Citation Nr: 21065085 Decision Date: 10/25/21 Archive Date: 10/25/21 DOCKET NO. 17-44 499 DATE: October 25, 2021 ORDER Entitlement to service connection for a left knee condition is denied. Entitlement to service connection for a right knee condition is denied. Entitlement to service connection for a left foot condition is denied. Entitlement to service connection for a right foot condition is denied. REMANDED Entitlement to service connection for migraines, to include as secondary to service-connected allergic rhinitis is remanded. FINDINGS OF FACT 1. The Veteran's left knee condition was not shown in service and has not been found to be etiologically related to service. 2. The Veteran's right knee condition was not shown in service and has not been found to be etiologically related to service. 3. The Veteran's left foot condition was not shown in service and has not been found to be etiologically related to service. 4. The Veteran's right foot condition was not shown in service and has not been found to be etiologically related to service. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a left knee condition have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for entitlement to service connection for a right knee condition have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for entitlement to service connection for a left foot condition have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 4. The criteria for entitlement to service connection for a right foot condition have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active military service from February 1976 to February 1979. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a November 2014 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). In April 2019, these issues were before the Board. The claims for service connection for a right knee disability, right foot disability, left foot disability, and headaches were reopened. Those claims, along with the claim for service connection for a left knee disability were remanded for further development. In an April 2019 rating decision, the Veteran was granted service connection for allergic rhinitis. In a May 2019 statement, the Veteran stated that his allergic rhinitis is also the cause of his headaches. A review of the record reflects substantial compliance with the Board's remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The matter has been returned to the Board for further appellate proceedings. SERVICE CONNECTION Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). 1. Entitlement to service connection for a left knee condition 2. Entitlement to service connection for a right knee condition 3. Entitlement to service connection for a left foot condition 4. Entitlement to service connection for a right foot condition The Veteran asserts that his current bilateral knee and foot conditions are related to his military service, specifically military duties, jumping, and running. The Veteran has current diagnoses of degenerative arthritis of the knees, bilateral pes planus, hammer toes, hallux valgus, plantar fasciitis, and calcaneal spur. The Veteran's service treatment records (STR) are silent for complaints of, treatment for, or diagnosis of any knee or foot conditions. Per the April 2019 Board remand, the VA scheduled the Veteran for knee and foot examinations in January 2020. During the examinations, the Veteran reported that his bilateral knee and foot conditions started in 1976; he did not seek any treatment during service; and he first sought post-service treatment for his knees in 2007. The examiner opined that it is less likely than not that the Veteran's current bilateral knee and foot conditions are etiologically related to his service. The examiner further stated that based on the available medical records, there was no diagnosed foot or knee disability until 30 plus years post service, there were no complaints of any problems during active service, and no foot or knee condition was found on the Veteran's separation from service. Additionally, the examiner stated that there was no evidence of a nexus or chronicity for any knee or foot condition. Further, in regard to the Veteran's bilateral knee disability, the examiner noted that the Veteran had early degenerative arthritis consistent with his age and weight. The examiner further noted the Veteran's increase in his weight and the effect it can have on the knees. The Board finds that the medical opinions are adequate as they were written by a competent medical professional who reviewed all pertinent medical records, solicited a history from the Veteran, examined the Veteran, and provided a fully informed, fully articulated, and well-reasoned opinion. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Importantly, there are no opposing opinions of record regarding a relationship between the Veteran's current bilateral knee and foot conditions and his active service. The Board acknowledges the Veteran's statements attributing his bilateral knee and foot conditions to his service, and although he is competent to describe symptoms of his bilateral knee and foot conditions, his lay observations are not competent to establish etiology. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Based on the above, the Board finds that service connection is unwarranted. Therefore, the claims for entitlement to service connection for left knee condition, right knee condition, left foot condition, and right foot condition are denied. REASONS FOR REMAND Entitlement to service connection for migraines, to include as secondary to service-connected allergic rhinitis The Veteran contends that his headaches are attributable to his military service and caused by his service-connected allergic rhinitis. The Veteran asserts that during basic training he was hospitalized for high fever and migraine headaches. The STRs reflect that he was treated for fever and headache associated with a viral upper respiratory infection in February 1976. There are no further treatments for, complaints of, or diagnosis of a headache condition during service or at separation. Per the April 2019 Board remand, the VA scheduled the Veteran for a headache examination in January 2020. A diagnosis of migraine, including migraine variants with an onset date of 2012 was noted. The Veteran reported that his headaches began in 1976 and that he has headaches every day. In a May 2019 statement, the Veteran stated that his allergic rhinitis is also the cause of his headaches. While the examiner offered a nexus opinion regarding direct service connection, no opinion was provided regarding secondary service connection. As such, the Board finds that a remand is necessary in order to obtain an opinion as to whether the Veteran's migraines are proximately due to or aggravated by his service-connected allergic rhinitis. The matters are REMANDED for the following action: Forward the Veteran's claims file to the appropriate clinician. The entire claims file, and a copy of this REMAND, must be reviewed by the examiner. The examiner is to conduct all necessary tests and studies. The examiner must provide an opinion regarding whether it is at least as likely as not (50 percent or greater probability) that the headaches are proximately due to OR aggravated (beyond the natural progression of the diseases) by the service-connected allergic rhinitis. Please review the January 2020 VA examination report and the October 2012 CT scan impression referenced therein. An explanation for all opinions expressed must be provided. If the examiner is unable to reach an opinion without resort to speculation, he or she should explain the reasons for this inability and comment on whether any further tests, evidence, or information would be useful in rendering an opinion. A. J. Spector Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Camille NeSmith, 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.