Citation Nr: 18146842 Decision Date: 11/01/18 Archive Date: 11/01/18 DOCKET NO. 13-05 040 DATE: November 1, 2018 ORDER Entitlement to service connection for left foot disabilities is denied. FINDINGS OF FACT The Veteran’s left foot disabilities including hallux valgus, plantar fasciitis with heel spur, subcortical marrow edema inflammatory disorder, and peroneal tendonitis are neither proximately due to nor aggravated beyond their natural progression by her service-connected knee disabilities, and are not otherwise related to an in-service injury, event, or disease. CONCLUSIONS OF LAW The criteria for service connection for left foot disabilities are not met. 38 U.S.C. §§ 1131, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.310(a) (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 1979 to September 1988. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a March 2015 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In April 2017, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A transcript of the hearing has been associated with the electronic claims file. In August 2017, the Board remanded the matter for additional development including a VA examination for the Veteran’s left foot disabilities. The matter is now back before the board. Service Connection The Veteran contends that her left foot disabilities were caused or aggravated by her service-connected knee disabilities. Specifically, she asserts that years of antalgic gait due to the knee disabilities resulted in left foot disabilities. The question for the Board is whether the Veteran has current disabilities that are proximately due to or the result of, or was aggravated beyond their natural progression by service-connected disability. A veteran is entitled to VA disability compensation if there is disability resulting from personal injury suffered or disease contracted in line of duty in active service, or for aggravation of a preexisting injury suffered or disease contracted in line of duty in active service. 38 U.S.C. § 1110 (2012). To establish an entitlement to service connection for a disability, a veteran must show: (1) a present disability; (2) an 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). Service connection may also be granted for a disability that is proximately due to or the result of an established service-connected disability. 38 C.F.R. § 3.310 (2017). This includes disability made chronically worse by a service-connected disability. Allen v. Brown, 7 Vet. App. 439 (1995). In Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990), the United States Court of Appeals for Veterans Claims stated that "a veteran need only demonstrate that there is an 'approximate balance of positive and negative evidence' in order to prevail." To deny a claim on its merits, the preponderance of the evidence must be against the claim. See Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert, 1 Vet. App. at 54. The Board concludes that, while the Veteran has had diagnoses of left foot disabilities including hallux valgus, plantar fasciitis with heel spur, subcortical marrow edema inflammatory disorder, and peroneal tendonitis during the pendency of her claim, the preponderance of the evidence is against a finding that the Veteran’s left foot disabilities are proximately due to or the result of, or aggravated beyond their natural progression by service-connected disability. 38 U.S.C. § 1131 (2012); 38 C.F.R. § 3.310(a) (2017). The Veteran was afforded a VA examination in October 2017. A VA examiner confirmed the diagnosis of left foot hallux valgus. However, the VA examiner reviewed the Veteran’s statement made in July 2015 of how her knees and antalgic gait caused foot problems and opined that “[a]ntalgic gait is generic term and can be intermittent but does not lead to bone spurs or hallux valgus.” See October 2017 VA examination. Further, the examiner reported that the Veteran was not experiencing any problems or pain associated with hallux valgus and she was unsure about why hallux valgus was considered in her claim. Id. The October 2017 VA examiner also reviewed a MRI result from March 2017 which was submitted by the Veteran. The VA examiner opined that there is no objective evidence of plantar fasciitis with heel spur, subcortical marrow edema inflammatory disorder, or tendonitis according to the MRI result and physical examination, and found that the previously diagnosed conditions have resolved without sequela. See October 2017 VA examination. Also, the VA examiner opined that there is no evidence to conclude that the Veteran’s foot disabilities were caused or aggravated beyond their natural progression by her service-connected bilateral knee disability. Id. The examiner stated that the weight of the medical literature is against a relationship between knee conditions and hallux valgus, plantar fasciitis, and calcaneal spur. Id. It was the examiner’s opinion that the Veteran’s long employment as a postal worker ambulating frequently is more likely the cause of heel spur. Id. The Board finds the October 2017 VA examination competent and credible medical evidence as it was performed by an appropriate medical professional who had necessary medical knowledge and training. The Board assigns high probative weight to it since the VA examiner reviewed all of the relevant treatment records from both VA and private sources, and gave an adequate rationale to support his opinion which directly addresses the issue at hand. The Board finds that the Veteran is competent and credible to make a statement on how her private doctors said her feet problems are caused by her knees. See July 2015 Veteran’s Statement in Support of Claim. However, the Board gives little probative weight to the Veteran’s statement, because the record lacks any private medical opinion to support it. Moreover, while the Veteran believes her left foot disabilities are the result of a service-connected disability, she is not competent to provide a nexus opinion in this case. These issues are medically complex, as they require knowledge of the interaction between multiple organ systems in the body. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the October 2017 VA examination opinion. Service connection may also be granted on a direct basis, but the preponderance of the evidence is also against finding that the Veteran’s left foot disabilities is related to an in-service injury, event, or disease. 38 U.S.C. § 1131 (2012); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d) (2017). The record does not indicate any in-service injury, event, or disease related to the Veteran’s left foot disabilities. The only in-service foot injury on record is a right   foot injury occurred in May 1983. See May 1983 Service Treatment Record. Therefore, the Veteran’s entitlement to service connection for left foot disabilities on a direct basis is not warranted. MICHAEL LANE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. E. Kim, Associate Counsel