Citation Nr: 18146731 Decision Date: 11/01/18 Archive Date: 10/31/18 DOCKET NO. 16-02 476 DATE: November 1, 2018 ORDER Entitlement to service connection for hammer toes of the left foot, including secondary to service-connected Reiter's syndrome, is denied. REMANDED Entitlement to an evaluation in excess of 40 percent for Reiter's s syndrome with history of rheumatoid spondylitis, anemia, urethritis, conjunctivitis, and polyathritis is remanded. Entitlement to an initial evaluation in excess of 30 percent for left total knee arthroplasty is remanded. Entitlement to an initial evaluation in excess of 30 percent for right total knee arthroplasty is remanded. Entitlement to a total disability rating based upon individual unemployability due to service-connected disabilities (TDIU). FINDING OF FACT The Veteran’s current hammer toes of the left foot are neither proximately due to nor aggravated beyond their natural progression by his service-connected Reiter’s syndrome, and are not otherwise related to an in-service injury, event, or disease. CONCLUSION OF LAW The criteria for service connection for hammer toes left foot, including secondary to service-connected Reiter’s syndrome, are not met. 38 U.S.C. §§ 1110, 1112, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from July 1969 to November 1970. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). 1. Entitlement to service connection for hammer toes left foot, including secondary to service-connected Reiter’s syndrome. Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Generally, in order to prove service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999). Service connection may also be established for disability that is proximately due to or the result of a service-connected disability. 38 C.F.R. § 3.310(a) (2018). Further, a disability that is aggravated by a service-connected disability may be service connected to the degree that the aggravation is shown. 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439 (1995). However, VA will not concede that a nonservice-connected disease or injury was aggravated by a service-connected disease or injury unless the baseline level of severity of the nonservice-connected disease or injury is established by medical evidence created before the onset of aggravation or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity of the nonservice- connected disease or injury. 38 C.F.R. § 3.310. The Veteran contends that his hammer toes of the left foot were caused or aggravated by his service-connected Reiter’s syndrome. The Board concludes that, while the Veteran has a current diagnosis of hammer toes of the left foot, the preponderance of the evidence is against finding that this condition is proximately due to or the result of, or aggravated beyond its natural progression by his service-connected Reiter’s syndrome. 38 U.S.C. §§ 1110, 1131; Allen v. Brown, 7 Vet. App. 439 (1995) (en banc); 38 C.F.R. § 3.310(a). The February 2011 VA examiner opined that the Veteran’s current hammer toes of the left foot are not caused by or due to his service-connected Reiter’s Syndrome. The rationale was that the Veteran did not have chronic reactive inflammatory arthritis or chronic rheumatoid spondylitis. The VA examiner also noted that the Veteran has a hallux valgus, which predisposes Veteran to developing hammer toes. The examiner also noted that the Veteran has diabetes mellitus and hammering of the toes is a common foot deformity in patients with diabetes mellitus. The October 2015 VA examiner opined that the Veteran’s current hammer toes of the left foot is less likely as not proximately due to or the result of his service-connected Reiter’s Syndrome. The rationale was that there is no basis in medical fact identified in support of the claim. While the Veteran believes his hammer toes of the left foot were caused by or aggravated beyond its natural progression by his service-connected disability, he is not competent to provide a nexus opinion in this case. In this regard, this question requires medical expertise to determine, which the Veteran is not shown to possess. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the VA examiner’s opinions in February 2011 and October 2015 than to the Veteran’s lay assertions. As a final matter, the Board has considered whether service connection may be granted on a direct basis; however, the preponderance of the evidence is also against finding that the Veteran’s hammer toes of the left foot are related to service. 38 U.S.C. §§ 1110, 1131; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). There is no evidence of this condition during the Veteran’s military service or for decades thereafter. There is also no competent evidence linking the Veteran’s current hammer toes of the left foot to his military service. Under these circumstances, service connection for hammer toes of the left foot is not warranted. In reaching the above conclusions, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107(b) (2012); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990). REASONS FOR REMAND The Veteran is seeking increased evaluations for his service-connected Reiter’s syndrome and bilateral total knee arthroplasties. He is also seeking entitlement to a TDIU. The most recent VA examinations of the Veteran’s service-connected Reiter’s syndrome and bilateral total knee arthroplasties were conducted more than five years ago. Updated treatment records relating to these conditions should be obtained and new VA examinations should then be conducted to ascertain the current severity of these conditions. Finally, because a decision on the increased rating issues could significantly impact a decision on the issue of entitlement to a TDIU, the issues are inextricably intertwined. A remand of the claim for a TDIU is required. The matters are REMANDED for the following action: 1. Obtain the Veteran’s updated VA treatment records dating since February 2017. 2. Schedule the Veteran for VA arthritis and knee examinations to determine the current severity of his service-connected Reiter’s syndrome and bilateral total knee arthroplasties. The claims file should be reviewed in conjunction with the examination. All indicated tests should be conducted and the results reported. The functional impairment resulting from these disabilities should be addressed. K. A. BANFIELD Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD W. Yates