Citation Nr: 1304591 Decision Date: 02/08/13 Archive Date: 02/19/13 DOCKET NO. 08-23 913 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Waco, Texas THE ISSUES 1. Entitlement to service connection for a left wrist disorder. 2. Entitlement to service connection for a left foot disorder. REPRESENTATION Appellant represented by: Texas Veterans Commission ATTORNEY FOR THE BOARD Hallie E. Brokowsky, Counsel INTRODUCTION The Veteran, who is the appellant in this case, had active duty service from May 1998 to May 2006. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a February 2007 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Waco, Texas. The Board has not only reviewed the Veteran's physical claims file, but also the Veteran's file on Virtual VA, to ensure a total review of the available evidence. The Board notes that, pursuant to his request in his substantive appeal, the Veteran was scheduled for a Board hearing in December 2012. However, the Veteran failed to report for his hearing, as scheduled. As such, the Veteran's hearing request is deemed withdrawn and the Board will proceed with its review on the present record. See 38 C.F.R. § 20.704(d), (e). FINDINGS OF FACT 1. The Veteran did not engage in combat with the enemy during service. 2. The Veteran had a left wrist fracture in 1992. 3. The Veteran did not sustain an injury or disease of the left wrist during service. 4. The Veteran did not experience chronic symptoms of a left wrist disorder during service. 5. The Veteran did not experience continuous symptoms of a left wrist disorder after service. 6. Arthritis of the left wrist did not manifest within one year of separation from service. 7. The Veteran's pre-existing open reduction and internal fixation of the left forearm did not undergo a permanent worsening beyond normal progression during the Veteran's active service. 8. The Veteran's current left wrist disorder is not causally or etiologically related to service. 9. The Veteran sustained and was treated for a left foot injury during service, in 2000; he was treated for plantar fasciitis of the left foot in 2001. 10. The Veteran did not experience chronic symptoms of a left foot disorder during service. 11. The Veteran did not experience continuous symptoms of a left foot disorder after service. 12. Arthritis of the left foot did not manifest within one year of separation from service. 13. The Veteran does not have a current left foot disorder. CONCLUSIONS OF LAW 1. A left wrist disability was not incurred or aggravated in active service, and may not be presumed to have been incurred or aggravated in service. 38 U.S.C.A. §§ 1110, 1112, 1154, 5103, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.307, 3.309 (2012). 2. A left foot disability was not incurred in active service, and may not be presumed to have been incurred in service. 38 U.S.C.A. §§ 1110, 1112, 1154, 5103, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.307, 3.309 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Duties to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA) and implementing regulations impose obligations on VA to provide claimants with notice and assistance. 38 U.S.C.A. §§ 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2012). The United States Court of Appeals for Veterans Claims (CAVC) issued a decision in the appeal of Dingess v. Nicholson, 19 Vet. App. 473 (2006), which held that the notice requirements of 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) apply to all five elements of a service connection claim, including the degree of disability and the effective date of an award. Those five elements include: (1) veteran status; (2) existence of a disability; (3) a connection between a veteran's service and the disability; (4) degree of disability; and (5) effective date of the disability. In this case, the agency of original jurisdiction (AOJ) issued notice letters, dated in August 2006, October 2006, and August 2008, to the Veteran. These letters explained the evidence necessary to substantiate the Veteran's claims of entitlement to service connection, as well as the legal criteria for entitlement to such benefits. The letters also informed him of his and VA's respective duties for obtaining evidence. The AOJ decision that is the basis of this appeal was decided after the issuance of an initial, appropriate VCAA notice. As such, there was no defect with respect to timing of the VCAA notice. See Pelegrini v. Principi, 18 Vet. App. 112 (2004). Additionally, the letters from VA to the Veteran explained how a disability rating is determined for a service-connected disability and the basis for determining an effective date upon the grant of any benefit sought. The United States Court of Appeals for the Federal Circuit (Federal Circuit) and the CAVC have held that, once service connection is granted the claim is substantiated, additional notice is not required, and any defect in notice is not prejudicial. Hartman v. Nicholson, 483 F.3d 1311 (Fed. Cir. 2007); Dunlap v. Nicholson, 21 Vet. App. 112 (2007); 38 C.F.R. § 3.159(b)(3)(i) (no duty to provide VCAA notice upon receipt of a notice of disagreement); VAOPGCPREC 8-2003 (in which the VA General Counsel interpreted that separate notification is not required for "downstream" issues following a service connection grant, such as initial rating and effective date claims). VA also has a duty to assist the Veteran with the development of facts pertinent to the appeal. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159(c). This duty includes the obtaining of "relevant" records in the custody of a Federal department or agency under 38 C.F.R. § 3.159(c)(2), as well as records not in Federal custody (e.g., private medical records) under 38 C.F.R. § 3.159(c)(1). VA will also provide a medical examination if such examination is determined to be "necessary" to decide the claim. 38 C.F.R. § 3.159(c)(4). In this case, the claims file contains the Veteran's service treatment records and reports of VA post-service treatment, as well as the Veteran's own statements in support of his claims. The Veteran was examined by VA in 2007, in connection with his claims of entitlement to service connection. The Board has reviewed the examination report, and finds that it is adequate for the purpose of deciding the issues on appeal. The examination report contains all the findings needed to evaluate the Veteran's claims, including his history and evaluations. The Board has reviewed the Veteran's statements and medical evidence of record and concludes that there is no outstanding evidence with respect to the Veteran's claims. For these reasons, the Board finds that the VCAA duties to notify and assist have been met. Service Connection It is the Board's responsibility to evaluate the entire record on appeal. See 38 U.S.C.A. § 7104(a) (West 2002). In this case, the Board has thoroughly reviewed all of the evidence in the Veteran's claims folder. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, all of the evidence submitted by the Veteran or on his behalf. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (the Board must review the entire record, but does not have to discuss each piece of evidence). When there is an approximate balance in the evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102. The Court held that an appellant need only demonstrate that there is an "approximate balance of positive and negative evidence" in order to prevail. See Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). The Court has also stated, "It is clear that to deny a claim on its merits, the evidence must preponderate against the claim." Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert. In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. See Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert, supra, 1 Vet. App. at 57. Service connection may be granted for disability or injury incurred in or aggravated by active service. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303(a). 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). Service connection may also 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 U.S.C.A. § 1113(b) (West 2002); 38 C.F.R. § 3.303(d). Service connection for a disability on the basis of the merits of such claim requires (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. Hickson v. West, 12 Vet. App. 247, 253 (1999), citing Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd, 78 F.3d 604 (Fed. Cir. 1996). Pursuant to 38 U.S.C.A. § 1154(b), with respect to combat veterans, "[VA] shall accept as sufficient proof of service- connection . . . satisfactory lay or other evidence of service incurrence or aggravation of such injury or disease, if consistent with the circumstances, conditions and hardships of such service . . . Service-connection of such injury or disease may be rebutted by clear and convincing evidence to the contrary." See also 38 C.F.R. § 3.304(d). 38 U.S.C.A. § 1154(b), however, can be used only to provide a factual basis upon which a determination could be made that a particular disease or injury was incurred or aggravated in service, not to link the claimed disorder etiologically to the current disorder. See Libertine v. Brown, 9 Vet. App. 521, 522- 23 (1996). 38 U.S.C.A. § 1154(b) does not establish service connection for a combat veteran; it aids him or her by relaxing the adjudicative evidentiary requirements for determining what happened in service. See Wade v. West, 11 Vet. App. 302, 305 (1998) (holding that "a combat veteran who has successfully established the in-service occurrence or aggravation of an injury pursuant to § 1154(b), must still submit sufficient evidence of a causal nexus between that in-service event and his or her current disability"). A veteran (or in this case, the appellant) must still generally establish the claim by competent medical evidence tending to show a current disability and a nexus between that disability and those service events. See Gregory v. Brown, 8 Vet. App. 563, 567 (1996). Further, a veteran is presumed to be in sound condition upon entrance into service, except for defects, infirmities or disorders noted when examined, accepted, and enrolled for service, or where evidence or medical judgment is such as to warrant a finding that the disease or injury existed before acceptance and enrollment. 38 U.S.C.A. § 1111 (West 2002). Only such conditions as are recorded in examination reports are to be considered as noted. 38 C.F.R. § 3.304(b) (2012). Where such defects, infirmities or disorders are not noted when examined, accepted, and enrolled for service, pursuant to 38 U.S.C.A. § 1111 and 38 C.F.R. § 3.304, in order to rebut the presumption of soundness on entry into service, VA must show by clear and unmistakable evidence both that the disease or injury existed prior to service and that the disease or injury was not aggravated by service. See Wagner v. Principi, 370 F.3d 1089 (Fed. Cir. 2004); VAOPGCPREC 3-03. VA may establish a lack of aggravation with a showing that there was no increase in disability during service or that any "increase in disability [was] due to the natural progress" of the preexisting condition. 38 U.S.C.A. § 1153. If this burden is met, then the veteran is not entitled to service-connected benefits. Aggravation may not be conceded where the disability underwent no increase in severity during service on the basis of all the evidence of record pertaining to the manifestations of the disability prior to, during, and subsequent to service. 38 U.S.C.A. § 1153 (West 2002); 38 C.F.R. § 3.306(b) (2012); Falzone v. Brown, 8 Vet. App. 398, 402 (1995). Moreover, "temporary or intermittent flare-ups of a pre-existing injury or disease are not sufficient to be considered aggravation in service unless the underlying condition, as contrasted to symptoms, is worsened." Crowe v. Brown, 7 Vet. App. 238, 247-48 (1994); Hunt v. Derwinski, 1 Vet. App. 292, 297 (1991). However, the increase need not be so severe as to warrant compensation. Browder v. Derwinski, 1 Vet. App. 204, 207 (1991). Lay assertions may serve 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 38 U.S.C.A. § 1153(a) (West 2002); 38 C.F.R. § 3.303(a); see also Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007) and Buchanan v. Nicholson, 451 F.3d 1331, 1336 (Fed. Cir. 2006) (addressing lay evidence as potentially competent to support presence of disability even where not corroborated by contemporaneous medical evidence). In certain circumstances, however, lay evidence may be sufficient to establish a medical diagnosis or nexus. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009). Competency of evidence differs from weight and credibility. Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) ("although interest may affect the credibility of testimony, it does not affect competency to testify"). Analysis of Service Connection Left Wrist Disorder The Veteran asserts that his limited mobility of the left wrist is related to his military service. According to the Veteran's Notice of Disagreement, the Veteran contends that his pre-existing open reduction and internal fixation of the left forearm worsened during service. In the VA Form 9, the Veteran states that his left wrist worsened as a result of his reliance upon it to perform his duties while he was treated for his now service-connected right wrist disability. The Veteran does not allege, and a review of his official military documentation contained in his claims file does not otherwise indicate, that he engaged in combat against enemy forces as contemplated by VA regulations. His DD Form 214 does not reflect that he received any decorations or medals indicative of involvement in combat. There is no other sufficient indication of combat service, either. For these reasons, the Board finds that the Veteran did not "engage in combat." After a review of all the evidence, the Board finds that, although the Veteran had treatment for complaints related to his pre-existing open reduction and internal fixation of the left forearm during the Veteran's active service in service, that the Veteran did not sustain an injury or disease of the left wrist, and did not experience chronic symptoms of a left wrist disorder during service. The Veteran's pre-existing open reduction and internal fixation of the left forearm did not undergo a permanent worsening beyond normal progression. Even assuming arguendo that the presumption of soundness attached at the time of induction in 1998, the Board finds that there is clear and unmistakable evidence that a left wrist disability existed prior to service. The service treatment records show that, at the entrance examination in September 1997, the Veteran was reported that he had a fracture of the left forearm in 1992, prior to service, which was asymptomatic. Treatment records dated June 1992 and July 1992 from the St. Paul Medical Center indicate that the Veteran underwent a release of the flexor compartment of the left forearm, open reduction and internal fixation of the fracture of the distal radius and closed reduction of the fracture of the distal ulna. A September 1997 military consultation report indicates that the Veteran's open reduction and internal fixation of the distal ulna was complicated by anterior compartment syndrome, which required a fasciotomy, but that the fracture was now healed and that the Veteran had full range of motion. Physical examination was normal and the Veteran was granted a waiver. Based on the evidence discussed, the Board finds clear and unmistakable error that a left wrist disorder preexisted service. Next, under Wagner, to rebut the presumption of soundness, the evidence must show that the disorder both clearly and unmistakably preexisted active service and clearly and unmistakably was not aggravated by service. In this case, the Board also finds that the evidence demonstrates that the preexisting left forearm disability clearly and unmistakably was not aggravated by service. Service treatment records for the Veteran's period of active duty indicate that the Veteran was treated for his left wrist in March 2004, wherein he complained of decreased range of motion and stiffness of the left index finger since the fasciotomy that he underwent after the fracture of the left wrist. The Veteran was provided with a service separation examination in March 2006, which indicated that the Veteran complained of wrist joint pain, without swelling or stiffness; he could bend and straighten his wrist, and examination did not show any abnormalities. Additionally, he underwent a VA examination in January 2007, less than a year after his May 2006 discharge. According to that report, the Veteran reported a history of an injury at age 16. He reported that he began experiencing left wrist pain in 2002, with limited flexion of the left wrist and numbness of the first and second fingers. Following a physical examination, the impression was dislocation of the left wrist with complicating compartment syndrome with operative repair at age 16 and degenerative joint disease of the left wrist, with decreased range of motion, decreased grip strength, and altered function of the first and second fingers. The VA examiner opined that the Veteran had moderate disability with progression. X-rays showed metallic plate along the distal shaft of the radius, compatible with a previous healed fracture. In this regard, a preexisting injury or disease will be considered to have been aggravated by active service, where there is an increase in disability during such service, unless there is a specific finding that the increase in disability is due to the natural progress of the disease. See 38 C.F.R. § 3.306(a) . Significantly, however, intermittent flare-ups of a preexisting disorder are insufficient to be considered an aggravation. In finding no aggravation, the Board places significant probative value on the absence of an injury or even an increase in complaints or treatment for his left wrist disability during service, and the absence of complaints at separation. As noted above, the service treatment records show only one episode of treatment for his left wrist. In the January 2007 VA examination, the VA examiner opined that the Veteran's degenerative changes and moderate disability were due to progression of the Veteran's pre-existing left wrist injury. This weighs against a finding of increased symptomatology during service. In finding no aggravation, the Board also places significant probative value on the March 2006 separation examination and the January 2007 VA examination undertaken to specifically address the issue. The Board also observes that VA medical records only demonstrate complaints of wrist pain on one occasion, wherein he complained of bilateral wrist pain in July 2009, and that the Veteran failed to report for a scheduled examination in January 2012 without good cause. See 38 C.F.R. § 3.655(b) (when a claimant fails to report for an examination scheduled in conjunction with an original compensation claim, the claim shall be rated based on the evidence of record); see also Wood v. Derwinski, 1 Vet. App. 190 (1991). The Board has also considered the Veteran's lay statements regarding aggravation. In this case, the Veteran is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses. See Layno, 6 Vet. App. at 470. He indicated that he experienced aggravation in service when he injured his right wrist, and had to rely upon his left arm and wrist more frequently. While the Board reiterates that the Veteran is competent to report symptoms, such as pain, swelling, tingling, or numbness as they come to him through his senses, the permanent worsening (aggravation) of a left wrist disorder is not the type of medical determination that a lay person can provide competent evidence. See Rucker, 10 Vet. App. at 74 (stating that a lay person is not competent to diagnose or make a competent nexus opinion about a disorder as complex as cancer). The Veteran's left wrist disability is complex, as it involves arthritis and placement of a plate, which can only by diagnosed by X-rays or other specialized medical testing. Because the record contains clear and unmistakable evidence showing that the Veteran had a left wrist disability which preexisted his entrance into active service in May 1998, and clear and unmistakable evidence that the preexisting left wrist disability was not aggravated by active service from May 1998 to May 2006, the presumption of sound condition for this period of service is rebutted, and claim must be denied. Because the record contains clear and unmistakable evidence showing that the Veteran's left wrist disability preexisted his entrance into active service and clearly and unmistakably was not aggravated by his active service, his claim must be denied. Left Foot Disorder The Veteran asserts that service connection for a chronic left foot disorder is warranted as he injured his left foot, and developed plantar fasciitis of the left foot, during his service. In an August 2009 statement, he indicated that the left foot injury and plantar fasciitis are both encompassed by his claim for a left foot disorder, and that he experiences pain at the top of his left foot and at the arch of the foot. As previously discussed, the Veteran did not engage in combat with the enemy. Therefore, the presumptions of 38 U.S.C.A. § 1154 do not apply. After a review of all the evidence, the Board finds that the Veteran did not sustain an injury or disease of the left foot during service, and did not experience chronic symptoms of a left foot disorder during service. The service treatment records show that the Veteran was treated for left foot pain after playing basketball; he had full range of motion with mild discomfort and x-rays were normal. In March 2001, the Veteran was seen for complaints of intermittent foot pain, increased upon plantar extension; following an examination, the assessment was probable left plantar tendonitis and tibialis. In May 2001, he was seen for follow up, and in August 2001, the Veteran was provided with heel cups for plantar fasciitis. In October 2003, he complained of left first digit pain worse with ankle flexion and extension; x-rays showed mild proliferative changes of the tarsal bones. At the Veteran's March 2006 separation examination, he denied pain foot and stiffness, but reported bone pain in the foot, without tendonitis; examination of the feet and ankles did not show any abnormalities. See 38 C.F.R. § 3.303(a), (b). The Board also finds that the weight of the evidence demonstrates that the Veteran did not experience continuous symptoms of a left foot disorder after service. The Veteran was provided with a VA examination in January 20007, wherein he reported a left ankle sprain while playing basketball in 2002; physical examination was normal. The impression was chronic left ankle sprain from 2002, with essentially normal examination and minimal symptoms. Medical records submitted after the Veteran's 2006 claim for benefits do not show that the Veteran has made any complaints or received any treatment for his claimed left foot disorder. The only report of injury or disease has been in connection with his claim for compensation, at the January 2007 VA examination. Although the Veteran is competent to report certain left foot symptoms, the Board finds that his reports of continuous symptoms since service are not credible. As noted above, the Veteran has not asserted that he has a left foot disorder except for in relation to his claim for compensation benefits. Additionally, he has not referenced his complaints or sought treatment beyond the January 2007 VA examination, and failed to report for a scheduled examination in 2012 without good cause. See 38 C.F.R. § 3.655(b). VA treatment records associated with the Veteran's claims file do not show that he reported any history of in-service left foot injuries or disabilities; the Veteran did not allege that his left foot disability was related to his service except for his claim for compensation benefits. See Pond v. West, 12 Vet. App. 341 (1999) (although Board must take into consideration the appellant's statements, it may consider whether self-interest may be a factor in making such statements); see also Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) ("although interest may affect the credibility of testimony, it does not affect competency to testify"). Furthermore, the Veteran's more recent contentions regarding a left foot injury in service are not credible because his report is inconsistent with the contemporaneous service treatment record evidence, the absence of complaints or treatment after service, the Veteran's own histories made for treatment purposes prior to filing a claim for VA compensation, and his own reported history at the VA examination. In his initial July 2006 claim for VA benefits, the Veteran claimed that he had a left foot disability that began during service and continued since that time. However, the January 2007 VA foot examination found that the Veteran's left foot and ankle were normal. Thus, there is no current left foot disability. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992) ("Congress specifically limits entitlement to service-connected disease or injury to cases where such incidents have resulted in a disability."). Likewise, as indicated earlier, at separation from service, the Veteran complained of bone pain of the foot, but otherwise denied experiencing any complaints related to his left foot and ankle; his contemporaneous physical examination was normal. Similarly, there was no evidence of a related, chronic left foot disorder during or after service, including within a year of discharge from service. In this regard, there is no evidence of complaints, treatment or diagnoses related to his claimed left foot disorder other than those related to his July 2006 compensation claim and the January 2007 VA examination. In short, there is no continuity of symptomatology. Additionally, symptoms such as pain, by itself and without an underlying medical condition, do not constitute a disability for VA disability compensation purposes. See Sanchez-Benitez v. West, 13 Vet. App. 282, 285 (1999). For these reasons, the Board finds that the Veteran's recent statements for compensation purposes that he had chronic symptoms during service and that he experienced continuous symptoms since service are outweighed by the other, more contemporaneous lay and medical evidence of record, and are not credible. See Caluza at 511 (1995); see also Cromer v. Nicholson, 19 Vet. App. 215, 217 (2005). The Board acknowledges that the record reflects that the Veteran was diagnosed with proliferative changes of the tarsal bones in 2003; however, there is no indication in the clinical evidence of record that there are any degenerative changes or indications of arthritis. In order to substantiate a claim of presumptive service connection for arthritis, there must be evidence that it was manifested to a compensable degree in the first post service year. A thorough review of the record found no evidence that the Veteran had arthritis of the left foot in the first post-service year. Furthermore, the Veteran has not specifically alleged any degenerative changes were manifested within the first post-service year. Notably, as a layperson, he is not competent to diagnose arthritis as that disability is an insidious process identified by diagnostic testing, X-ray, or MRI. See Jandreau v. Nicholson, 492 at 1377 (Fed. Cir. 2007). Given that there is no competent evidence of arthritis within the first post service year, service connection for an upper back disability on a presumptive basis (for arthritis as a chronic disease under 38 U.S.C.A. § 1112) is not warranted. The preponderance of the evidence of record is against a finding that the Veteran's left foot disorder is related to his service; therefore, the claim for service connection of this disability must be denied. 38 U.S.C.A. § 5107; 38 C.F.R. § 3.102. (CONTINUED ON NEXT PAGE) ORDER Service connection for a left wrist disorder is denied. Service connection for a left foot disorder is denied. ____________________________________________ T. D. JONES Acting Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs