Citation Nr: 18145207 Decision Date: 10/30/18 Archive Date: 10/26/18 DOCKET NO. 10-23 602 DATE: October 30, 2018 ORDER Entitlement to a 10 percent disability rating for the Veteran’s left foot hallux valgus and bunion throughout the period of the claim is granted. Entitlement to secondary service connection for a right knee disability is denied. Entitlement to secondary service connection for a left knee disability is denied. FINDINGS OF FACT 1. Throughout the period of the claim, the Veteran’s left foot hallux valgus and bunion has manifested as painful motion of the left great toe joint. 2. The Veteran’s bilateral knee disability was not caused or aggravated by her service-connected left foot hallux valgus and bunion. CONCLUSIONS OF LAW 1. Throughout the period of the claim, the criteria for a 10 percent rating, but not higher, for left foot hallux valgus and bunion, have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 3.321, 4.59, 4.71a, Diagnostic Code (DC) 5280 (2018). 2. The criteria for secondary service connection for a bilateral knee disability have not been met. 38 U.S.C. §§ 1110, 1154(b), 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Introduction The Veteran had active service from June 2002 to November 2003. This matter comes before the Board of Veterans’ Appeals (Board) on appeal of a February 2006 rating decision by the Winston-Salem, North Carolina, Regional Office of the Department of Veterans Affairs (VA). In March 2017, the Veteran testified at a Travel Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is of record. When this case was last before the Board in June 2017, it was remanded for additional development. The case has now been returned to the Board for further appellate consideration. General Legal Criteria Increased ratings Disability evaluations are determined by the application of the Schedule for Rating Disabilities, which assigns ratings based on the average impairment of earning capacity resulting from a service-connected disability. 38 U.S.C. § 1155 (2012); 38 C.F.R. Part 4 (2018). 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. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (2018). Service connection Service connection may be established for a disability resulting from personal injury suffered or disease contracted in the line of duty or for aggravation of preexisting injury suffered or disease contracted in the line of duty. 38 U.S.C. § 1110 (2012); 38 C.F.R. § 3.303 (2018). In addition, disability which is proximately due to or the result of a service-connected disease or injury shall be service connected. 38 C.F.R. § 3.310 (2018). Furthermore, when aggravation of a veteran’s nonservice-connected condition is proximately due to or the result of a service-connected condition, the veteran shall be compensated for the degree of disability over and above the degree of disability existing prior to the aggravation. Allen v. Brown, 7 Vet. App. 439 (1995). Burden of proof The Board must assess the credibility and weight of all the evidence, including the medical evidence, to determine its probative value, accounting for evidence which it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. See Masors v. Derwinski, 2 Vet. App. 181 (1992); Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992). Equal weight is not accorded to each piece of evidence contained in the record; every item of evidence does not have the same probative value. 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 v. Derwinski, 1 Vet. App. 49, 57 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the benefit of the doubt shall be given to the claimant. 38 U.S.C. § 5107(b) (2012). Background and Analysis Increased rating for left foot hallux valgus and bunion The Veteran’s left foot hallux valgus and bunion is rated under 38 C.F.R. § 4.71a, DC 5280 (2018). Under DC 5280, a 10 percent rating is warranted for severe hallux valgus, if equivalent to amputation of the great toe. A 10 percent rating is also warranted for hallux valgus operated upon with resection of the metatarsal head. The Veteran was afforded a VA examination in December 2005. The examiner noted the presence of painful motion of the left great toe with dorsiflexion and extension. On x-ray, mild hallux valgus was noted. The physical examiner diagnosed hallux valgus. The Veteran was afforded an additional VA examination in January 2013. The examiner indicated the Veteran had mild or moderate symptoms of hallux valgus. The examiner noted surgery had never been performed for the condition, and indicated there were not severe symptoms with function equivalent to amputation of the great toe. At his March 2017 hearing, the Veteran testified to continuing, significant left foot pain and swelling. Pursuant to the Board’s June 2017 remand instructions, the Veteran was afforded an additional VA examination in August 2017. The examiner noted left foot pain on examination, and indicated the Veteran’s left foot hallux valgus presented mild or moderate symptoms. Upon a review of the foregoing, the Board observes there is no medical evidence indicating the Veteran’s hallux valgus is so severe as to be equivalent to amputation of the great toe. Instead, as noted above, VA examiners have consistently indicated the Veteran’s hallux valgus symptoms are mild to moderate. In addition, there is no indication the Veteran’s hallux valgus has been operated upon. For these reasons, the Board finds a compensable rating is not warranted for the Veteran’s left foot hallux valgus at any time during the period of the claim under DC 5280. The Board notes, however, that under 38 C.F.R. § 4.59, painful joints are entitled to at least the minimum compensable rating for the joint. A review of the foregoing shows the Veteran has clearly experienced and reported pain in her left great toe joint throughout the period of the claim. Accordingly, the Board finds the Veteran is entitled to a 10 percent rating for her left foot hallux valgus for the entire period of the claim pursuant to § 4.59. Service connection for a bilateral knee disability The record shows the Veteran has been diagnosed with bilateral patellofemoral syndrome with crepitation, and bilateral patellofemoral spurring. She has contended that her bilateral knee condition is secondary to her service-connected left foot hallux valgus. Specifically, she has contended her left foot pain has caused an altered gait, which has led to strain on her knees. The Veteran was afforded a VA knee examination in December 2005. After diagnosing mild patellofemoral crepitation in both knees, the examiner opined that the condition was less likely than not proximately due to the Veteran’s left foot hallux valgus. In support of her opinion, the examiner stated there was no gait disorder or evidence of asymmetric weight bearing. Pursuant to the Board’s June 2017 remand instructions, the Veteran was afforded an additional VA examination in August 2017. Ultimately, the examiner opined that the Veteran’s bilateral knee disability had not been caused or aggravated by her service-connected left foot hallux valgus. In support of her opinion, the VA examiner first stated that a thorough review of the Veteran’s service treatment records (STRs) and post-service medical records showed the Veteran’s gait had never been anything but normal and ambulatory. The examiner noted the Veteran had never been documented to have altered weight-bearing in any medical records and stated that there was, thus, simply no medical evidence to substantiate that the Veteran’s left foot hallux valgus had caused a gait disturbance to create a secondary right or left knee condition. Further, the examiner noted, an April 2016 foot X-ray showed the Veteran had a small bunion formation of the first metatarsophalangeal joint, but otherwise a normal left foot. On this basis, the examiner stated the Veteran’s left foot simply did not have severe enough pathology to cause a problem in either knee. The examiner next stated the Veteran’s patellofemoral spurs were indicative of early osteoarthritis, which was not unusual for someone in their “fourth decade.” More importantly, the examiner stated, this condition was not unusual considering the Veteran’s post-military weight gain, which resulted in a body mass index in the obese range for years since her discharge. Obesity, the examiner stated, was known to be a “great risk factor” in the development of osteoarthritis of the knees. The examiner further stated, regarding aggravation, that upon examination, the Veteran’s range of motion of the knees was better than it had been at her December 2005 VA examination. Thus, the examiner concluded, there was no evidence the Veteran’s bilateral knee condition had been aggravated by her left foot hallux valgus. Upon a review of the record, the Board observes that, consistent with the August 2017 VA examiner’s opinion, numerous VA examination reports, to include reports following headache, spine, knee, foot, and ear examinations, have indicated the Veteran’s gait was normal during the period of the claim. Specifically, the Veteran’s gait was noted to be within normal limits at VA examinations in December 2003, December 2005, January 2007, October 2008, and August 2017. After a careful review of the foregoing, the Board finds no reason to doubt the credibility of the Veteran’s statements to the effect that she has experienced pain in her left foot which has caused her to favor her right lower extremity to some degree. The medical evidence, however, indicates that the Veteran’s gait has not been so altered by her left foot hallux valgus as to have caused or aggravated her bilateral knee disability. The Board finds the August 2017 VA medical opinion to be thoroughly-reasoned and supported by a detailed, convincing medical explanation. Upon review, there is no medical evidence of record contradicting the August 2017 opinion, or otherwise supporting the Veteran’s claim. As to the medical question of whether the Veteran’s left foot hallux valgus has caused or aggravated her bilateral knee disability, the Board finds the medical evidence is more probative than the Veteran’s lay opinion. Thus, after careful consideration, the Board finds a preponderance of the evidence weighs against the Veteran’s claim. Because the Board has determined a preponderance of the evidence weighs against the Veteran’s claim, the benefit-of-the-doubt doctrine is inapplicable, and the claim must be denied. BARBARA B. COPELAND Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Hampton, Associate Counsel