Citation Nr: 18150654 Decision Date: 11/15/18 Archive Date: 11/15/18 DOCKET NO. 17-52 114 DATE: November 15, 2018 ORDER Entitlement to service connection for aggravation of congenital talipes equinovarus, status post fusion of ankle bones (claimed as right ankle arthritis) is granted. FINDING OF FACT The Veteran’s pre-existing congenital talipes equinovarus, status post fusion of ankle bones was aggravated by his active service. CONCLUSION OF LAW The criteria for service connection for congenital talipes equinovarus, status post fusion of ankle bones have been met. 38 U.S.C. §§ 1110, 1111, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.306. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served in the U.S. Army from May 1967 to September 1967. Service Connection - Congenital Disease Service connection generally may not be granted for congenital or developmental defects, as they are not diseases or injuries within the meaning of applicable legislation. 38 C.F.R. §§ 3.303 (c), 4.9. However, the VA Office of General Counsel has held that service connection may be granted for a congenital disease based on in-service aggravation. See VAOPGCPREC 82-90, 55 Fed. Reg. 45,711 (1990) (a reissue of General Counsel Opinion 01-85 (March 5, 1985)). The VA General Counsel’s opinion indicated that there is a distinction under the law between a congenital or developmental “disease” and a congenital or developmental “defect” for service connection purposes. A “disease” considered by medical authorities to be of congenital, familial (or hereditary) origin by its very nature pre-exists claimants’ military service, but that service connection for such diseases could be granted only if manifestations of the disease in service constituted aggravation of the condition. See Carpenter v. Brown, 8 Vet. App. 240, 245 (1995). Entitlement to service connection for aggravation of congenital talipes equinovarus, status post fusion of ankle bones (claimed as right ankle arthritis) There is no dispute that the Veteran congenital talipes equinovarus, status post fusion of ankle bones preexisted his active service as noted in the Veteran’s representative January 2018 correspondence, “[t]his office does not dispute the fact that the Veteran had a pre-existing disorder.” The dispute instead centers on whether the Veteran’s pre-existing disability was worsened by his active duty service. Addressing this question, the Board finds that the evidence supports the Veteran’s contention that his pre-existing disability was worsened. The Board will address the pertinent evidence in-turn. First, service treatment records indicate that the Veteran demonstrated a clinically normal right foot at enlistment. In an August 1967 examination, the Veteran, there are no complaints, diagnoses or treatments for any foot/ankle disabilities. In December 1968, at the Veteran’s separation, it was noted that the Veteran had no internal or external rotation of the right foot with diagnoses of “[t]alipe equina varus right foot with multiple surgical intervention – fusion of tarsals and “atrophy gastrocnemius.” Second, in October 2017, the Veteran’s orthopedic physician indicated that the Veteran’s active service “worsened” his preexisting foot deformity, noting that, the Veteran’s service worsened due to his physically demanding training for the military as his foot was not meant for this type of physically demanding activities. The Board finds that evidence especially probative given the unique position the Veteran’s orthopedic physician is in as a clinical professional that has treated the Veteran over a course of years thus able to provide a more insightful opinion on the nature of the Veteran’s disability. This unique position coupled with the physician’s exhaustive review of the Veteran’s history and medical explanation of how he reached his conclusion bolsters the physician opinion above all others. As the Court of Veterans Claims has held most of the probative value of a medical opinion comes from its reasoning and the Board must be able to conclude that a medical expert has applied valid medical analysis to the significant facts of the particular case in order to reach the conclusion submitted in the medical opinion. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The Board thus considers the Veteran’s physician’s opinion from October 2017 to be the most probative on the matter of aggravation of the Veteran’s disability. (Continued on the next page)   Considering the aforementioned, the claim for service connection for aggravation of a congenital talipes equinovarus, status post fusion of ankle bones is granted. There is probative medical evidence that indicates the Veteran’s active service aggravated his preexisting disability. Given the probative medical evidence that the Veteran’s active service aggravated his preexisting right foot disability, the claim is granted. GAYLE E. STROMMEN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Acosta, Counsel