Citation Nr: 18158022 Decision Date: 12/14/18 Archive Date: 12/13/18 DOCKET NO. 16-34 460 DATE: December 14, 2018 ORDER Service connection for bilateral pes planus is granted. REMANDED The claim for service connection for residuals of a left knee contusion, to include strain and arthritis, is remanded. The claim for service connection for residuals of a right knee injury, to include strain and arthritis, is remanded. The claim for service connection for gastrointestinal disorder is remanded. FINDING OF FACT The presumption of soundness applies and is not rebutted; pes planus is attributable to service. CONCLUSION OF LAW The criteria for service-connected for bilateral pes planus have been met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.304. REASONS AND BASES FOR FINDING AND CONCLUSION Establishing service connection generally requires competent evidence of three things: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. 38 U.S.C. § 1110, 1131; 38 C.F.R. § 3.303. VA regulations provide that every Veteran shall be taken to have been in sound condition when examined, accepted, and enrolled for service, except as to defects, infirmities, or disorders noted at the time of examination, acceptance, and enrollment. 38 C.F.R. § 3.304 (b). If a disability is not noted upon entrance, clear and unmistakable evidence is needed to rebut the presumption, both on the finding that the disability existed prior to service and that is was not aggravated by service. See Wagner v. Principi, 370 F.3d 1089 (Fed. Cir. 2004). Here, service records document treatment for pes planus, but the disability is not noted upon entrance into service. The claim was denied based on a VA opinion, with a May 2015 addendum, that the disability clearly and unmistakably existed prior to service and clearly and unmistakably was not aggravated by service. The basis for this opinion, however, is simply the examiner’s opinion that pes planus could not develop in eight days (the time between entrance and first treatment). The agent-representative has submitted evidence to refute this finding. Further, the Veteran has provided credible lay statements that he was never treated or diagnosed for pes planus prior to service. The Board finds that the rationale of this opinion, combined with the additional evidence of record, fails to rise to the level of clear and unmistakable evidence, despite the examiner’s own conclusion. Therefore, the presumption of soundness is not rebutted. Further, in the addendum opinion, the examiner opined that there was clear and unmistakable evidence that the disability was not aggravated by service; the rationale in contrast, however, concludes that there was aggravated by the activities of service. The record clearly shows treatment for this disability in service, and the opinion evidence is sufficient to indicate a link between the current disability and that treated in service. On this basis, service connection is warranted on a direct basis. REASONS FOR REMAND The Veteran claims that service connection is warranted for bilateral knee disabilities. Since a May 2015 VA examination, which found that the Veteran’s knee disabilities are not directly related to military, the Veteran’s attorney has raised the issue of secondary service connection for his right knee disabilities. As the Board granted service connection for bilateral pes planus, additional examination and opinion are needed regarding secondary service connection. Further, in this regard the Board notes that in reporting the Veteran’s medical history, the VA examiner in May 2015, only noted that the Veteran received treatment in February 1976 for left knee contusion. She did not refer to the fact that the Veteran was also treated for a right knee injury in April 1975. His complete clinical history should be taken into consideration in providing the additional opinion. The Veteran received treatment for viral enteritis as well as diarrhea on several occasions during military service (March 1975, June 1975, September 1975, November 1975, and February 1976). He has been diagnosed with gastroesophageal reflux disease (GERD) during the appeal period. The Board finds that VA examination and opinion are needed. The matters are REMANDED for the following action: 1. Obtain updated VA treatment records. 2. Thereafter, schedule the Veteran for appropriate VA examinations to determine the etiology of the claimed disabilities. The entire e-file, to include a complete copy of this remand, should be made available to, and reviewed by, the examiners. All appropriate tests and studies should be performed and all clinical findings should be reported in detail. Left Knee Disability The examiner should provide an opinion as to whether it is at least as likely as not (i.e., 50% or greater probability) that any currently diagnosed left knee disability manifested in or is otherwise related to the Veteran’s period of service. The examiner should also opine on whether any diagnosed left knee disability was caused or aggravated by his service connected bilateral pes planus and/or any alteration in gait/posture associated with his bilateral foot disorder. Right Knee Disability The examiner should provide an opinion as to whether it is at least as likely as not (i.e., 50% or greater probability) that any currently diagnosed right knee disability manifested in or is otherwise related to the Veteran’s period of service. The examiner should also comment on whether any right knee disability was caused or aggravated by his service connected bilateral pes planus and/or any alteration in gait/posture associated with his bilateral foot disorder. Gastrointestinal Disorder The examiner should provide an opinion as to whether it is at least as likely as not (a 50 percent or greater probability) that any currently diagnosed gastrointestinal disorder manifested in or is otherwise related to the Veteran’s period of service. The examiner should comment on his treatment for gastrointestinal problems in March 1975, June 1975, September 1975, November 1975, and February 1976 and any reports of continuing gastrointestinal problems.   A complete rationale must accompany all opinions rendered. Nathaniel J. Doan Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A.D. Jackson, Counsel