Citation Nr: 21064310 Decision Date: 10/19/21 Archive Date: 10/19/21 DOCKET NO. 15-21 953 DATE: October 19, 2021 ORDER Service connection for a left toe/foot disability of left great toe arthralgia and plantar calcaneal spur (previously claimed as Left great toe nerve damage) is granted. FINDINGS OF FACT 1. The Veteran has a current diagnosis of left great toe arthralgia and left plantar calcaneal spur. 2. The Veteran fell from a truck in 1994 and sustained an injury to the left foot during a period of ACDUTRA. 3. Symptoms of left toe/foot disability began during service and have been present since service. CONCLUSION OF LAW Resolving reasonable doubt in the Veteran's favor, the criteria for service connection for left great toe arthralgia and left plantar calcaneal spur have been met. 38 U.S.C. §§ 1110, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty in the United States Air Force from August 1973 to October 1979, and on ACDUTRA or INADUCTRA in the Air Reserves from October 1979 to January 1988 and in the Army National Guard from January 1988 to April 1996. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a June 2013 rating decision from the Regional Office (RO). This matter was previously before the Board in March 2019 and May 2019. As the Board grants service connection for a left toe/foot disorder, which is a full grant of the benefits sought on appeal, the Board need not address the duties to notify and assist at this time. Service Connection for a Left Toe/Foot Disability is Granted. The Veteran contends that during summer camp in 1994 in Fort Hood he fell from a truck and landed on hard rock surface, injuring his left foot. The Veteran contends he developed slight pain and swelling in the left foot immediately following the injury which subsided after a week, but that he has continued to have slight pain and discomfort in the left toes and foot on and off over the years. The Veteran reported that he self-treated these symptoms with medication for years until the symptoms became worse, requiring him to seek medical care. See January 2011, February 2011, May 2019 correspondence. Under the relevant laws and regulations, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Generally, service connection for a disability requires evidence of: (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. The Veteran has a current diagnosis of a left toe/foot disorder, including left great toe arthralgia and left plantar calcaneal spur as reflected in the September 2019 and July 2021 VA examination reports. The Board finds that the Veteran fell from a truck and sustained an injury to the left foot during service in 1994. While the complete service treatment (STRs) during this period of service in the Army National Guard from January1988 to April 1996 are unavailable, the Veteran and a fellow service member have provided competent lay evidence of an injury to the left foot due to a fall in 1994. The Veteran reported that while preparing to serve breakfast to the troops in 1994 he fell of the back of a truck, injuring the left foot. The fellow service member wrote that he served with the Veteran as a cook during summer camps between 1993 to 1995, that the Veteran fell off the mess truck while they were serving breakfast near the end of a two-week training camp, the Veteran had difficulty moving around for the last few days of training camp after the fall, and that the Veteran endorsed pain and discomfort in the left foot. See January 2011, May 2011 correspondence. These accounts of injury to the left foot following a fall in 1994 to consistent with the places, types, and circumstances of the Veteran's service. 38 U.S.C. § 1154(a) After a review of all the lay and medical evidence of record, the Board finds that the evidence is at least in equipoise on the question of whether there was an onset of symptoms of a left toe/foot disorder in service that continued after service separation, and were later diagnosed as left plantar calcaneal spur and left great toe arthralgia. A January 1993 National Guard enlistment examination shows that the Veteran denied any trouble with the feet. The Veteran has provided credible lay statements of an onset of left foot pain and swelling after a fall during service in 1994. Additionally, credible lay evidence of record indicates that the Veteran continued to have slight pain and discomfort in the left toes and foot on and off over the years since service, which he self-managed until his symptoms worsened after service. Post-service VA treatment records show that the Veteran reported problems with left foot pain as well as pain in the front and under the toes between 2009 and 2011. August 2009 Imaging of the left foot showed small corticated density posterior to the talus that may represent sequela of prior trauma, as well as plantar calcaneal spurring. VA examinations were provided in September 2019 and July 2021. In July 2021, the VA examiner diagnosed left great toe arthralgia and opined that the condition was less likely than not related to service. The examiner reasoned that the Veteran sought treatment for foot pain, in 2009, 2010, and 2011 but did not seek treatment for the left great toe; therefore, the examiner could not relate left great toe arthralgia to service in the absence of complaints and treatment. However, the VA examiner did not adequately consider the history of pain in the left toes and foot on and off over the years since the injury. Moreover, August 2009 treatment note specifically indicates that the Veteran reported his foot pain was located on the front and under the toes, which does not preclude the left great toe. Imaging of the left foot also showed a small density that "may represent sequalae of old trauma" and left calcaneal spurs, which the examiner did not address. (Continued on the next page) Furthermore, this same VA examiner opined that that the Veteran's right plantar calcaneal spurs is related to service, noting that, in addition the 1994 injury, the Veteran's military duties required him to stand for many hours at a time on a concrete floor as well as partake in rigorous training and that repetitive impact to the heel is the leading cause of calcaneal spur development. By necessary logical inference, as there is no reasoned basis for differentiation, the same injury and repetitive activities that cause the right calcaneal spurs likely caused the left calcaneal spurring. As such, the Board finds the July 2021 opinion to be of little probative value as it relates to the left toe/foot disorder, as it is based and inaccurate factual history and did not considered all the disabilities of the left foot. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (holding that the Board may reject a medical opinion based on an inaccurate factual basis, but cannot reject the opinion solely because the history was from the veteran). While left great toe arthralgia and plantar calcaneal spurs are not chronic diseases listed under 38 C.F.R. § 3.309(a), the Board has nonetheless found the evidence at least in equipoise on the question of whether the Veteran had left toe/foot disorder symptoms that began during service and continued since service separation, which symptoms were later diagnosed as left great toe arthralgia and plantar calcaneal spurs, thus tending to show direct service incurrence. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a), (d). The Board is granting the service connection claim based on evidence, including that pertinent to service, which establishes that symptoms of left toe/foot disorder (later diagnosed as left great toe arthralgia and plantar calcaneal spurs) began in service, so was "incurred in" service. The grant of direct service connection renders moot other theories of service connection. J. PARKER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Moore, Shanna 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.