Citation Nr: 18160207 Decision Date: 12/26/18 Archive Date: 12/26/18 DOCKET NO. 15-39 368 DATE: December 26, 2018 ORDER A flatfoot disorder is denied. REMANDED Service connection for a bilateral knee disorder. FINDINGS OF FACT 1. The Veteran had active service during the following periods from June to December 2003, June 2004 to May 2005, and May 2009 to February 2010, in addition to periods of service in the Reserve. 2. A flatfoot disorder preexisted service but was not aggravated in service. CONCLUSION OF LAW A bilateral flat foot disorder was not aggravated in service. 38 U.S.C. §§ 1153 (2012); 38 C.F.R. §§ 3.303, 3.306, 3.307, 3.310 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSION Service connection may be granted on a direct basis as a result of disease or injury incurred in service based on nexus using a three-element test: (1) the existence of a present 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 in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). On the other hand, a preexisting injury or disease will be considered to have been aggravated by service where there is an increase in disability during such service, unless there is a specific finding that the increase in disability is due to the natural progress of the disease. 38 U.S.C. § 1153; 38 C.F.R. § 3.306. Aggravation may not be conceded where the disability underwent no increase in severity during service on the basis of all the evidence of record pertaining to the manifestations of the disability prior to, during, and subsequent to service. 38 U.S.C. § 1153; 38 C.F.R. § 3.306 (b). “[I]f a preexisting disorder is noted upon entry into service, the veteran cannot bring a claim for service connection for that disorder, but the veteran may bring a claim for service-connected aggravation of that disorder.” See Wagner v. Principi, 370 F.3d 1096 (Fed. Cir. 2004); see also 38 U.S.C. § 1153; 38 C.F.R. § 3.306. In such claims, the claimant has the burden of showing that there was an increase in disability during service to establish the presumption of aggravation. Jensen v. Brown, 19 F.3d 1413, 1417 (Fed. Cir. 1994). Clear and unmistakable evidence (obvious or manifest) is required to rebut the presumption of aggravation where the pre-service disability underwent an increase in severity during service. To meet the clear and unmistakable standard to rebut the presumption of aggravation, the evidence must go well beyond the speculation of medical professionals. See 38 C.F.R. § 3.306 (b); see also Wagner v. Principi, 370 F.3d 1089 (Fed. Cir. 2004). The Veteran’s October 2002 enlistment examination reflected a diagnosis of mild, asymptomatic pes planus. Thus, he is not presumed to have been in sound condition upon entrance into service when he entered in June 2003. Consequently, to the extent that he seeks compensation for a bilateral flatfoot disorder, the burden is on him to demonstrate an increase in disability during service, which would trigger the presumption of aggravation. The evidence of record does not show that the Veteran’s bilateral flatfoot disorder underwent an increase in severity while in service. Specifically, the service treatment records (STRs) reflect treatment for ankle sprain, flu-like symptoms, groin strain, ear pain, and left knee pain, but never complained of flat feet. He also underwent several health assessments and no complaints related to flat feet were noted. In addition, in the March 2010 separation examination, his foot arches were clinically normal. This evidence weighs against a finding that flat feet were aggravated during service. It is not a question of whether his flat feet are worse now, the question is whether the preexisting disorder was aggravated by service. The evidence outlined above shows complaints related to other medical problems during service but not with flat feet. The Board has considered the Veteran’s lay statements regarding the manifestation of his flat feet in service. While he is competent to report symptoms because this requires only personal knowledge, as it comes to him through his senses., Layno v. Brown, 6 Vet. App. 465, 469 (1994), he is not competent to offer an opinion as to the etiology or aggravation of a preexisting disorder due to the medical complexity of the matter involved. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007). In light of the above discussion, the preponderance of the evidence is against the claim for service connection and there is no doubt to be otherwise resolved. As service connection is not warranted, the appeal is denied. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board’s consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). REASONS FOR REMAND With respect to the remaining claims on appeal, the Veteran asserts that a bilateral knee disorder was incurred in service. The 2015 rating decision denied service condition because there was no evidence that this condition occurred in or was caused by service. The record reflects that he was diagnosed with knee arthralgia in a June 2011 VAMC record and chondromalacia patella in a December 2015 VAMC record. The STRs show multiple in-service injuries relating to the left knee. In May 2004, he was seen for left knee pain while in the Reserve. He was also seen in August 2008 after he injured his left foot while running. The STRs also show multiple in-service injuries relating to the right knee including in March 2004, he incurred a right ankle sprain while inactive, in July 2004, he injured his right ankle while running during active duty, and in a May 2014 VAMC record, he contended that he injured his right ankle in September 2009 after stepping on a rock in Iraq. In a May 2011 VAMC record, the Veteran contended that he incurred knee injuries as a result of trying not to put weight on his injured right ankle raising a secondary claim. However, a medical opinion has not been obtained. As such, the claim for service connection for a bilateral knee disorder is remanded for further development. Accordingly, the case is REMANDED for the following actions: 1. Identify and obtain any outstanding VA treatment records and associate them with the claims file. 2. Appropriate efforts should be made to obtain and associate with the claims file any further private medical records identified and authorized for release by the Veteran, specifically records regarding the treatment of his bilateral knee disorder. 3. Schedule the Veteran for an examination to determine the etiology of his bilateral knee disorder. The claims file, to include a copy of this remand, should be reviewed. Then, the examiner is asked to provide the following opinion: • is the Veteran’s bilateral knee disorder at least as likely as not (50 percent or greater probability) related to his active duty service? The examiner must take as true and specifically consider the Veteran’s statements regarding his in-service injuries. A complete rational for the opinion must be provided. 4. Readjudicate the issues on appeal. If the decision is adverse to the Veteran, issue a supplemental statement of the case and wait the appropriate time for response. Then, return the case to the Board. The Veteran has the right to submit additional evidence and argument on the matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans’ Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate   action must be handled in an expeditious manner. See 38 U.S.C. §§ 5109B, 7112 (2012). L. HOWELL Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD D. Ragofsky, Legal Clerk