Citation Nr: 21070348 Decision Date: 11/23/21 Archive Date: 11/23/21 DOCKET NO. 18-19 390 DATE: November 23, 2021 ORDER Entitlement to service connection for bilateral foot disorders, to include right foot metatarsalgia, bilateral hallux valgus, and bilateral feet arthritis, is denied. FINDING OF FACT Bilateral foot disorders, to include right foot metatarsalgia, bilateral hallux valgus, and bilateral feet arthritis, were not manifest during active service; degenerative arthritis was not manifest within one year of service; and the preponderance of the evidence fails to establish that a present foot disorder is etiologically related to service. CONCLUSION OF LAW The criteria for service connection for bilateral foot disorders, to include right foot metatarsalgia, bilateral hallux valgus, and bilateral feet arthritis, have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from November 1961 to November 1963. The matters arise from a June 2015 rating decision. In July 2019, the Veteran testified before the undersigned Veterans Law Judge at a Board of Veterans' Appeals (Board) Travel hearing. A transcript of the hearing has been associated with the claims file. The claims were remanded by the Board in July 2019, September 2020, and June 2021. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a). Service connection may be granted for any disease initially diagnosed after service when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). Service connection for a disability requires evidence of: (1) a current disability; (2) a disease or injury in service, and (3) a relationship or nexus between the current disability and any injury or disease during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). 1. Entitlement to service connection for bilateral foot disorders, to include right foot metatarsalgia, bilateral hallux valgus, and bilateral feet arthritis, is denied. Presumptive Service Connection Certain chronic diseases, such as arthritis, are subject to presumptive service connection if manifest to a compensable degree within one year from separation from service even though there is no evidence of such disease during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C. § 1112, 1113; 38 C.F.R. § 3.307 (a)(3), 3.309(a). The presumption may be applied from any continuous 90-day period of qualifying service. See 38 U.S.C. § 1112; 38 C.F.R. § 3.307 (a)(1); see also Lorenzano v. Brown, 4 Vet. App. 446, 449-450 (1993). Here, as to presumptive service connection for a chronic disease, the Board finds that the Veteran's bilateral arthritis of the feet did not manifest during service or within one year of separation from service. There is no evidence of diagnosed bilateral arthritis of the feet in service. Upon examination, it was noted that the Veteran's feet were normal. The Board has carefully reviewed the evidence of record and finds that the preponderance of the evidence is against the award of service connection for bilateral foot disorders, to include right foot metatarsalgia, bilateral hallux valgus, and bilateral feet arthritis, based on presumptive service connection. Direct Service Connection Turning to direct service connection, the Veteran has been diagnosed with right foot metatarsalgia, bilateral hallux valgus, and bilateral feet arthritis. See February 2020 VA Foot Conditions Disability Benefits Questionnaire (DBQ) (right foot metatarsalgia, bilateral hallux valgus, bilateral feet arthritis). Given such, the Veteran has satisfied the first element of service connection. Next, as to the second element of service connection, the Veteran's STRs note the Veteran complained of pain in his right foot during active service. See Service Treatment Record. Based on the aforementioned, the second element of service connection has been satisfied. Turning to element (3) of service connection, evidence of a nexus between the current disabilities and service or a service-connected disability, the Board finds that the preponderance of the evidence is against such a nexus. There is no competent evidence in the record that relates the Veteran's foot disabilities to his active duty service. The Veteran was first diagnosed with right foot metatarsalgia, bilateral hallux valgus, and bilateral feet arthritis in 2019, decades following the noted right foot in-service pain and decades following service discharge. A September 2021 VA examiner also opined that the Veteran's foot conditions are independent of his active military service. Moreover, a July 2021 VA examiner opined that the Veteran's hallux valgus was developed due to aging. In addition, there is no competent evidence in the record that relates the Veteran's foot disabilities to any service-connected disability. The September 2021 VA examiner opined that there is no evidence to suggest that injury from one joint would have any significant impact on another or opposite uninjured joint or limb, unless the injury resulted in a major muscle or nerve damage causing partial or complete paralysis, or shortening of the injured limb resulting in length discrepancy of more than 5 cm so that the individuals gait pattern has been altered to the extent that clinically there is an obvious Trendelenburg gait. This level of severity is not supported based on record review, history or exam. It is not unusual for two joints to share properties in the same person, but one joint's disease does not 'spread' to another or cause damage to it. An October 2021 VA examiner also confirmed that there is no relation between the Veteran's feet disabilities and his service-connected disabilities, as the different body systems do not relate to each other. The Board finds that these opinions establish that the Veteran's feet disabilities are not related to service or any service-connected disability. The opining examiners were aware of the Veteran's medical history, provided fully articulated opinions, and also furnished reasoned analyses. The Board therefore attaches significant probative value to these opinions. To the extent that the Veteran himself believes that there is a nexus between diabetes mellitus and service, as a lay person, he is not competent to opine on matters requiring medical expertise, such as the etiology of diabetes mellitus. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis). The record does not demonstrate that the Veteran has special training or acquired any medical expertise. See King v. Shinseki, 700 F.3d 1339, 1345 (2012). However, as the Veteran had foot pain in ser The Veteran's STRs note foot pain but is silent as to any degenerative arthritis of the feet. Furthermore, the record has a competent September 2021 VA opinion, in which the examiner persuasively opined that the Veteran's foot disability is unrelated to service. Alternatively, the Veteran can establish the third element of service connection, based on continuity of symptomatology. Under 38 C.F.R. § 3.303 (b), an alternative method of establishing the second and third Shedden element is through a demonstration of continuity of symptomatology if the disability claimed qualifies as a chronic disease listed in 38 C.F.R. § 3.309 (a). Regulations also provide that service connection may be granted for a disability diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability is due to disease or injury which was incurred in or aggravated by service. 38 C.F.R. § 3.303 (d). Upon review of the evidence of record, it does not demonstrate that the Veteran's symptoms have been continuous since separation from service. See 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a). Notably, there were no complaints, diagnosis, or treatment for bilateral degenerative arthritis of the feet for approximately decades following service discharge until the Veteran was diagnosed in 2019 with a foot disability. The absence of post-service complaints, findings, diagnosis, or treatment for decades after service is one factor that tends to weigh against the Veteran's statement of continuous symptoms. Moreover, at the Board hearing, the Veteran testified that his foot swells since service due to his shin splints and not due to an injury or event in service. Unfortunately, the Veteran is not service connected for shin splints and a claim for such was previously denied and is not before the Board. Nonetheless, the Board may weigh the absence of contemporaneous medical evidence, which here, there is none. In sum, the Board concludes that the preponderance of the evidence of record is against the Veteran's claim for service connection for a foot disability. The benefit-of-the-doubt doctrine enunciated in 38 U.S.C. § 5107(b) is not applicable, as there is no approximate balance of evidence. As such, the Board finds that service connection for bilateral foot disorders, to include right foot metatarsalgia, bilateral hallux valgus, and bilateral feet arthritis, is not warranted. When all the evidence is assembled, VA is then responsible for determining whether the evidence supports the claim or is in relative equipoise, with the claimant prevailing in either event, or whether a preponderance of the evidence is against the claim in which case the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001). The Board is grateful to the Veteran for his service, and regrets that it cannot render a favorable decision in this matter Accordingly, the claim is denied. YVETTE R. WHITE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. J. Cho, 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.