Citation Nr: 21077113 Decision Date: 12/28/21 Archive Date: 12/28/21 DOCKET NO. 15-42 808 DATE: December 28, 2021 ORDER Entitlement to service connection for bone spurs left big toe is denied. Entitlement to service connection for bone spurs right big toe is denied. Entitlement to service connection for bone spurs right heel is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that a left big toe disability began during active service, or is otherwise related to an in-service injury or disease. 2. The preponderance of the evidence is against finding that a right big toe disability began during active service, or is otherwise related to an in-service injury or disease. 3. The preponderance of the evidence is against finding that a right heel disability began during active service, or is otherwise related to an in-service injury or disease. CONCLUSIONS OF LAW 1. The criteria for service connection for a left big toe disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for a right big toe disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for service connection for a right heel disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty service from October 1988 to September 1992. His service included service in the Southwest Asia Theater of Operations. In July 2021, the Board of Veterans' Appeals (Board) remanded the claim for additional development. As the actions specified in the remand have been completed, the matter has been properly returned to the Board for appellate consideration. See Stegall v. West, 11 Vet. App. 268 (1998). Service connection for bone spurs of the right and left big toes, and bones spurs of the right heel The Veteran contends that his bilateral big toe bone spurs and right heel spur are due to his active duty service. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has diagnoses of current foot disabilities to include degenerative joint disease of his bilateral feet, bilateral foot hallux rigidus, and bilateral foot calcaneal spurs of the great toe, the preponderance of the evidence weighs against finding that the Veteran's bilateral foot disabilities began during service or are otherwise related to an in-service injury, event, or disease. Service treatment records (STRs) from December 1990 note that the Veteran reported left ankle soreness. Upon examination, there was slight swelling and tenderness. Later in December 1990, the Veteran reported that his left medial foot felt better and that his swelling and tenderness had decreased. Also, his STRs show that the Veteran had two degree bilateral pes planus (flatfoot) during his entrance examination in May 1988. A February 2007 private treatment note indicated that the bottom of the Veteran's feet had a burning sensation and that the Veteran had bone spurs for years. He was diagnosed with plantar fascial pain. In a 2010 medical questionnaire, the Veteran reported difficulty bending his big toes due to bone spurs on the top of both big toes. He reported onset around 2005. Also, he noted that he had an altered gait due to his bone spurs which caused painful ambulation. In July 2010, the Veteran reported that his bilateral great toes hurt with bending with onset around 2005. In November 2010, the Veteran reported severe pain from bone spurs in his bilateral metatarsal phalangeal joints. He had surgery scheduled to remove his bilateral big toe bone spurs. In January 2011, the Veteran underwent left foot first metatarsal cheilectomy to correct his left foot hallux rigidus. In March 2011, the Veteran underwent right foot first metatarsal cheilectomy to correct his right foot hallux rigidus. Arthritis of his great toes was diagnosed in August 2011. During a June 2012 VA treatment consultation, the Veteran indicated that his bilateral foot and ankle pain began in the mid-1990s. He noted that he began to have pain and swelling in his bilateral great toes approximately 6-7 years ago. His activities of daily living were limited by foot pain. He noted that shoe inserts helped a little. A July 2012 VA physical therapy note indicated that the Veteran requested a walking aid due to frequent falls and increased pain of his bilateral feet. In August 2012, the Veteran underwent a VA examination for foot conditions. He was diagnosed with degenerative joint disease of his bilateral feet and an image study revealed bilateral calcaneal spurs. In 2011, the Veteran had bilateral spurs of his big toe removed by a private doctor. An opinion was not rendered by the VA examiner. A July 2016 private podiatry note indicated that the Veteran was having bilateral hallux pain. X-ray showed loss of joint space and spurring with sclerosis of the bone, bilaterally. The Veteran was diagnosed with bilateral foot hallux rigidus, and bilateral ankle and foot joint pain. During his July 2018 Board hearing, the Veteran stated that his foot disabilities were due to the foot trauma he endured during training and his duties while repairing leaks and clogs on his ship. He stated that a private doctor opined that wearing combat boots for long hours in wet conditions caused his foot disabilities; however, this is not of record. Also, the Veteran asserted that his flatfoot condition was aggravated by his active-duty foot trauma which caused his bilateral big toe spurs and heel spurs. He noted that he had foot problems, such as discomfort, during active service and since, and that it had progressed since. In March 2020, the Veteran's wife noted that the Veteran had complained of foot pain since they met in 2003. He reported onset during active service. In May 2020, a VA examiner opined that the Veteran's left and right heel bone spurs and left and right big toe bone spurs were less likely as not incurred in or caused by the claimed in-service injury, event, or illness. The examiner explained that the Veteran reported a left foot contusion that was acute and self-limited, which was confirmed by his separation examination and post-service examination in February 1993. The examiner noted that the Veteran was first diagnosed with plantar fasciitis in February 2007. The Veteran reported that he first had symptoms around 2002. The VA examiner concluded that the Veteran did not have a diagnosed foot condition during service, other than the resolved left foot contusion, including bilateral foot heel spurs, degenerative arthritis of the feet, or arthritis/spurs of the bilateral great toes. Though the private podiatrist, based on the Veteran hearing testimony, expressed a positive opinion according to the Veteran, the examiner indicated that there is no justification for this opinion based on the records and the premise. It is unlikely that the Veteran would have served his full-term of active service with the associated rigors of shipboard duty without manifesting complaints. It is also unlikely that the Veteran would have not sought treatment for 15 years had the in-service events caused his bilateral heel bone spurs and bilateral big toe bone spurs. Lastly, the Veteran's pes planus had not been aggravated during active service his condition remained asymptomatic during active service. The Veteran was noted to have second-degree, asymptomatic pes planus on entry to active service with no change in the diagnosis during his separation examination. The Veteran had no documented complaints during service related to his diagnosed pes planus. In January 2021, the Board found that the May 2020 VA examiner's opinion was inadequate as he incorrectly noted that the Veteran was first diagnosed with plantar fasciitis in February 2007. A September 1993 treatment note indicates that he was diagnosed with left foot plantar fasciitis months after separation from active service. Also, the examiner's rationale did not address the Veteran, or his wife's, reports of foot pain since active service. Therefore, the Board remanded the claim for a complete medical opinion. In February 2021, a VA examiner opined that the Veteran's right heel bone spur was less likely than not incurred in or caused by the claimed in-service injury, event, or illness, to include wearing combat boots in wet conditions. The examiner explained that while the Veteran's lay statements conveys confirmation of pain during and since service, the STRs did not show a diagnosis of right foot plantar fasciitis. Right foot plantar fasciitis was diagnosed many years post service. In July 2021, the Board found that the February 2021 VA medical opinion was inadequate as the examiner did not address the Veteran's lay contentions of bilateral foot pain since active service. Notably, the VA examiner did not specifically address or discuss the Veteran's assertions of bilateral foot discomfort during, and since, active service. Rather, the examiner generically referred to 'lay statements." In September 2021, a VA examiner opined that the claimed bilateral foot conditions were less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner explained that there is no objective evidence to support an etiology for the bilateral big toe bone spurs and right heel bone spurs being incurred in or caused by service. Specifically, there was no radiological evidence of any bone spurs during service. There is no record of the Veteran having difficulty performing physical training or his job specific duties, or a profile record for bone spurs. The Veteran noted that he did not have foot trouble upon his separation Report of Medical History and his separation examination did not note bone spurs. He was found fit for separation from active service with no recommendation for a podiatry follow-up due to a bone spur. The Veteran's testimony that he has had foot pain since his active service and his wife's report of foot pain since 2003 were considered. However, the examiner noted that when a determinative issue involves causation or medical diagnosis, the lay statements are not sufficient for a positive nexus opinion because such evidence does not constitute competent medical authority. The Veteran has not been shown to have the requisite medical training as to opine diagnosis or etiology. Therefore, the lay statements, standing on their own, are insufficient upon which to establish a relationship between a current disability and a period of active service. The examiner found that there is a reasonable medical nexus that the Veteran's bilateral big toe bone spurs and right heel bone spurs are related to his employment as a welder for many years after active service. As a welder, the Veteran had daily prolonged standing which can cause foot pain and the Veteran's bilateral big toe bone spurs and right heel bone spurs. Thus, there is no established medical nexus supporting an etiology for the bilateral big toe bone spurs and right heel bone spurs being incurred in or caused by service. Further, because the bilateral foot arthritic changes were not shown as chronic in service, did not manifest to a compensable degree within a presumptive period, and was not noted in service with competent, credible and probative evidence of attributable continuity of symptomatology, the claimed condition cannot be presumed to be related to service. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). As noted, the Veteran's report of bilateral foot arthritis is not confirmed by X-ray evidence in service, and indeed, arthritis was not demonstrated until August 2011. The Veteran believes his bilateral great toe disabilities and right heel disability are related to an in-service injury or event. The Veteran in this case is not competent to provide a nexus opinion regarding these issues. The issues are medically complex, as they require knowledge of anatomical relationships, pathology, and interpretation of complicated diagnostic medical testing. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the VA examiner that rendered the September 2021 opinions. The evidence in this case is not so evenly balanced so as to allow application of the benefit-of-the-doubt rule as required by law and VA regulations. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. The preponderance is against the Veteran's claims, and they must be denied. S. L. Kennedy Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Costello, 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.