Citation Nr: 18154632 Decision Date: 11/30/18 Archive Date: 11/30/18 DOCKET NO. 14-00 344 DATE: November 30, 2018 ORDER Service connection for a right foot disability, to include as secondary to a low back disability, is denied. FINDING OF FACT The Veteran’s right foot disability is neither proximately due to nor aggravated beyond its natural progression by his service-connected low back disability, and is not otherwise related to an in-service injury, event, or disease. CONCLUSION OF LAW The criteria for service connection for a right foot disability, to include as due to a low back disability, are not met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.310(a). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from November 1960 to October 1964. These matters come before the Board of Veterans’ Appeals (Board) on appeal from an October 2011 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) which denied service connection for entitlement to service connection for an eye disability, a low back disability, and a right foot disability, to include as secondary to a low back disability. In July 2017, the Board remanded these issues to obtain new VA examinations for all three claimed disabilities. In September 2017, the Veteran was afforded new VA examinations were obtained for the claimed disabilities. In June 2018, the RO issued a rating decision granting service connection for an eye disability and a low back disability. The Veteran has not disagreed with the ratings or effective dates assigned and these issues are no longer before the board. The issue of the right foot is once again before the Board for appellate consideration of the issue on appeal. Stegall v. West, 11 Vet. App. 268 (1998). The Veteran testified at a videoconference hearing before the undersigned in February 2017, and a transcript of that hearing is of record. 1. Entitlement to service connection for a right foot disability, to include as secondary to a low back disability The Veteran contends that he has a right foot disability that was either caused when he fell in a deep latrine while on active duty or is due to his service-connected low back disability. The Board concludes that, while the Veteran has a current diagnosis of a healed stress fracture, the preponderance of the evidence is against finding that the Veteran’s healed stress fracture is proximately due to or the result of service or caused by or aggravated beyond its natural progression by his service-connected disability. 38 U.S.C. §§ 1110, 1131; Allen v. Brown, 7 Vet. App. 439 (1995) (en banc); 38 C.F.R. § 3.310(a). The September 2017 VA examiner opined that the Veteran’s diabetes, poor circulation, and morbid obesity could contribute to his healed right foot stress fracture. The Board also notes that while the September 2017 VA examiner reported that the Veteran was suffering from chronic plantar fasciitis on the right foot according to a May 1986 letter from the Veteran’s physician, he did not have a current diagnosis for plantar fasciitis at the time of the September 2017 VA examination. While the Veteran believes his right foot disability is proximately due to or the result of his service-connected low back disability, he is not competent to provide a nexus opinion in this case. The issue is medically complex, as it requires knowledge of the interaction between multiple systems in the body and interpretation of complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the opinion of the September 2017 VA examiner. Service connection may also be granted on a direct basis, but the preponderance of the evidence is also against finding that the Veteran’s right foot disability is related to an in-service injury, event, or disease. 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). The Veteran is competent to report that he fell in a latrine during service, and his reports are credible and entitled to probative weight. His reports have been internally consistent, and are consistent with other evidence of record, including service medical records indicating that the Veteran was seen for back pain and buddy statements. Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006). However, the September 2017 VA examiner opined that the Veteran’s right foot disability is not at least as likely as not related to an in-service injury, event, or disease, including when the Veteran fell into a larine during service. Instead, the September 2017 VA examiner opined that the Veteran’s diabetes, poor circulation, and morbid obesity could contribute to his right foot disability. While the Veteran believes his right foot disability is related to the in-service incident when he fell into a latrine, he is not competent to provide a nexus opinion in this case. The issue is medically complex, as it requires knowledge of the interaction between multiple systems in the body and interpretation of complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the opinion of the September 2017 VA examiner. H. SEESEL Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Boal, Associate Counsel