Citation Nr: 21000587 Decision Date: 01/05/21 Archive Date: 01/05/21 DOCKET NO. 17-33 616 DATE: January 5, 2021 ORDER Entitlement to service connection for bilateral foot disability, to include plantar fasciitis and pes planus, is denied. FINDING OF FACT The preponderance of the evidence is against a finding that the Veteran’s bilateral foot disability had its onset in or was aggravated by his active duty service. CONCLUSION OF LAW The criteria for service connection for a bilateral foot disability have not been met. 38 U.S.C. §§ 1110, 1116, 1131, 5103, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty with the U.S. Navy from January 1991 to May 1991, and from February 2015 to November 2015. He also had additional years of service in the Navy Reserves from May 1989 to December 1989. The February 2019 Board decision reopened a claim of entitlement to service connection for a bilateral foot disability and remanded the issue in order to obtain an addendum VA medical opinion. The opinion was completed in May 2020. The Board remanded the appeal once more in July 2020 in order to obtain an additional VA opinion addressing treatment records overlooked by prior examiners. The addendum opinion was completed in November 2020. 1. Entitlement to service connection for a bilateral foot disability. Establishing service connection generally requires (1) evidence of a presently existing disability; (2) evidence of in-service incurrence or aggravation of a disease or injury; and (3) evidence of a nexus between the claimed in-service disease or injury and the present disability. Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)); Hickson v. West, 12 Vet. App. 247, 253 (1999). Service connection may also be established on a secondary basis when a disability is shown to be proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. See Allen v. Brown, 7 Vet. App. 439 (1995). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). The Veteran contends that he had flat feet prior to entering service but his condition was aggravated by prolonged walking during his deployment. The Veteran has current diagnoses of bilateral pes planus and plantar fasciitis per VA examinations of record. The first element of service connection has been met. Service treatment records (STRs) show he was seen for flat feet after a basketball game in April 2015. He complained of pain to his feet for several days, which was the first time in five years that he had those symptoms. An October 2015 record noted an episode of bilateral foot pain to arches that had resolved. The second element of service connection has been met. Thus, this appeal turns on whether there exists a medical nexus between the Veteran’s current diagnoses and the disease/injury noted during service. Based on the preponderance of available evidence, the Board finds that it does not. A disability benefits questionnaire (DBQ) was completed by a private physician in April 2016 and indicated that the Veteran had longterm pes planus that was aggravated by his deployment to Afghanistan and caused chronic foot pain. The Veteran was afforded a VA examination in May 2016 and additional opinions were completed in March, May, and November 2020. The May 2016 examiner indicated the Veteran had a diagnoses of pes planus (prior to service) and plantar fasciitis (2015). The accompanying opinion found that his pes planus was less likely as not aggravated beyond its natural progression by treatment during service. The rationale indicated: “Medical literature indicates Pes Planus, flat arch, does not occur in isolation, but affects the dynamics of the foot. Common adaptations of the foot in response to pes planus include valgus of the heel, pronation, valgus of the forefoot, bunions, hammertoe, deformities, foot pain (diagnoses as plantar fasciitis) and other common complications.” Both the March and May 2020 examiners indicated that there was no evidence in the STRs that the Veteran had any chronic foot condition documented, to include plantar fasciitis and pre-existing pes planus. The November 2020 opinion indicated the Veteran was diagnosed with asymptomatic pes planus dating back in 1988. However, the record has been silent since and failed to confirm aggravation beyond its natural progression. In April 2015, the Veteran experienced sharp and aching pains in his arches but it was noted as resolved in October 2015. Therefore, it is less likely than not that Veteran’s bilateral pes planus was aggravated (permanently worsened beyond the natural progression) by any period of active duty service. Based on the foregoing, the Board finds that service connection for a bilateral foot disability is not warranted as there is no competent evidence showing a medical nexus. The Veteran’s pes planus was not found to be permanently aggravated by his service and his plantar fasciitis did not have its onset in service. The Veteran is competent to report that he experienced pain in his feet in service. However, he is not competent to self-diagnose a bilateral foot disability then or since service. The Board acknowledges the Veteran’s opinion that his claimed foot disability/symptoms are due to his in-service foot complaints. As a lay person, he does not have the education, training, or experience to opine as to the etiology of any current related disability. See Jandreau v. Nicholson, 492 F. 3d 1372, 1376 (2007) (lay persons not competent to diagnose conditions such as cancer). “Competent medical evidence” is evidence that is provided by a person qualified through education, training, or experience to offer medical diagnoses, statements, or opinions. 38 C.F.R. § § 3.159(a); see also Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). The November 2020 VA opinion found that the Veteran’s pes planus was not aggravated by his service, despite reports of foot pain in 2015. That pain had resolved without any further complaints of chronic pain. The examiner noted his reports, reviewed the file and provided a rationale for the reported opinion. The Veteran’s STRs show the Veteran denied any foot problems in December 2015, months after treatment for bilateral foot pain As such, the November 2020 opinion outweighs the Veteran’s contentions and is the most probative opinion of record. The April 2016 private opinion failed to review the file or provide a rationale for its findings. Therefore, it is afforded minimal probative weight. The VA opinions, when taken together, far outweigh the private opinion as they were based on review of the file, the Veteran’s medical history, and physical examination of the feet. Moreover, they included a detailed rationale for all opinions reached. The Board acknowledges that there are service treatment records that show complaints of and treatment for symptoms related to his feet. These records show pain in his arches during service and there is no competent evidence linking these in-service foot complaints to any current symptoms in the feet. Also, records in late 2015 show the Veteran’s complaints had resolved. There is no probative evidence linking any current foot symptomatology to an event, injury, or disease during service. H.M. WALKER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Price, 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.