-ray as slight loss of the arch on both sides, slightly worse on the left. An internal medicine report in 2013 noted the Veteran's gait was within normal limits. The Veteran did ambulate with the use of a cane but was also noted to ambulate with only mild difficulty without the cane, according to the examiner. Thus, based on the competent evidence of record, the Board must conclude that service connection on a direct basis is not warranted. The service treatment records are negative for any diagnosis of or treatment for a knee disability, and none was reported by the Veteran or noted by a service examiner in 1984, within a year of service separation. Additionally, no competent evidence has been presented establishing a nexus between any disease, injury, or other incident of service, and a current knee disorder. Regarding service connection on a secondary basis, the 2011, 2016, and 2020 VA examiners all opined that the Veteran's current knee disabilities were neither caused nor aggravated by a service-connected disability or disabilities. In the absence of competent evidence to the contrary, service connection for a bilateral knee disability on any basis is not warranted. While the Veteran has submitted his own lay contentions, and those of a friend, regarding the etiology of his bilateral knee disabilities, the Board does not find this lay evidence probative. Laypersons are not capable of making medical conclusions; thus, his statements regarding causation are not competent evidence. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Lay statements may be competent to support a claim for service connection by supporting the occurrence of lay-observable events or the presence of disability or symptoms of disability subject to lay observation. See also Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006) (addressing lay evidence as potentially competent to support presence of disability even where not corroborated by contemporaneous medical evidence). However, orthopedic disorders are complex disorders which require specialized training for a determination as to diagnosis and causation, and they are therefore not susceptible of lay opinions on etiology, and the lay statements therein cannot be accepted as competent medical evidence. The Veteran is also not reporting an expert opinion as told to him, and his lay contentions have not subsequently been confirmed by a competent expert. Regarding the credibility of these lay assertions, the Board notes the Veteran himself denied any knee problems both during and following service in 1984 and did not report or seek treatment for knee pain for many years thereafter. In conclusion, the preponderance of the evidence is against the award of service connection for bilateral knee disabilities on any basis. Such a disability was not incurred in service, has not been chronic or continuous since service separation, did not manifest to a compensable degree within a year of service separation, and is not due to or aggravated by a service-connected disability. A current diagnosis of a knee disorder is also not due to or aggravated by a service-connected disability. As a preponderance of the evidence is against the award of service connection, the benefit of the doubt doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107(b); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001). 12. Entitlement to service connection for a right ankle disability 13. Entitlement to service connection for a left ankle disability The Veteran seeks service connection for bilateral ankle disabilities. He asserts such disabilities had their onset in service, and service connection is therefore warranted. In the alternative, he asserts his bilateral ankle disabilities are due to or aggravated by service-connected disabilities, to include bilateral pes planus. Considering first the service treatment records, these indicate the Veteran sought treatment for ankle pain during active duty service. In April 1983, the Veteran sought treatment for bilateral ankle pain for the past 48 hours. On examination, he had tenderness bilaterally of the Achilles tendons, without swelling. The impression was of bilateral ankle tendonitis, mild. He was given medication and light duty for two days. He again sought treatment for bilateral ankle pain in May 1983. He reported pain in the Achilles tendon region following physical training and running. The impression was of possible tendonitis aggravated by exercise. He was given medication and placed on profile. A service separation examination is not of record, but the Veteran was afforded a November 1984 reserve service physical examination. At that time, he was without any abnormality of either ankle. On a November 1984 periodic report of medical history, the Veteran denied any history of bone, joint, or other deformity. A statement was received in December 2015 from F.W., who served with the Veteran. She wrote that during service, the Veteran reported bilateral ankle pain following physical training. Post-service, the Veteran was not diagnosed with and did not seek treatment for a disability of either ankle for many years. Moreover, when he initially filed for service connection for unrelated disabilities in August 2010, he did not report a disability of either ankle at that time. The first reports of symptoms of either ankle date to approximately 2011, more than 25 years after service separation. This lengthy period without complaint or treatment is one piece of evidence that there has not been ongoing symptomatology and weighs heavily against the claim. See Buczynski v. Shinseki, 24 Vet. App. 221, 224 (2011) (the Board may consider a lack of notation of a medical condition or symptoms where such notation would normally be expected). Based on this evidence, the Board must conclude that a current diagnosis of a disability of either ankle did not have their onset in service and have not been chronic and continuous since service separation. The Veteran was afforded a VA medical examination and opinion in December 2011. The claims file was reviewed in conjunction with the examination. After examining the Veteran and reviewing the record, the examiner concluded it was less likely than not any current disability of either ankle was due to or aggravated by the Veteran's bilateral pes planus. Another VA examination and opinion was obtained in December 2016, and that VA examiner also concluded it was less likely than not any current bilateral ankle disability was due to or aggravated by the Veteran's bilateral pes planus. This examiner noted the Veteran did not have a leg length discrepancy, abnormal gait, or other orthopedic finding resulting from his bilateral pes planus which would result in a disability of either ankle. On VA examination in January 2020, the Veteran was diagnosed with bilateral ankle strains. After reviewing medical records, the examiner opined it is less likely than not that the Veteran's current bilateral knee disabilities were aggravated beyond its natural progression by his bilateral pes planus. The examiner could find no evidence within the record supporting such aggravation. The examiner noted that a VA medical report in 2013 described the Veteran's gait as within normal limits. The Veteran did ambulate with the use of a cane but was also noted to ambulate with only mild difficulty without the cane, according to the examiner. Thus, based on the competent evidence of record, the Board must conclude that service connection on a direct basis is not warranted. While the Veteran did report bilateral ankle pain in service, no such pain was reported by the Veteran or noted by a service examiner in 1984, within a year of service separation. He also denied any bone or joint deformity on a concurrent report of medical history. Additionally, no competent evidence has been presented establishing a nexus between any disease, injury, or other incident of service, and a current disorder of either ankle. Regarding service connection on a secondary basis, the 2011, 2016, and 2020 VA examiners all opined that the Veteran's current ankle disabilities were neither caused nor aggravated by a service-connected disability or disabilities. In the absence of competent evidence to the contrary, service connection for a bilateral knee disability on any basis is not warranted. While the Veteran has submitted his own lay contentions, and those of a friend, regarding the etiology of his bilateral ankle disabilities, the Board does not find this lay evidence probative. Laypersons are not capable of making medical conclusions; thus, his statements regarding causation are not competent evidence. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Lay statements may be competent to support a claim for service connection by supporting the occurrence of lay-observable events or the presence of disability or symptoms of disability subject to lay observation. See also Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006) (addressing lay evidence as potentially competent to support presence of disability even where not corroborated by contemporaneous medical evidence). However, orthopedic disorders are complex disorders which require specialized training for a determination as to diagnosis and causation, and they are therefore not susceptible of lay opinions on etiology, and the lay statements therein cannot be accepted as competent medical evidence. The Veteran is also not reporting an expert opinion as told to him, and his lay contentions have not subsequently been confirmed by a competent expert. Regarding the credibility of these lay assertions, the Board notes the Veteran himself denied any ankle problems following service in 1984 and did not report or seek treatment for ankle pain for many years thereafter. In conclusion, the preponderance of the evidence is against the award of service connection for bilateral ankle disabilities on any basis. Such a disability was not incurred in service, has not been chronic or continuous since service separation, did not manifest to a compensable degree within a year of service separation, and is not due to or aggravated by a service-connected disability. A current diagnosis of an ankle disorder is also not due to or aggravated by a service-connected disability. As a preponderance of the evidence is against the award of service connection, the benefit of the doubt doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107(b); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001). Increased Rating Disability evaluations are based upon the average impairment of earning capacity as contemplated by the schedule for rating disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. In order to evaluate the level of disability and any changes in condition, it is necessary to consider the complete medical history of the Veteran's condition. Schafrath v. Derwinski, 1 Vet. App. 589, 594 (1991). In adjudicating increased rating claims, the level of disability in all periods since the effective date of the grant of service connection must be taken into account, to include the possibility that a staged rating may be assigned. Hart v. Mansfield, 21 Vet. App. 505 (2007). As such, the Board will consider whether staged ratings are appropriate to the pending appeals. In cases in which a reasonable doubt arises as to the appropriate degree of disability to be assigned, such doubt shall be resolved in favor of the Veteran. 38 C.F.R. § 4.3. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. 38 C.F.R. § 4.7. 14. Entitlement to an initial disability rating in excess of 10 percent for postoperative scar resulting from removal of sebaceous cyst The Veteran seeks an initial disability rating in excess of 10 percent for a postoperative scar resulting from removal of a sebaceous cyst of the scalp. For his postoperative scar, the Veteran has been granted a 10 percent rating under Diagnostic Code (DC) 7804, for painful or unstable scars. VA amended the criteria for rating skin disabilities effective from August 13, 2018. These new regulations apply to all applications for benefits received by VA or that are pending before the agency of original jurisdiction on or after August 13, 2018. Claims pending prior to the effective date will be considered under both old and new rating criteria, and whatever criteria is more favorable to the veteran will be applied. The Board may not apply a current regulation prior to its effective date, unless the regulation explicitly provides otherwise. Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). However, the Board is not precluded from applying prior versions of the applicable regulation to the period on or after the effective dates of the new regulation if the prior version was in effect during the pendency of the appeal. Here, the Veteran submitted his claim for service connection in August 2010 and he appealed the initial rating assigned. As such, the pre-amended criteria will be considered throughout the entire appeal period and the amended criteria will be considered from August 13, 2018. Under DC 7804, one or two scars that are unstable or painful warrant a 10 percent rating. A 20 percent rating requires three or four scars that are unstable or painful. A 30 percent rating is warranted for five or more scars that are unstable or painful. Note (1) provides that an unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. Note (2) for that code provides that if one or more scars are both unstable and painful, 10 percent be added to the evaluation based on the total number of unstable or painful scars. Note (3) provides that scars evaluated under DCs 7800, 7801, 7802, or 7805 may also receive an evaluation under Diagnostic Code 7804, when applicable. 38 C.F.R. § 4.118, DC 7804. 38 C.F.R. § 4.118 further provides that scars (including linear scars) not otherwise rated under DCs 7800-7804 are to be rated based on any disabling effects not provided for by the applicable codes. In addition, the effects of scars otherwise rated under DCs 7800-7804 are to be considered. 38 C.F.R. § 4.118, DC 7805. The Board notes that the Veteran has been granted a separate compensable rating under DC 7800, effective September 16, 2010, for a disfiguring scar of the posterior scalp resulting from sebaceous cyst removal. Effective December 6, 2016, this award was increased to 30 percent. As this disability rating is not currently perfected for appellate review, it will not be considered by the Board at this time. The Board finds that none of the other diagnostic codes are applicable here. Under the amended criteria which became effective on August 13, 2018, DC 7804 was not changed. In every instance where the schedule does not provide a 0 percent rating for a diagnostic code, a 0 percent rating will be assigned when the requirements for a compensable rating are not met. 38 C.F.R. § 4.31. The Veteran was afforded VA examinations in November 2010, December 2016, and January 2020. On each occasion, his surgical scar site was noted to be well-healed, without redness or drainage. While he had two excision scars on his scalp, these were less than 39 sq. cm., and were not noted to be deep or involve loss of tissue. They were also not found to be unstable, or with frequent loss of covering of the skin at the scar site. Overall, based on the totality of the evidence of record, the Board finds the preponderance of the evidence is against a disability rating in excess of 10 percent for the Veteran's postoperative scar following surgical removal of a sebaceous cyst. He does not have three or more painful or unstable scars of the scalp, as would warrant the next higher evaluation under DC 7804. Finally, as noted above, the Veteran has already been awarded a separate compensable rating for disfigurement resulting from this scar under DC 7800. In conclusion, the preponderance of the evidence is against the award of a disability rating in excess of 10 percent for the Veteran's postoperative scar resulting from removal of sebaceous cyst. As a preponderance of the evidence is against the award of an increased rating, the benefit of the doubt doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107(b); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001). 15. Entitlement to an initial compensable disability rating for degenerative joint disease of the left little finger The Veteran seeks a compensable rating for his degenerative joint disease of the left little finger. He asserts this disability results in significant impairment, and a compensable rating is therefore warranted. This disability is currently rated under DC 5230-5003. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the specific basis for the evaluation assigned. The additional code is shown after a hyphen. 38 C.F.R. § 4.27. DC 5230, for limitation of motion of the ring or little finger, provides a noncompensable rating for such a disability involving either the major (dominant) or minor (nondominant) hand. As the Veteran has already been assigned the maximum schedular rating under DC 5230, a higher increased rating is not warranted. The Board has also considered entitlement to a compensable initial rating based on other criteria for little finger. DC 5227, for ankylosis of the ring or little finger, likewise provides only a noncompensable rating for favorable or unfavorable ankylosis of either finger. DCs 5155-56, for amputation of the ring or little finger, provides up to 20 percent ratings based on the location of the amputation site. According to the various VA examination reports, however, the Veteran has neither amputation nor the functional equivalent of the little finger. On objective examination in January 2020, the left little finger displayed at least some range of motion and was able to assist in gripping objects and performing other tasks with the hand. Based on these findings, no examiner has concluded that the functional equivalent of amputation has been demonstrated. Finally, although x-ray studies of the left hand were performed as recently as January 2020, arthritis of the left hand was not diagnosed on that occasion. Regardless, the left little finger is not considered a major joint of the body. Therefore, the weight of the evidence is against finding that a compensable initial rating under Diagnostic Code 5003, for degenerative arthritis, is warranted. For these reasons, the Veteran's service-connected limitation of motion of the little finger of the left hand does not warrant a compensable initial rating. As a preponderance of the evidence is against the award of an increased rating, the benefit of the doubt doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107 (b); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1991). 16. Entitlement to an initial disability rating in excess of 30 percent for bilateral pes planus The Veteran seeks an initial disability rating in excess of 30 percent for his bilateral pes planus. He asserts this disability results in a higher degree of impairment, and an increased rating is therefore warranted. The Veteran has been granted a 30 percent rating under DC 5276, for acquired flatfoot. While portions of the rating schedule addressing the musculoskeletal system were revised effective February 7, 2021, this diagnostic code was not changed. Under Diagnostic Code 5276, a noncompensable rating is warranted for mild acquired flatfoot; symptoms relieved by built-up shoe or arch support. A 10 percent rating is warranted for moderate acquired flat foot; weight-bearing line over or medial to great toe, inward bowing of the tendo achillis, pain on manipulation and use of the feet, bilateral or unilateral. A 20 percent rating is assigned for severe unilateral acquired flat foot; objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, characteristic callosities. A 30 percent rating is warranted for severe bilateral acquired flat foot; objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, characteristic callosities. A 30 percent rating is also warranted for pronounced unilateral acquired flatfoot; marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo achillis on manipulation, not improved by orthopedic shoes or appliances. A maximum 50 percent rating is warranted for pronounced bilateral acquired flatfoot; marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo achillis on manipulation, not improved by orthopedic shoes or appliances. 38 C.F.R. § 4.71a, Diagnostic Code 5276. The Veteran was initially afforded a June 2011 VA examination of his bilateral pes planus. His reported symptoms included pain of the bilateral feet, worsening with use. He claimed he was unable to stand more than a few minutes and could only walk for no more than 25 yards. He used a cane and orthotic inserts in his shoes to aid mobility. On physical examination, there was tenderness bilaterally, and callosities were observed, evidence of abnormal weightbearing. Achilles alignment for both feet was within normal limits on weight-bearing and nonweight-bearing, and no midfoot alignment was present. He was also without pronation bilaterally, and no pain on manipulation was reported. He was next afforded a VA examination in December 2016, when he again reported pain of the bilateral feet, worsening with use. On physical examination, he was again without marked pronation or pain on manipulation of the feet, but characteristic callouses were present bilaterally. No extreme tenderness of the plantar surfaces of either foot was present, but decreased longitudinal arch height was observed bilaterally with weight-bearing. No inward bowing, marked inward displacement, or severe spasm of the Achilles tendon on manipulation of either foot was observed. Most recently, the Veteran was afforded a VA examination in January 2020. Reported symptoms included sharp aching pain and tenderness, resulting in difficulty in prolonged walking. He denied any history of foot surgery or hospitalization due to his bilateral pes planus. On physical examination, the examiner reported pain on manipulation of the feet, but no swelling on use or characteristic calluses. The Veteran continued to use orthotics in his shoes. Decreased longitudinal arch height was observed bilaterally with weight-bearing. No evidence was reported of marked deformity, marked pronation, or lower extremity deformity. No objective evidence of the weight-bearing line falling over or medial to the great toe of either foot was present. No inward bowing, marked inward displacement, or severe spasm of the Achilles tendon on manipulation of either foot was reported. After considering the totality of the record, the Board finds the preponderance of the evidence to be against the award of a disability rating in excess of 30 percent for the Veteran's bilateral pes planus. As noted above, the Veteran's disability does not result in marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo achillis on manipulation of either foot. In the absence of such findings, a disability rating in excess of 30 percent is not warranted. The intent of the Rating Schedule is to recognize actually painful, unstable or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint, even in the absence of arthritis, to include in situations where the disability at issue is not evaluated based on range of motion measurements. 38 C.F.R. § 4.59; Burton v. Shinseki, 25 Vet. App. 1, 5 (2011); Southall-Norman v. McDonald, 28 Vet. App. 346 (2016). In evaluating this claim, the Board has also considered the other Diagnostic Codes pertaining to the foot. Other disability ratings may be assigned only if the symptomatology for a disability is not duplicative or overlapping with the symptomatology of any other disability. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994); see also Lyles v. Shulkin, 29 Vet. App. 107 (2017). In Scott v. Wilkie, the U.S. Court of Appeals for the Federal Circuit (Federal Circuit) expressly adopted the Court's holding that disabilities specifically listed in the rating schedule may only be rated under Diagnostic Codes which specifically pertain to them. Scott v. Wilkie, 920 F.3d 1375 (Fed. Cir. 2019) (citing Copeland v. McDonald, 27 Vet. App. 333, 336 (2015)). The Federal Circuit also expressly adopted the Court's holding that unlisted conditions may be rated by analogy to Diagnostic Codes that may not describe the unlisted disability but addresses disabilities that may be productive of similar symptoms. Scott, 920 F.3d 1375 (citing Yancy v. McDonald, 27 Vet. App. 484, 493 (2016). Finally, the Federal Circuit concluded that the Board must also consider assigning separate ratings under analogous Diagnostic Codes, when rating an unlisted service-connected foot disability exhibiting distinct manifestations, even when service connection has also been granted for one of the eight conditions listed in the rating schedule. Id. In this context, the Board notes that pes planus is specifically listed under the rating schedule and, thus, cannot be rated under a different Diagnostic Code. The Board further notes that the Veteran does not have other service-connected foot disabilities with distinct manifestations and, thus, DCs 5280 and 5282 are not applicable, as they evaluate hallux valgus and hammertoes. (Continued on the next page) As for the remaining Diagnostic Codes pertaining to the foot, the Board notes that the lay and medical evidence of record does not reflect that the Veteran's bilateral pes planus disability is manifested by weak foot, claw foot, metatarsalia, or hallux rigidus. Therefore, Diagnostic Codes 5277, 5278, 5279, 5281, and 5283 are not relevant to this case and are not applicable. In conclusion, the Board finds that the preponderance of the evidence is against a disability rating in excess of 30 percent for the service-connected bilateral pes planus at any time during the appeal period. As a preponderance of the evidence is against the award of an increased rating, the benefit of the doubt doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107(b); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001). Jenna Brant Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Thomas D. Jones, Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.