Citation Nr: 21076796 Decision Date: 12/27/21 Archive Date: 12/27/21 DOCKET NO. 11-17 505 DATE: December 27, 2021 ORDER Entitlement to service connection for the Veteran's right foot degenerative joint disease (DJD), to include as secondary to his service-connected right foot tarsal tunnel syndrome or his residuals of right foot contusion, is denied. FINDING OF FACT The preponderance of the evidence establishes the Veteran's right foot DJD was not present until more than one year following his discharge from service and is not etiologically related to his active service, to include as secondary to his service-connected right foot tarsal tunnel syndrome and residual of right foot contusion disabilities. CONCLUSION OF LAW The criteria for establishing entitlement to service connection for the Veteran's right foot DJD, to include as secondary to his service-connected right foot tarsal tunnel syndrome or his residuals of right foot contusion, have not been met. 38 U.S.C. §§ 1110, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from October 1969 to March 1973 and from January 1983 to June 1997. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2010 rating decision from a Department of Veteran's Affairs (VA) Regional Office (RO). In August 2019, the Board remanded the claim for further development. In September 2020, the Board, in relevant part, denied the issue of entitlement to service connection for degenerative joint disease of the right foot. The Veteran subsequently appealed the denial decision to the United States Court of Appeals for Veterans Claims (Court). In a May 2021 Order, the Court granted a Joint Motion for Partial Remand (JMPR) and vacated that portion of the Board's September 2020 decision that denied entitlement to service connection for degenerative joint disease of the right foot. In September 2021, the Board remanded the claim for additional development. On remand, the RO was instructed to obtain an addendum opinion regarding the etiology of the Veteran's right foot DJD. An appropriate addendum medical opinion was obtained. As such, the Board finds that the AOJ substantially complied with the directives in the September 2021 remand. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Service ConnectionLegal Criteria Establishing service connection generally requires evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. See Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). 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 may be granted on a secondary basis for a disability which is aggravated by, proximately due to, or the result of a service-connected disease or injury under 38 C.F.R. § 3.310. Allen v. Brown, 7 Vet. App. 439 (1995). In order to establish service connection on a secondary basis, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical evidence establishing a link between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded the claimant. To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996). In this case, the Board has reviewed all of the evidence of record, with an emphasis on the evidence relevant to this appeal. Although the Board has an obligation to provide reasons and bases supporting its decision, there is no need to discuss, in detail, every piece of evidence of record. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (holding that VA must review the entire record, but does not have to discuss each piece of evidence). Hence, the Board will summarize the relevant evidence where appropriate and the Board's analysis below will focus specifically on what the evidence shows, or fails to show, as to the claim. Right Foot DJD The Veteran is seeking service connection for right foot DJD, which he claims is etiologically related to his active-duty service. In the alternative, the Veteran claims that this disability could be etiologically related to his service-connected right foot tarsal tunnel syndrome or his residuals of right foot contusion. The Board notes that the Veteran has a current diagnosis right foot DJD. See October 2021 VA Medical Opinion. Therefore, the central issue that must be resolved is whether the Veteran's current disability originated in service or is otherwise related to service, to include as on a secondary basis. See Newhouse v. Nicholson, 497 F.3d 1298 (Fed. Cir. 2007); Gonzalez v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). While the Veteran has a currently diagnosed right foot DJD disability, competent medical evidence of record does not support that this disability was incurred in service or otherwise related to service. The Veteran's service treatment records (STRs) contain no complaints, treatment, or diagnosis of right foot DJD. There are no treatment records for this condition while the Veteran was in service, and no medical examiner has given an opinion linking the Veteran's current disability to his active-duty service. However, the Board does note that the Veteran has multiple complaints of, and treatment for, right foot conditions while in active-duty service. For example, in December 1969, a clinician noted that the Veteran had sprained his right foot. In March 1983, the Veteran complained of a one-day history of a swollen foot and was assessed with mechanical foot pain. In January 1991, the Veteran complained of a 4-week history of right foot pain and was assessed with a foot sprain and pes planus. In February 1991, the Veteran was treated for a right foot sprain. In November 1995, the Veteran complained of chronic pain in his right foot and was assessed with right foot tendinitis. In the Veteran's February 1997 self-reported medical history, the Veteran complained of symptoms such as foot trouble and swollen or painful joints. The Veteran's February 1997 separation examination noted that the Veteran had right foot tendinitis. Following the Veteran's separation from service he underwent an August 1997 x-ray of his right foot. The x-ray report indicated that the Veteran's right foot was unremarkable with no fractures, subluxations, dislocations, soft tissue abnormalities, or degenerative changes seen. In an August 1997 VA examination, the Veteran complained of right foot pain since participating in basic training in 1983. The examiner noted no right foot pain upon examination and reviewed the above-mentioned x-ray of the Veteran's right foot which was normal without degenerative changes. In November 2008, the Veteran complained of a 6-week history of right foot pain, and a contemporary x-ray of the Veteran's right foot showed early degenerative joint disease. A Foot Conditions disability benefits questionnaire (DBQ) was received and associated with the record in March 2015. However, the current copy of this DBQ is incomplete, as the record only includes eight pages and is missing, at least, the page indicating the name of the physician who completed the DBQ along with that physician's dated signature. In September 2016, the Veteran was provided with a VA Foot Conditions examination. During this examination the Veteran reported that he has experienced right foot pain since 1983. The examiner noted that the Veteran's longstanding complaints of right foot pain were compatible with his diagnosed right sided tarsal tunnel syndrome. In December 2016 the Veteran was provided with a December 2016 VA Acceptable Clinical Evidence (ACE) review regarding his claimed disabilities. The examiner opined that after a review of the Veteran's claims file, and his relevant lay statements, that it was less likely than not (less than a 50 percent probability) that the Veteran's diagnosed disability was etiologically related to his period of service. The examiner noted that there was no evidence which supported that the Veteran's right foot DJD was etiologically related to his service. The Board, in a December 2017 decision, found the December 2016 ACE review inadequate, and remanded the claim to obtain an adequate medical opinion. In response to the Board's remand, the Veteran was provided a September 2018 VA ACE review. The examiner opined that the Veteran's right foot DJD was less likely than not (less than a 50 percent probability) etiologically related to his in-service injuries. The examiner explained that the in-service foot conditions are not known to cause or lead to the development of the current foot disabilities. Further, the examiner noted that the Veteran's DJD was more likely the result of wear and tear and aging. The examiner additionally opined that the Veteran's right foot disability was less likely than not (less than 50 percent probability or greater) proximately due to, the result of, or aggravated by his service-connected right foot contusion. The Board, in an August 2019 decision, again remanded the Veteran's claim in order to obtain an additional opinion regarding the Veteran's claimed right foot DJD and whether it was etiologically related to his service-connected right foot tarsal tunnel syndrome. In response to the Board remand, the Veteran was provided with an April 2020 VA ACE review. In this opinion the VA examiner opined that it was less likely than not (less than a 50 percent probability) that the Veteran's right foot disability was related to his service. The rationale provided that x-ray findings from 2008 and 2015 showed arthritic changes in the toes of the right foot, which was far distal to the Veteran's in-service complaints of pain in the dorsum of the foot. The examiner found the Veteran's arthritis of the right foot to be consistent with the normal aging process. The April 2020 examiner additionally opined that it was less likely than not (less than a 50 percent probability) that the Veteran's right foot disability was etiologically related to or aggravated by his service-connected tarsal tunnel syndrome. The rationale provided was that tarsal tunnel occurs as a result of a nerve impingement of one nerve along the ankle, which is located far proximal to the distal foot. The examiner continued that the tarsal tunnel is due to compression within the ankle causing a mononeuropathy, which does not cause distal joint changes physiologically, including arthritic changes in the distal toes. Therefore, the examiner opined, as there is not an anatomic or physiologic relationship between tarsal tunnel and osteoarthritis in the distal foot, and as the current radiographic findings of distal arthritis in the toes is consistent with his age outside of any factors of service, it was less likely than not (less than a 50 percent probability) that the Veteran's tarsal tunnel syndrome played any role in the development of the arthritic changes in his toes The Board denied the Veteran's claim in a September 2020 decision, which the Veteran appealed to the Court of Appeals for Veteran's Claims (Court). In May 2021, the Court granted a Joint Motion for Partial Remand and returned the case to the Board for action consistent with the motion. Specifically, the Court noted that the Board must discuss the Veteran's lay statements from his September 2016 examination where he noted he experienced right foot pain since 1983. The Board then remanded the Veteran's claim in September 2021 in order to obtain an addendum medical opinion which addressed the etiology of the Veteran's right foot DJD. In response to the Board remand, the Veteran was provided with an October 2021 Addendum Medical Opinion. After a review of the Veteran's claims file, to include his lay statements, the examiner opined that the Veteran's right foot DJD was more likely than not (a 50 percent probability or greater) etiologically related to normal aging and wear and tear. The rationale provided was that DJD of the right foot was first noted in November 2008, which was approximately 11 years after his military service. The examiner noted that the Veteran's 1997 right foot x-ray, which was done shortly after he left service, documented no degenerative changes or degenerative arthritis. The examiner continued that DJD occurs when the cartilage, which serves as a protective cover and cushion for the ends of the bones that form a joint, gradually wears down. This is due to mechanical wear-and-tear on the joints of the foot. The examiner noted that degenerative arthritis is very common as the feet are used so heavily on a daily basis. The examiner noted that the Veteran's lay statements of record regarding the onset and continuity of the right foot symptomatology were considered and did not change their findings. The examiner noted that the Veteran's right foot degenerative arthritis was clearly not noted during active-duty service and was found multiple years after military service to an early and mild degree. The examiner concluded that it is less likely than not (less than a 50 percent probability) that the Veteran's right foot DJD is etiologically related to his active-duty service. The Board weighs the above-mentioned VA examinations against the Veteran's lay contentions that his right foot DJD is due to service, to include as secondary to a service-connected disability. The Veteran is competent to report symptoms he directly observed because this requires only personal knowledge as it comes to him through his senses. Layno v. Brown, 6 Vet. App. 465, 469 (1994). However, the Veteran is not competent to offer an opinion as to the etiology of his current DJD due to the medical complexity of the matter involved. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007). As such, the Board finds the VA examinationsspecifically the October 2021, The April 2020, September 2018, and September 2016 examinationswhich opined against a link between the Veteran's currently diagnosed right foot DJD and his service, to include his service-connected right foot tarsal tunnel syndrome and right foot contusion residuals, to be of high probative value. Additionally, the Board notes that the Veteran was not diagnosed with right foot DJD until November 2008, approximately 11 years after he left active-duty service. Further, while the Veteran stated during the September 2016 examination that he had been experiencing right foot pain since February 1983, the examiner noted that his longstanding complaints of right foot pain were related to his right foot tarsal tunnel syndrome, which the Veteran is already service-connected and compensated for. Indeed, no medical examiner has provided a nexus opinion which links the Veteran's right foot DJD to his active-duty service, to include as due to his service-connected disabilities. Thus, the probative evidence of record preponderates against the Veteran's claim for service connection. In light of the above discussion, there is no evidence that the Veteran sought treatment for or was diagnosed with right foot DJD while in service, or within a year after service, and there is no medical opinion in the record linking his current disability to his active-duty service, to include as secondary to his service-connected right foot tarsal tunnel syndrome and residuals of right foot contusion disabilities. Therefore, the claim must be denied. In reaching this decision, the Board has considered the doctrine of reasonable doubt but has determined that it is not applicable to this claim because the preponderance of the evidence is against the claim. TIFFANY HANSON Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Gresham 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.