Citation Nr: 18145755 Decision Date: 10/30/18 Archive Date: 10/30/18 DOCKET NO. 12-16 014 DATE: October 30, 2018 ORDER Entitlement to service connection for a bilateral foot injury, to include pes planus and metatarsalgia is denied. FINDINGS OF FACT Entitlement to service connection for a bilateral foot injury, to include pes planus and metatarsalgia is denied. CONCLUSIONS OF LAW The criteria for entitlement to service connection for a bilateral foot injury, to include pes planus and metatarsalgia have not been met. 38 U.S.C. §§ 1110; 38 U.S.C. §§ 1131; 38 C.F.R. § 3.303(a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from June 1973 to May 1976 and was a veteran of the Vietnam Era. This matter came before the Board through an appeal of the October 2011 rating decision. In June 2017, the Board remanded this claim and to the Agency of Original Jurisdiction (“AOJ”) for additional development. The appeal for service connection for the bilateral foot disability has since returned to the Board. Since the June 2017 decision, the AOJ has obtained a new VA examination, issued a new rating decision, and issued a new supplemental statement of the case which considered the new evidence. As a result, the Board finds substantial compliance with its previous remand instructions, and has properly continued with the foregoing decision. Substantial compliance, rather than strict compliance, is required. See D’Aries v. Peake, 22 Vet. App. 97, 105 (2008); see also Stegall v. West, 11 Vet. App. 268, 271 (1998). In June 2017, the Board also remanded a claim for service connection for bilateral hearing loss to the Agency of Original Jurisdiction (“AOJ”) for additional development. In the August 2018 rating decision, the Veteran’s claim for service connection for bilateral hearing loss was granted. As such, the claim for service connection for bilateral hearing loss is no longer on appeal. Service Connection Entitlement to service connection for a bilateral foot injury, to include pes planus and metatarsalgia is denied. A veteran is entitled to VA disability compensation if there is a disability resulting from a personal injury suffered or diseased contracted in the line of duty in active service, or for aggravation of a preexisting injury suffered or disease contracted in the line of duty in active service. 38 U.S.C. §§ 1110, 1131. To establish a right to compensation for a present disability, a Veteran must show: “(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service” – the so-called “nexus” requirement. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). The Veteran asserts that his bilateral foot injury is connected to wearing oversized boots while on active duty. The question before the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The record reflects current diagnoses for bilateral pes planus, right heel spur, ingrown toenail of great toes removal, toenail removal of 2/3/5 toes, left foot plantar callus, and right foot contusion-resolved. See VA Examination dated October 2017. The Veteran’s service treatment records show that while in service he complained of foot pain due to his oversized boots. On those occasions, the treating physician found that the Veteran had a plantar wart on the left foot and excised the wart. See Service Treatment Records from November 1973; Service Treatment Records from January 1974. The service treatment records also indicate that the Veteran complained of right arch pain. The VA conducted an examination in April 2015. The VA examiner diagnosed the Veteran with flat feet, or pes planus, but opined that the injury was less likely to have occurred in or been caused by the Veteran’s military service because the separation exam is silent as to foot complaints and the service treatment records do not show flat feet had been diagnosed. See VA Examination dated April 2015. The VA conducted another examination in August 2017. The VA examiner opined that the Veteran’s bilateral foot injury, including pes planus and metatarsalgia, is not at least as likely as not related to an in-service injury, event, or disease, including due to wearing oversized boots in 1974. The rationale was that the Veteran gained a substantial amount of weight after separating from service and he was 41-years-old when he was diagnosed with pes planus. According to the examiner, two risk factors for developing pes planus are age and obesity. He also noted that pes planus and metatarsalgia are not noted in the separation examination and the enlistment examination for the National Guard. Similarly, the examiner stated that the metatarsalgia that is occurring in the ball or forefoot as described by the Veteran during the examination is in a different location of the foot than the foot pain described in the Veteran’s service treatment records. The examiner also addressed the Veteran’s other diagnosed foot conditions of right heel spur, ingrown toenail of great toes removal, toenail removal of 2/3/5 toes, left foot plantar callus, and right foot contusion-resolved and opined that they were not related to his service because the treatment records are silent as to any foot conditions until 1993. The April 2017 examiner’s opinion is highly probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The service treatment records and the Veteran’s medical records support the examiner’s findings. While the Veteran believes his bilateral-foot injury is related to an in-service injury, event, or disease, including wearing oversized boots while in service, he is not competent to provide a nexus opinion in this case. Similarly, while the Veteran is competent to report having experienced symptoms of bilateral foot pain consistently since service, he is not competent to provide a diagnosis in this case. This issue is medically complex, as it requires knowledge of podiatry and an examination of the Veteran’s other medical diagnoses and disabilities, such as his obesity and knee disabilities. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the Veteran’s medical records. The Board concludes that, while the Veteran has a current diagnosis of pes planus, and evidence shows that he was treated for foot injuries due to oversized boots, the preponderance of the evidence weighs against finding that the Veteran’s diagnosis of pes planus began during service or is otherwise related to an in-service injury,   event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). L. M. BARNARD Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S. Bognar, Associate Counsel