Citation Nr: 18143223 Decision Date: 10/18/18 Archive Date: 10/18/18 DOCKET NO. 11-22 197 DATE: October 18, 2018 ORDER Entitlement to service connection for left foot osteoarthritis, to include as secondary to service-connected left little toe fracture, is denied. Entitlement to service connection for right foot osteoarthritis, to include as secondary to service-connected left little toe fracture, is denied FINDING OF FACT The probative evidence of record does not show that the Veteran’s osteoarthritis of the left and right foot is proximately due to or aggravated by his service-connected left little toe fracture, or otherwise related to his active duty service. CONCLUSIONS OF LAW 1. The criteria for service connection for left foot osteoarthritis have not been met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.304, 3.310. 2. The criteria for service connection for right foot osteoarthritis have not been met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.304, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSIONS The Veteran served on active duty in the United States Air Force from May 1955 to August 1958. Service Connection Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). In order to establish service connection, the record must show competent evidence of three things: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d, 1362, 1366 (Fed. Cir. 2009). When considering such a claim for service connection, the Board must consider on a case-by-case basis, the competence and sufficiency of lay evidence offered to support a finding of service connection. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009) (quoting Jandreau v. Nicholson, 492 F.3d 1372, 1377 Fed. Cir. 2007)). The mere conclusory or generalized lay statements that a service event or illness caused a current disability are insufficient. Waters v. Shinseki, 601 F.3d 1274, 1278 (2010). Osteoarthritis of the Left and Right Foot The Veteran contends that his osteoarthritis of the left and right foot is due to or aggravated by his service-connected left little toe fracture. Service connection on a secondary basis essentially requires evidence sufficient to show: (1) that a current disability exists; and (2) that the current disability was either caused or aggravated by a service-connected disability. 38 C.F.R. § 3.310 (2017). As an initial matter, the Board acknowledges that the Veteran has been diagnosed with osteoarthritis in his left and right foot. Further, the Veteran is service-connected for fracture of the left foot little toe. Thus, the issue turns upon whether there is evidence of a nexus between an in-service disease or injury and the present diagnosed disability, or a nexus between the service-connected disability and present diagnosed disability. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). The Board finds there is not. In May 2009, the Veteran received a VA examination. The examiner opined that the Veteran’s bilateral foot osteoarthritis is less likely than not caused by his service-connected residuals of the left little toe fracture. The examiner rationalized that x-rays performed did not reveal changes in the region of the right fifth tarsal or metatarsal bones. The examiner stated as there are no residuals found on x-ray of left little toe fracture, it is likely that if there was a fracture present, it is healed and has not likely lead to any significant long-term disability or alteration of the gait that would be responsible for compensatory changes and development of arthritis in both feet. In January 2018, the Veteran received another VA examination. The examiner opined that the Veteran’s degenerative disease in both feet is less likely as not incurred in, caused by, or a result of active military service. The examiner also opined that the Veteran’s degenerative disease in both his feet is less likely as not aggravated by his service-connected left little toe fracture. The examiner noted that the opinion was based on evaluation of the Veteran and on reviewing the medical records of the Veteran. The examiner further provided a thorough recap of all the medical records reviewed. The examiner then rationalized that the evidence is absent for a diagnosis of degenerative diseases for both feet being incurred in, caused by, or a result of military service, and there was no objective evidence showing the degenerative disease of both feet was aggravated by his service-connected left little toe fracture. The examiner also provided that there was no evidence showing the diagnosis of the left foot degenerative disease is related to his period of service. The Board notes that VA treatment records and private medical records show treatment for left and right foot pain, secondary to degenerative disc disease (arthritis) pain. The Veteran has further been seen by private medical doctors for orthopedic treatment, to include being fitted for orthopedic shoes. The Board acknowledges a March 2009 letter from his private physician, in which the physician notes the Veteran suffered from an in-service accident in 1957 or 1958 where his right foot was run over by a truck, and has had pain ever since. The physician then opined that his joint arthritis appeared to be more likely than not due to his underlying history of military trauma. The Veteran also submitted a January 2012 private medical assessment in which a private physician also notes the Veteran suffered from an in-service 1957 accident and has suffered from right foot pain ever since the truck ran over his right foot. The January 2012 physician then stated that based on the information presented, it appeared that the Veteran’s pain began at the time of his injury as he did not appear to have any symptoms of his foot before the injury, and therefore it appears that the Veteran’s symptoms stem from injury sustained during his military duty in 1957. However, the Board notes that the Veteran’s military records show the Veteran suffered a fracture of his left little toe after a truck ran over his left foot and not his right foot. The Board finds this suggests the private physicians did not see or review any of the Veteran’s prior medical records. Further, both physicians stated it “appeared” that the Veteran’s symptoms started after his in-service incident. The Board finds this language is suggestive, especially since their descriptions of the in-service incident noted the wrong foot. Therefore, the Board puts low probative value on the March 2009 private physician letter and January 2012 private physician assessment, as the opinions were not based on a complete review of the Veteran’s file, and such speculative opinions are not probative, but, rather are inconclusive. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000). See also Warren v. Brown, 6 Vet. App. 4, 6 (1993) (stating that a physician’s statement framed in terms such as “may,” “could,” or “possible” is not probative). Given the above, the Board finds the May 2009 and January 2018 VA medical examinations and opinions to be of significant probative value in determining that the Veteran’s left and right foot osteoarthritis are not due to or aggravated by his service-connected left little toe fracture, or are otherwise related to his period of service. The Board notes that the probative value of medical opinion evidence is based on the medical experts’ personal examination of the patient, their knowledge, and skill in analyzing the data, and their medical conclusion. As is true with any piece of evidence, the credibility and weight to be attached to these opinions are within the province of the adjudicator. Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993). Whether a physician provides a basis for his or her medical opinion goes to the weight or credibility of the evidence in the adjudication of the merits. See Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998). Here, the reviewing physicians’ opinions were based on review of the Veteran’s lay contentions, his reported medical history, and review of the medical evidence of record. Further, complete and thorough rationales were provided for the opinions rendered and are consistent with the evidence of record. The Board also acknowledges the Veteran’s assertions that his left and right foot osteoarthritis are due to his service-connected left little toe fracture and in-service truck incident. The Board recognizes that lay persons are competent to provide medical opinions on some medical issues. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). However, although the Veteran is competent to report his symptoms, any opinion regarding whether any bilateral foot arthritis is related to his military service, to include a service-connected left little toe fracture, requires medical expertise that the Veteran has not demonstrated since arthritis can have many causes. See Jandreau v. Nicholson, 492 F.3d 1372, 1376 (2007). In light of the foregoing, the Board concludes that the preponderance of evidence is against the claim and the benefit of the doubt doctrine is not for application. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990); Ortiz v. Principi, 274 F.3d 1361 (Fed Cir. 2001). JENNIFER HWA Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Negron, Associate Counsel