Citation Nr: 18156710
Decision Date: 12/11/18	Archive Date: 12/10/18

DOCKET NO. 15-15 767
DATE:	December 11, 2018
ORDER
Entitlement to service connection for a left foot condition, to include osteoarthritis, hallux valgus, and plantar fasciitis, to include as secondary to a service-connected disability, is denied.
FINDING OF FACT
The left foot condition, to include osteoarthritis, hallux valgus, and plantar fasciitis, was not incurred in or aggravated by service, and is not proximately due to, or the direct result of, a Veteran’s service-connected disability.
CONCLUSION OF LAW
The criteria for entitlement to service connection for a left foot condition, to include osteoarthritis, hallux valgus, and plantar fasciitis, to include as secondary to a service-connected disability, have not been met. 38 U.S.C. § 1110, 1154, 5107; 38 C.F.R. § 3.303; 38 C.F.R. § 3.309; 8 C.F.R. § 3.385; 38 C.F.R. § 3.310.
REASONS AND BASES FOR FINDING AND CONCLUSION
The Veteran served on active duty in the United States Marine Corps from April 1972 to July 1979. Thereafter, the Veteran served on active duty in the United States Navy from August 1980 to May 1993.
This appeal comes to the Board of Veterans’ Appeals (Board) from a rating decision, dated February 2014, issued by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Paul, Minnesota (hereinafter Agency of Original Jurisdiction (AOJ)). In its decision, the RO denied service connection for left foot hallux valgus, to include as secondary to a service-connected disability. The Veteran timely appealed.
In the February 2014 rating decision, the AOJ denied the Veteran’s claim for entitlement to service connection for left foot osteoarthritis, left foot hallux valgus, and left foot plantar fasciitis, to include as secondary to left knee meniscectomy, because the medical evidence did not show a nexus between the Veteran’s current medical condition and his service or his service-connected left knee disability.
Service Connection
In seeking VA disability compensation, a Veteran generally seeks to establish that a current disability results from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110. “Service connection” basically means that the facts, shown by evidence, establish that a particular injury or disease resulting in disability was incurred coincident with service in the Armed Forces, or if preexisting such service, was aggravated therein. 38 C.F.R. § 3.303.
Establishing service connection generally requires competent evidence showing: (1) the existence of a current 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. Shedden v. Principi, 381, F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).
Service connection may also be granted for a disability that is proximately due to, or the result of, a service-connected disability. See 38 C.F.R. § 3.310(a). When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. See id.; Harder v. Brown, 5 Vet. App. 183, 187 (1993). The controlling regulation has been interpreted to permit a grant of service connection not only for disability caused by a service-connected disability, but for the degree of disability resulting from aggravation of a non-service-connected disability by a service-connected disability. See Allen v. Brown, 7 Vet. App. 439, 448 (1995). In other words, service connection may be granted for a disability found to be proximately due to, or aggravated by, a service-connected disease or injury. To prevail on the issue of secondary service connection, the record must show (1) evidence of a current disability, (2) evidence of a service-connected disability, and (3) medical nexus evidence establishing a connection between the current disability and the service-connected disability. Wallin v. West, 11 Vet. App. 509, 512 (1998); Reiber v. Brown, 7 Vet. App. 513, 516-17 (1995).
The determination of whether the requirements of service connection have been met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. See Baldwin v. West, 13 Vet. App. 1, 8 (1999). In making these determinations, the Board must consider and assess the credibility and weight of all evidence in the claim file, including the medical and lay evidence, to determine its probative value. In doing so, the Board must provide its reasoning for rejecting any evidence favorable to the claimant. See Masors v. Derwinski, 2 Vet. App. 181 (1992); Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992); Barr v. Nicholson, 21 Vet. App. 303 (2007).
When there is an approximate balance of evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each issue shall be given to the claimant. See 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3. A claimant need only demonstrate an approximate balance of positive and negative evidence in order to prevail. See Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). For a claim to be denied on the merits, a preponderance of the evidence must be against the claim. See Alemany v. Brown, 9 Vet. App. 518, 519 (1996).
That being the relevant, generalized, law applicable to the Veteran’s claims, the Board finds that the Veteran is not entitled to an award of service connection for left foot hallux valgus, left foot osteoarthritis, or left foot plantar fasciitis.
Entitlement to service connection for a left food condition, to include osteoarthritis, hallux valgus, and plantar fasciitis, as secondary to left knee meniscectomy
The Veteran claims entitlement to service connection for left foot osteoarthritis, left foot hallux valgus, and left foot plantar fasciitis, secondary to left knee meniscectomy. Following a thorough review of the Veteran’s longitudinal medical records, the Board finds that he is not entitled to an award of service connection, as no nexus exists between the Veteran’s claimed disabilities and his service-connected disability.
As an initial matter, the Board finds that the Veteran has satisfied the first element of service connection, a current disability for each claimed disorder. A review of the Veteran’s medical records shows the Veteran has current diagnoses of left foot hallux valgus, left foot osteoarthritis, and left foot plantar fasciitis. A February 2013 X-ray indicated the Veteran had left foot hallux valgus, left foot osteoarthritis, and left foot plantar fasciitis. See February 2013 Medical Imaging Report. Therefore, the Board finds that the Veteran has satisfied the first prong of service connection, the existence of a current disability. 38 U.S.C. §§ 1110, 1131; Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000).

As to evidence of a service-connected injury or disease, the Board notes that the Veteran was granted service connection for left knee meniscectomy in a July 1993 rating decision. Therefore, the Board finds that the Veteran has satisfied the second prong of service connection, the existence of a service-connected disability. 38 U.S.C. §§ 1110, 1131; Boyer, 210 F.3d at 1353.
Turning next to evidence of a causal relationship between the service-connected left knee meniscectomy and left foot osteoarthritis, left foot hallux valgus, and left foot plantar fasciitis, the Board finds the weight of the medical evidence does not support a credible nexus. In reaching this determination, the Board finds the medical opinion of the September 2013 VA examiner to be probative and entitled to significant weight.
In September 2013, a VA examiner completed a detailed review of the Veteran’s medical files, including past VA examinations, service medical records, post-service medical records, and a review of the Veteran’s lay reports of symptom onset and chronicity. Following this review, the examiner concluded that the Veteran’s current left condition, to include osteoarthritis, hallux valgus, and plantar fasciitis, are less likely than not caused by the service-connected left knee meniscectomy. See September 2013 VA Examination. Based upon the timeline of diagnoses, the examiner opined the left foot condition, to include osteoarthritis, hallux valgus, and plantar fasciitis, was not caused by the service-connected left knee meniscectomy.
The September 2013 VA examiner further noted that the Veteran’s left condition, to include osteoarthritis, hallux valgus, and plantar fasciitis, were not aggravated beyond its natural progression by his service-connected left knee meniscectomy. See September 2013 VA Examination. The VA examiner concluded that because the Veteran had been diagnosed with his left knee condition within recent months, not enough time had even passed to assess if the condition would progress or improve. See September 2013 VA Examination.
Overall, the Board finds the September 2013 VA medical opinion is adequate, as it is supported by a rational explanation, with detailed references to the Veteran’s longitudinal medical records, and was based upon a review of both the medical and lay evidence of record. Importantly, the Veteran has not submitted any contrary medical nexus opinion of record with regard to his left foot condition, to include osteoarthritis, hallux valgus, and plantar fasciitis. Therefore, based upon the evidence as outlined above, the Board finds the Veteran is not entitled to an award of service connection for a left foot condition, to include osteoarthritis, hallux valgus, and plantar fasciitis, as secondary to his service-connected left knee meniscectomy.
The Veteran also contends that his left foot conditions were caused by his left foot cellulitis that occurred while in-service in May/June 1988. See C&P Examination dated January 2015. The VA examiner concluded that the left foot conditions were less likely than not incurred in or caused by the claimed in-service injury. See C&P Examination dated January 2015. The VA examiner stated that the Veteran had a history of left foot/great toe cellulitis in May 1988 and January 1992 while in service. See C&P Examination dated January 2015. These were temporary conditions and were resolved. Additionally, the Veteran’s separation examination in April 1993 did not mention any residuals of these infections or any foot pain. See C&P Examination dated January 2015. Moreover, the Veteran’s service treatment records (STRs) did not show complaints, diagnosis or treatment of the left foot arthritis, plantar fasciitis or hallux valgus. See C&P Examination dated January 2015. The VA examiner stated that according to a February 2013 private podiatry report, the Veteran’s foot pain began in 2012. See C&P Examination dated January 2015. This evidence led the VA examiner to conclude that the Veteran’s current foot conditions were new conditions that developed many years after service and were not related to the left foot infection while in service. See C&P Examination dated January 2015. Therefore, the Veteran’s left foot conditions, to include osteoarthritis, hallux valgus, and plantar fasciitis, were not caused by his in-service left foot cellulitis.
Finally, as to the Veteran’s remaining lay assertions of a nexus, the Board has considered his lay allegations, but finds these statements do not establish proof of any causal nexus. While the Veteran is competent to report his symptoms and experiences, he is not competent to ascertain the etiology of a left foot condition, to include hallux valgus, left foot osteoarthritis, and left foot plantar fasciitis. The Board recognizes that there is no bright line rule that laypersons are not competent to offer etiology opinions. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009) (rejecting the view that competent medical evidence is necessarily required when the determinative issue is medical diagnosis or etiology). Whether a layperson is competent to provide an opinion as to the etiology of a condition depends on the facts of the particular case.
The Board finds that the question of whether the Veteran’s current left foot disabilities are a result of his service-connected left knee meniscectomy are too complex to be addressed by a layperson. This connection or etiology is not amenable to observation alone. Rather it is common knowledge that such relationships are the subject of extensive research by scientific and medical professionals. See 38 C.F.R. § 3.159(a)(1) (setting forth that competent medical evidence means evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions). Hence, the Veteran’s opinion of the etiology of his current disability is not competent evidence and is entitled to low probative weight.
Moreover, the Board finds the contemporaneous medical evidence of record to be more probative as to the onset of the Veteran’s left foot conditions. See Curry v. Brown, 7 Vet. App. 59, 68 (1994) (contemporaneous evidence has greater probative value than history as reported by the veteran). As noted above, a thorough review of the Veteran’s medical records does not show any treatment for, or diagnosis of, left foot osteoarthritis, left foot hallux valgus, or left foot plantar fasciitis until several years following the Veteran’s separation from active duty service.
Therefore, the Board has reviewed all medical and lay evidence, but finds there is no probative evidence of record which establishes that no nexus exists between the Veteran’s current disabilities and his service-connected disability. Although the Veteran is entitled to the benefit of the doubt where the evidence is in approximate balance, the benefit of the doubt doctrine is inapplicable where, as here, the 
 
preponderance of the evidence is against the claim for service connection. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.
 
DAVID L. WIGHT
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	Kathryn Bristor