Citation Nr: 20003840 Decision Date: 01/15/20 Archive Date: 01/15/20 DOCKET NO. 19-20 218 DATE: January 15, 2020 ORDER Service connection for left flat foot, to include as secondary to service-connected stress fractures, bilateral feet and hallux valgus is granted. FINDING OF FACT The evidence of record demonstrates that the Veteran’s left foot, to include left flat foot condition was caused by his service-connected stress fractures, bilateral feet and hallux valgus disabilities. CONCLUSION OF LAW The criteria for Service connection for left flat foot, to include as secondary to stress fractures, bilateral feet and hallux valgus have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from September 2005 to November 2005. Service connection for left flat foot, to include as secondary to stress fractures, bilateral feet and hallux valgus. The Veteran is seeking service connection for left flat foot disability, which he contends is attributable to his service-connected stress fracture, bilateral feet and hallux valgus. See April 2019 Notice of Disagreement. He also reports left foot problems since service. Service connection may also be granted on a secondary basis for a condition that is not directly caused by the Veteran’s service. 38 C.F.R. § 3.310. In order to prevail under a theory of secondary service connection, the evidence must demonstrate an etiological relationship between (1) a service-connected disability or disabilities and (2) the condition said to be proximately due to the service-connected disability or disabilities. Buckley v. West, 12 Vet. App. 76, 84 (1998); see also Wallin v. West, 11 Vet. App. 509, 512 (1998). In addition, secondary service connection may also be found in certain instances when a service-connected disability aggravates another condition. See Allen v. Brown, 7 Vet. App. 439 (1995); 38 C.F.R. § 3.310 (b). Thus, service connection may be established either by showing (1) direct service incurrence or aggravation, (2) an etiological relationship between the claimed condition and a service-connected disability, or (3) using applicable presumptions, if available. See Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded to the claimant. The determination as to whether the requirements for service connection are met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. 38 U.S.C. § 7104 (a); Baldwin v. West, 13 Vet. App. 1 (1999); see 38 C.F.R. § 3.303 (a). A layperson is competent to report on the onset and continuity of his current symptomatology. See Layno v. Brown, 6 Vet. App. 465, 470 (1994) (a Veteran is competent to report on that of which he or she has personal knowledge). Lay evidence can also be competent and sufficient evidence of a diagnosis or to establish etiology if (1) the layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). When considering whether lay evidence is competent, the Board must determine, on a case by case basis, whether the Veteran’s particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau, supra. As noted above, service connection may be granted on a secondary basis for a condition that is not directly caused by the Veteran’s service, if it is proximately due to or the result of a service-connected disability. 38 C.F.R. § 3.310. For these claims, establishing service connection on a secondary basis requires evidence sufficient to show that a current disability exists and that the current disability was either proximately caused by or proximately aggravated by a service-connected disability. See Allen v. Brown, 7 Vet. App. 439, 448 (1995); 38 C.F.R. § 3.310 (b). The Veteran has a diagnosis of pes planus (flatfoot), left foot. See May 2019 Foot Conditions DBQ. The Veteran stated, that when he was discharged from the military, it was because of both of his feet not just the one foot. He added, that his left foot was the one that was damaged the most and the left heel, ankle and achilles tendon which has caused more problems later with my knees and lower back and hips and more occurring problems to this day. See July 2019 VA Form 9, Appeal to Board of Veterans’ Appeal. The May 2018 examiner opined, that the Veteran’s flatfoot, left is less likely than not proximately due to or the result of the Veteran’s service- connected condition. The examiner reasoned that the Veteran had flat foot since he was young, even before military service, and reported no change in his flat foot condition even after stress fractures and/or service-connected left foot hallux valgus with painful bunion status post resection of metatarsal head. While the entrance exam states there is no history of pain in the feet, this does not rule out flat feet, and the flat foot issue was not and still is not causing the pain. Flat foot is a mid-foot problem, but service-connected left foot hallux valgus with painful bunion status post resection of metatarsal head is forefoot condition. The examiner concluded, flat foot is not caused by or the result of the veteran’s stress fractures and/or service-connected left foot hallux valgus with painful bunion status post resection of metatarsal head. The May 2019 examiner noted the Veteran’s diagnosis changed from his previously service-connected diagnosis. The examiner stated, the new diagnosis is a progression of the previous diagnosis. She reasoned, the Veteran’s bilateral x-rays of the feet showed stressed fractures. She noted that the Veteran was discharged from the military to return home, and follow up with VA. She added, the Veteran continues to experience bilateral feet pain after stress fracture and eventually was diagnosed with hallux valgus; acquired flat foot; as well as bunions. She noted the Veteran was prescribed pain medications and eventually underwent surgery on March 2009 for left big toe bunionectomy and left calcaneal osteotomy with gastrocnemius resection, bunionectomy December 2017 and on September 2017 had a right foot big bunionectomy. The Veteran reported that he continues to suffer from bilateral residual foot pain and decreased range of motion. The examiner noted that the Veteran has right ankle strain, heel and big toe pain toward small toe; pain on top of toes with pressure/strain; every time he moves his right foot it causes pain and swelling; a lot of popping on right foot. (Continued on the next page)   Here, the Veteran’s left foot disability was not noted at service entry. Thus, based on the lay and medical evidence of record, and with resolution of all reasonable doubt in the Veteran’s favor, the Board finds that the establishment of service connection for left flat foot condition as secondary to the service-connected stress fractures, bilateral feet and hallux valgus is warranted. STEVEN D. REISS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Jacquelynn M. Jordan, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.