Citation Nr: 21067933 Decision Date: 11/08/21 Archive Date: 11/08/21 DOCKET NO. 16-03 177 DATE: November 8, 2021 ORDER Entitlement to service connection for a bilateral foot disability is denied. FINDING OF FACT The preponderance of the evidence is against finding that a bilateral foot disability began during active service, or is otherwise related to an in-service injury or disease. CONCLUSION OF LAW The criteria for service connection for a bilateral foot disability are not met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from November 1975 to December 1982. This matter comes before the Board of Veterans' Appeals (Board) from a March 2014 rating decision. This claim was previously before the Board in April 2019, March 2020, and May 2021. In each instance, the Board remanded the claim for further development. Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 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). The first two elements are satisfied. Post-service treatment records indicate a diagnosis of hyperkeratosis and metatarsalgia. The record indicates the Veteran was treated for calluses, mild pes planus, plantar facia strain, blisters, and foot pain in-service. The Veteran reports running the two-mile run barefoot while in service, and the treatment records indicate she needed to wear tennis shoes during runs. The Veteran asserts that she was treated for frost bite in her toes while in service, in addition to being treated for a "flat foot condition." Despite meeting the first two elements, the third element is unsatisfied. During the Veteran's exit examination, she did not report any foot problems. In February 2014, after examining the Veteran, a VA examiner stated that there was no clinical evidence of pes plenus, and left and right foot x-rays looked normal, except for a tiny bone spur. During the examination, the Veteran had plantar calluses on her distal fifth metatarsal regions. The examiner stated objective findings did not explain the Veteran's subjective pain and added that the pain was more diffuse than where the calluses were located. The examiner opined that it was less likely than not that her bilateral foot condition was service connected. In support of the examiner's opinion, the examiner noted there was not a forceful traumatic event in service that would justify the Veteran having pain for the rest of her life. The Veteran was afforded another VA examination in December 2019 which provided a negative nexus opinion. At the examination, the Veteran stated that she had problems in her feet since she left the Army. Still, the Veteran reported that her feet improved after she got out of service because she was not wearing boots and was in an administrative job. The examiner asserted the Veteran's post-service foot treatment cannot be etiologically related to the treatments and complaints of foot pain while in-service. The examiner opined that the Veteran's foot condition was less likely than not related to service. In support of his opinion, the examiner stated the Veteran is uncertain whether the calluses she had were a continuation of the calluses she had while in service. The examiner added the Veteran did not have pes planus nor does she have retro-cal bursitis. The examiner stated that bone spurs were common and in the Veteran's age population. While the examiner did not discuss metatarsalgia, the examination is probative as it relates to other avenues of service connection for bilateral foot issues. The Board will not address the May 2020 VA examination as it gives the opinion no weight for reasons discussed in prior decisions. In May 2021, a VA examiner opined that the Veteran's bilateral foot disability was less likely than not related to service. In support of the examiner's contention, the examiner stated that the Veteran's current calluses are not a continuation of the calluses the Veteran had while in service, adding that a 2019 examination noted no blisters on the Veteran's feet. Moreover, the 2015 diagnosis of bilateral calluses indicated a condition separate from the unilateral callus noted in service. The examiner added, any further development of blisters outside of service would be a separate condition from the blisters while in service and that the diagnosis of pes planus was not a confirmed condition. In addition, according to the exit examination, the Veteran's retro-cal bursitis had resolved. Previously the Board remanded the decision for a VA examination on hyperkeratosis. Even though the May 2020 VA examination which specifically discussed "hyperkeratosis" was found insufficient, the Board has since understood that callus and hyperkeratosis are the same medical phenomemon. Therefore, that request was redundant with prior examinations. Another opinion on hyperkeratosis will not serve a purpose other than to delay a decision on the case. Therefore, the Board does not find fault in the 2021 VA examination. The Veteran submitted statements that she has experienced foot pain since service. In December 2015, the Veteran stated that she has not engaged in work outside of service that would have otherwise caused her disability. An additional statement from the Veteran's sister states that the Veteran has complained of pain since her separation from service. The Board does not dispute the Veteran has foot problems. However, there is nothing linking those problems to service. In rendering the decisions below, the Board acknowledges that the Veteran and her sister attribute her foot disability to service. However, neither has the requisite medical knowledge, training, or experience to be able to render a competent medical opinion regarding the cause of such medically complex disabilities. While some VA examinations do not discuss the sister's statements, those examinations are still probative as the sister's statements mirror those of the Veteran. The Veteran's representative cites a host of different webpages in his Written Brief Presentation. However, the representative fails to connect the literature he cited to the Veteran's condition and specific circumstances. No specific argument was put forward concerning service connection as they relate to the literature cited. Therefore, the Board is unable to respond to the Written Brief Presentation as it relates to any connection between the literature and the Veteran's condition. Considering the pertinent evidence in light of the governing legal authority, the Board finds that the preponderance of the evidence is against the claim. In reaching this decision the Board considered the doctrine of reasonable doubt, however, the doctrine is not for application and the claim must be denied. JOHN Z. JONES Veterans Law Judge Board of Veterans' Appeals Attorney for the Board P. Chalker, 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.