Citation Nr: 21073115 Decision Date: 12/07/21 Archive Date: 12/07/21 DOCKET NO. 16-57 228 DATE: December 7, 2021 ORDER Entitlement to service connection for bilateral hammertoes is denied. FINDING OF FACT The preponderance of the evidence is against finding that the Veteran's hammertoes began during active service or is otherwise related to an in-service injury or disease. CONCLUSION OF LAW The criteria for service connection for bilateral hammertoes have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from December 1972 to July 1975. On appeal is a July 2017 rating decision that denied service connection for bilateral hammertoes. The Veteran testified before the undersigned Veterans Law Judge in February 2021. A transcript of this hearing is of record. When the matter was initially before the Board of Veterans' Appeals (Board) in June 2021, the Board remanded for additional development. The requested development has been completed and the matter returned to the Board. Duty to Notify and Assist The Veteran has not raised any issues with the duty to notify. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that "the Board's obligation to read filings in a liberal manner does not require the Board . . . to search the record and address procedural arguments when the veteran fails to raise them before the Board"). The Board also finds that the duty to assist requirements have been fulfilled. All relevant, identified, and available evidence has been obtained, and VA has notified the appellant of any evidence that could not be obtained. Also of record are VA examinations conducted in January 2017, September 2019 and August 2021. The Veteran has not referred to any additional, unobtained, relevant, available evidence. Thus, the Board finds that VA has satisfied the duty to assist. No further notice or assistance to the Veteran is required to fulfill VA's duty to assist in development. Smith v. Gober, 14 Vet. App. 227 (2000); Dela Cruz v. Principi, 15 Vet. App. 143 (2001); Quartuccio v. Principi, 16 Vet. App. 183 (2002). Service Connection To prevail on a direct service connection claim, there must be competent evidence of (1) a current disability, (2) in-service incurrence or aggravation of a disease or injury, and (3) a nexus between the in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). 1. Entitlement to service connection for bilateral hammertoes. The Veteran contends that he has bilateral hammertoes as a result of his active-duty service. As will be discussed below, he has a current diagnosis of hammertoes. However, the Board has closely reviewed the medical and lay evidence in the Veteran's claims file and finds no evidence that may serve as a medical nexus between the Veteran's service and his diagnosed bilateral hammertoes. Service treatment records are associated with the Veteran's claims file. The December 1972 entrance Report of Medical Examination reflects the Veteran had a normal feet examination and he was determined to be fit for duty. The companion December 1972 entrance Report of Medical History reflects the Veteran specifically denied "foot trouble." There are no records of any treatment for foot problems during service. A May 1979 Report of Medical Examination reflects the Veteran had a normal feet examination with no defects or diagnoses noted related to his feet. In the companion May 1979 Report of Medical History, the Veteran specifically denied "foot trouble." Post service treatment records from the East Orange VAMC are associated with the Veteran's claim file. An August 2012 outpatient podiatry note reflects the Veteran was seen in follow up to an ER visit where his toe was painful and draining pus. After reviewing the Veteran's history, a physical, and clinical findings, the examiner diagnosed the Veteran with bilateral hammertoes. In January 2017, the Veteran underwent a VA examination for his feet. The examiner noted a diagnosis of flat feet only (not hammertoes) and as such, no etiological opinion was rendered for the Veteran's bilateral hammertoes. (The Board notes that the Veteran was granted service connection for flat feet in a February 2017 rating decision issued by the VA.) In September 2019, the Veteran underwent another VA examination for his feet. Again, the examiner noted a diagnosis of flat feet only (not hammertoes) and as such, no etiological opinion was rendered for the Veteran's bilateral hammertoes. At the February 2021 Board hearing in this matter, the Veteran testified about his bilateral hammertoes. He stated that during active duty, he was wearing tight boots and he had a wide foot, so it caused his toes to be crunched up. He stated further that at that time, he was wearing a size 12, but he wears a size 13 now. He stated he believes his current condition is related to his situation in service. In August 2021, the Veteran underwent a VA examination specifically to address the etiology of his bilateral hammertoes, as instructed by the Board's June 2021 remand. The examiner opined that the claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event or illness. As rationale, the examiner stated that he reviewed the entrance and separation medical examinations, as well as the medical evidence of record, and noted the Veteran did not have a diagnosis of the condition prior to joining the military and there was no record of this condition while the Veteran was in-service. The examiner stated further that hammertoe is a condition that is caused secondary to muscle/tendon imbalances that may be due to deficiency over long period of time or from a neurologic cause. The examiner opined that the likelihood that wearing tight boots while in service over a three-year period would have led to the current documented foot condition is very low and less likely than not. The Veteran has an established condition of diabetes and HIV, both of which disorders are known to cause peripheral neuropathy. The examiner opined that the Veteran's non-service-connected peripheral neuropathy is the more likely cause of the hammertoe and foot disability condition. Therefore, after review of medical record, the examiner concluded that the Veteran's bilateral hammertoe disability was less likely than not incurred in or caused by service. Upon consideration of the relevant medical and lay evidence in this case, the Board concedes that the Veteran has a current diagnosis of bilateral hammertoes, but none of his treatment providers or VA examiners have provided an opinion that this disability began in or is otherwise related to service. To the contrary, the August 2021 VA examiner found that the Veteran's hammertoes did not have a nexus to his active-duty service and was more likely related to his non-service-connected peripheral neuropathy. Thus, there is simply no competent and probative evidence of record to suggest that the Veteran's bilateral hammertoes is in any way related to his time on active duty. In this case, when weighing the evidence of record, the Board finds compelling the lack of competent and probative evidence linking the Veteran's bilateral hammertoes to his military service. In this case, the only evidence in favor of the Veteran's claim is his own statements concerning his belief that his bilateral hammertoe disability began in or is otherwise due to service. With regard to the Veteran's contentions, although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), as to the specific issue in this case, it falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Although the Veteran is competent to report symptoms of foot pain, the claimed disability is not the type of condition that is amenable to lay determination regarding its etiology, as specific findings are needed to properly determine etiology. Id.; see Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). As such, the Board finds that, other than the Veteran's unsupported contentions, there is simply no evidence in the record of any etiological relationship between the Veteran's diagnosed bilateral hammertoes and his time in service. Further, the Veteran has not presented or identified any contrary medical opinion that supports the claim for service connection for bilateral hammertoes. Thus, the criteria for service connection for bilateral hammertoes have not been met. The evidence weighs against the Veteran's claim. Service connection for bilateral hammertoes must be denied. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). Caroline B. Fleming Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Jiggetts, Tenisha 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.