Citation Nr: 21007524 Decision Date: 02/09/21 Archive Date: 02/09/21 DOCKET NO. 15-46 250 DATE: February 9, 2021 ORDER Entitlement to service connection for fibromyalgia, to include as secondary to service-connected hallux valgus, is denied. Entitlement to service connection for a low back disability, to include as secondary to service-connected hallux valgus, is denied. Entitlement to service connection for a left thigh disability, to include as secondary to service-connected hallux valgus, is denied. Entitlement to service connection for a right thigh disability, to include as secondary to service-connected hallux valgus, is denied. Entitlement to service connection for a left lower leg disability, to include as secondary to service-connected hallux valgus, is denied. Entitlement to service connection for a right lower leg disability, to include as secondary to service-connected hallux valgus, is denied. Entitlement to service connection for a left ankle disability, to include as secondary to service-connected hallux vulgus, is denied. Entitlement to service connection for a right ankle disability, to include as secondary to service-connected hallux valgus, is denied. FINDINGS OF FACT 1. The probative evidence of record does not establish that the Veteran’s fibromyalgia is the result of or aggravated by the Veteran’s service-connected hallux valgus. 2. The probative evidence of record does not establish that the Veteran’s low back disability is the result of or aggravated by the Veteran’s service-connected hallux valgus. 3. The probative evidence of record does not establish that the Veteran’s left thigh disability is the result of or aggravated by the Veteran’s service-connected hallux valgus. 4. The probative evidence of record does not establish that the Veteran’s right thigh disability is the result of or aggravated by the Veteran’s service-connected hallux valgus. 5. The probative evidence of record does not establish that the Veteran’s left lower leg disability is the result of or aggravated by the Veteran’s service-connected hallux valgus. 6. The probative evidence of record does not establish that the Veteran’s right lower leg disability is the result of or aggravated by the Veteran’s service-connected hallux valgus. 7. The probative evidence of record does not establish that the Veteran’s left ankle disability is the result of or aggravated by the Veteran’s service-connected hallux valgus. 8. The probative evidence of record does not establish that the Veteran’s right ankle disability is the result of or aggravated by the Veteran’s service-connected hallux valgus. CONCLUSIONS OF LAW 1. The criteria for service connection for fibromyalgia, to include as secondary to service-connected hallux valgus, have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. § 3.303, 3.310. 2. The criteria for service connection for a low back disability, to include as secondary to service-connected hallux valgus, have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. § 3.303, 3.309, 3.310. 3. The criteria for service connection for a left thigh disability, to include as secondary to service-connected hallux valgus, have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. § 3.303, 3.309, 3.310. 4. The criteria for service connection for a right thigh disability, to include as secondary to service-connected hallux valgus, have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. § 3.303, 3.309, 3.310. 5. The criteria for service connection for a left lower leg disability, to include as secondary to service-connected hallux valgus, have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. § 3.303, 3.309, 3.310. 6. The criteria for service connection for a right lower leg disability, to include as secondary to service-connected hallux valgus, have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. § 3.303, 3.309, 3.310. 7. The criteria for service connection for a left ankle disability, to include as secondary to service-connected hallux vulgus, have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. § 3.303, 3.310. 8. The criteria for service connection for a right ankle disability, to include as secondary to service-connected hallux valgus, have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. § 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served active duty in the United States Air Force from August 1979 to February 1980. In February 2019, the Veteran testified before the undersigned Veterans Law Judge at a Travel Board hearing. A copy of the transcript has been associated with the claims file. In August 2019, the Board remanded the appeal for further development. Service Connection 1. Service connection for fibromyalgia, to include as secondary to service-connected hallux valgus The Veteran contends that her fibromyalgia is due to her period of active duty service, to include as secondary to her service-connected hallux valgus. The question for the Board is whether the Veteran has a current disability that began during active duty service or is at least as likely as not related to an in-service injury, event, or disease or to a service-connected disability. The Board concludes that, while there is evidence of a current diagnosis of fibromyalgia, the preponderance of the evidence weighs against finding that the fibromyalgia began during active duty service or is otherwise related to an active duty service injury, event, or disease or a service-connected disability. The Veteran’s service treatment records are silent on complaint of or treatment for fibromyalgia during her period of active duty. As the second element of service connection on a direct basis has not been met, analysis will turn to service connection on a secondary basis. In a January 2007 private medical record, the Veteran reported pain all over the body and headaches. The Veteran reported onset of pain in the back and arms in 1989. In an April 2014 lay statement, the Veteran asserted that her fibromyalgia began as a complication with her feet that began to extend throughout her body. In a February 2019 private medical opinion, the examiner opined that the Veteran’s fibromyalgia was secondary to her service-connected hallux valgus. The Board notes that while the examiner provided an opinion, no reasons or bases were given in support of the opinion. As such, the medical opinion is afforded low probative value. In a February 2019 Board hearing, the Veteran asserted that it was possible that her different joint pains were associated with her fibromyalgia. The Veteran noted that she was diagnosed with fibromyalgia in the mid-or late 1990s, and she did not believe she was in the military at the time of diagnosis. In a January 2020 VA examination, the examiner opined that it is less likely than not that the Veteran’s fibromyalgia is due to the Veteran’s service-connected hallux valgus. The examiner explained that a cause and effect relationship between the Veteran’s hallux valgus and her fibromyalgia has not been established by the preponderance of the medical literature. Citing medical literature, the examiner stated that fibromyalgia is characterized by unexplained, widespread pain throughout the body, persisting longer than 3 months. The examiner went on to report that there is no known direct cause or cure for fibromyalgia, but there are effective treatments to manage symptoms. The examiner noted that fibromyalgia has been linked to repetitive injuries, physical and emotional trauma, stress, and infections. The examiner further noted that the current severity of the Veteran’s fibromyalgia was not greater than the baseline. The Board notes that the totality of the opinion indicates that the examiner found that the medical evidence does not show aggravation of the fibromyalgia by the hallux valgus. The Board finds this opinion to be highly probative in nature due to the use of medical literature and the Veteran’s medical history regarding the Veteran’s fibromyalgia and service-connected hallux valgus. After review of the record, the Board finds that the probative evidence of record does not establish service connection for fibromyalgia, to include as secondary to service-connected hallux valgus. The evidence indicates that the Veteran’s fibromyalgia is not related to, the result of or aggravated by the Veteran’s service-connected hallux valgus. As such, service connection for fibromyalgia is not warranted. While the Veteran believes that her fibromyalgia is related to her service-connected hallux valgus, the Veteran is not competent to provide an etiology opinion on fibromyalgia, as this is a complex medical matter. The Board reiterates that the preponderance of the evidence weighs against findings that her fibromyalgia is due to or the result of her active duty service or to a service-connected disability. 2. Service connection for a low back disability, to include as secondary to service-connected hallux valgus The Veteran contends that her low back is due to her period of active duty service, to include as secondary to her service-connected hallux valgus. The question for the Board is whether the Veteran has a current disability that began during active duty service or is at least as likely as not related to an in-service injury, event, or disease or to a service-connected disability. The Board concludes that, while there is evidence of a current diagnosis of degenerative disc disease and radiculopathy of the bilateral lower extremities, the preponderance of the evidence weighs against finding that the low back disabilities began during service or are otherwise related to an active duty service injury, event, or disease or a service-connected disability. The Veteran’s service treatment records are silent on complaint of or treatment for a low back injury during the Veteran’s active duty service. The Board notes that the Veteran’s June 1988 reserve treatment record notes recurrent back pain; however, the Veteran has not asserted a back injury during any period of active duty service during her period in the Air Force reserve. Rather, the Veteran asserts that her back condition is due to her service-connected hallux valgus. In an April 2014 lay statement, the Veteran asserted that, due to her foot condition, other members of her body manifested, to include her back. She noted that a 2009 fall further aggravated her back condition. In a February 2019 private medical opinion, the examiner opined that the Veteran’s low back disability was secondary to her service-connected hallux valgus. The Board notes that while the examiner provided an opinion, no reasons or bases were given in support of the opinion. As such, the medical opinion is afforded low probative weight. In a February 2019 Board hearing, the Veteran again asserted that her hallux valgus resulted in her current back condition, stating that her altered gait resulted in secondary issues. In a January 2020 VA examination, the examiner reported that the Veteran had guarding that resulted in abnormal gait of spinal contour. The examiner opined that it was less likely than not that the Veteran’s lumbar spine disability resulted from the Veteran’s service-connected hallux valgus. The examiner explained that, according to the literature, the most common cause of degenerative disc disease is aging. The examiner stated that degeneration refers to the natural aging process of the spine. The examiner also stated that the spine is responsible for supporting the body, allowing movement and bending and giving the body posture and slowly deteriorates over time. The examiner reported that other risk factors include obesity, alcohol, strenuous activity, injury, and sedentary lifestyle. The examiner went on to state that the Veteran’s weight is a contributing factor of the degenerative disc disease and degenerative joint disease of the spine. The examiner noted the Veteran reports a fall in 2007 injuring the low back. The examiner stated that, absent further information to the contrary, probative evidence supports that the degenerative disc disease of the spine is most likely due to the injury described above. The examiner stated that, regrettably, documented correlation between service-connected hallux valgus and the low back condition is lacking. The examiner also opined that the current severity of the lumbar spine disability was not greater than the baseline. The Board notes that the totality of the opinion indicates that the examiner found that the medical evidence does not show aggravation of the claimed lumbar spine conditions by the hallux valgus. The Board finds this opinion to be highly probative in nature due to the use of medical literature and the Veteran’s medical history regarding the Veteran’s claimed low back disability and service-connected hallux valgus. After review of the record, the Board finds that the probative evidence of record does not establish service connection for a low back disability, to include as secondary to service-connected hallux valgus. The evidence indicates that the Veteran’s low back disability is not related to, the result of or aggravated beyond natural progression by the Veteran’s service-connected hallux valgus. Moreover, evidence indicated that the Veteran’s abnormal gait is the result of guarding in the low back itself rather than due to her hallux valgus condition. As such, service connection for a low back disability is not warranted. The Board has also considered presumptive service connection under 38 C.F.R. § 3.309(a) for arthritis and service connection based on a continuity of symptomatology under 38 C.F.R. § 3.303(b); however, the probative evidence does not indicate that the disability manifested within a year of separation of service or that it occurred continuously since discharge from service. Therefore, presumptive service connection and service connection based on continuity of symptomatology are not warranted. While the Veteran believes that her low back disability is related to her service-connected disability, the Veteran is not competent to provide an etiology opinion on a low back disability, as this is a complex medical matter. The Board reiterates that the preponderance of the evidence weighs against findings that her low back disability is due to or the result of her active duty service or to a service-connected disability. 3. Service connection for a left thigh disability, to include as secondary to service-connected hallux valgus 4. Service connection for a right thigh disability, to include as secondary to service-connected hallux valgus The Veteran contends that her left and right thigh disabilities are due to her service-connected hallux valgus. The question for the Board is whether the Veteran has a current disability that began during active duty service or is at least as likely as not related to an in-service injury, event, or disease or to a service-connected disability. The Board concludes that, while there is evidence of current diagnoses of degenerative arthritis and sacroiliac joint arthritis of both thighs, the preponderance of the evidence weighs against finding that the left and right thigh disabilities began during service or are otherwise related to an active duty service injury, event, or disease or a service-connected disability. The Veteran’s service treatment records are silent on complaint of or treatment for a left or right thigh injury during the Veteran’s active duty service. As the second element of service connection on a direct basis has not been met, analysis will turn to service connection on a secondary basis. In an April 2014 lay statement, the Veteran asserted that, due to her foot condition, other members of her body manifested, to include her thighs. In a February 2019 private medical opinion, the examiner opined that the Veteran’s bilateral thigh disability was secondary to her service-connected hallux valgus. The Board notes that while the examiner provided an opinion, no reasons or bases were given in support of the opinion. As such, the medical opinion is afforded low probative weight. In a February 2019 Board hearing, the Veteran again asserted that her hallux valgus resulted in her current thigh disabilities, stating that her altered gait resulted in secondary issues, including bracing with her thighs. The Veteran also reported that pain radiated downward and upward to her thighs. In a January 2020 VA lumbar spine examination, the examiner reported that the Veteran had guarding that resulted in abnormal gait of spinal contour. In a January 2020 VA hip and thigh examination, the examiner stated that the Veteran’s bilateral thigh disability is related to radiculopathy. The examiner noted that the Veteran reported nerve pain over the buttock down the back of the thigh to the calf three to four times a week and lasting several hours, which is relieved by rest. The examiner also noted that the Veteran has degenerative joint disease of both hips. The examiner opined that it was less likely than not that the Veteran’s left and right thigh disabilities resulted from the Veteran’s service-connected hallux valgus. The examiner explained that the Veteran has degenerative joint disease of all the weight-bearing joints and the lumbar spine. The examiner went on to state that the Veteran’s weight is a contributing factor of the bilateral hip and sacroiliac joint degenerative joint disease. The examiner further stated that the radiculopathy is due to the degenerative disc disease of the lumbar spine claimed as the lower leg and thigh, and not the hallux valgus. The examiner stated that, regrettably, documented correlation between service-connected hallux valgus and the thigh disabilities is lacking. The examiner also opined that the current severity of the left and right thigh disabilities was not greater than the baseline. The Board notes that the totality of the opinion indicates that the examiner found that the medical evidence does not show aggravation of the left and right thigh disabilities by the hallux valgus. The Board finds this opinion to be highly probative in nature due to the use of medical literature and the Veteran’s medical history regarding the Veteran’s thigh disabilities and service-connected hallux valgus. After review of the record, the Board finds that the probative evidence of record does not establish service connection for the left and right thigh disabilities, to include as secondary to service-connected hallux valgus. The evidence indicates that the Veteran’s left and right thigh disabilities are not related to, the result of or aggravated by the Veteran’s service-connected hallux valgus. Moreover, evidence indicated that the Veteran’s thigh disabilities are due to the non-service-connected low back disability. As such, service connection for left and right thigh disabilities is not warranted. The Board has also considered presumptive service connection under 38 C.F.R. § 3.309(a) for arthritis and service connection based on a continuity of symptomatology under 38 C.F.R. § 3.303(b); however, the probative evidence does not indicate that the disability manifested within a year of separation of service or that it occurred continuously since discharge from service. Therefore, presumptive service connection and service connection based on continuity of symptomatology are not warranted. While the Veteran believes that her left and right thigh disabilities are related to her service-connected disability, the Veteran is not competent to provide an etiology opinion on thigh disabilities, as this is a complex medical matter. The Board reiterates that the preponderance of the evidence weighs against findings that her left and right thigh disabilities are due to or the result of her active duty service or to a service-connected disability. 5. Service connection for a left lower leg disability, to include as secondary to service-connected hallux valgus 6. Service connection for a right lower leg disability, to include as secondary to service-connected hallux valgus The Veteran contends that her left and right leg disabilities are due to her service-connected hallux valgus. The question for the Board is whether the Veteran has a current disability that began during active duty service or is at least as likely as not related to an in-service injury, event, or disease or to a service-connected disability. The Board concludes that, while there is evidence of a current diagnosis of radiculopathy of the bilateral lower extremities, the preponderance of the evidence weighs against finding that the left and right leg disabilities began during service or are otherwise related to an active duty service injury, event, or disease or a service-connected disability. The Veteran’s service treatment records are silent on complaint of or treatment for a left or right leg injury during the Veteran’s active duty service. As the second element of service connection on a direct basis has not been met, analysis will turn to service connection on a secondary basis. In an April 2014 lay statement, the Veteran asserted that, due to her foot condition, other members of her body manifested, to include her legs. In a February 2019 private medical opinion, the examiner opined that the Veteran’s bilateral leg disability was secondary to her service-connected hallux valgus. The Board notes that while the examiner provided an opinion, no reasons or bases were given in support of the opinion. As such, the medical opinion is afforded low probative weight. In a February 2019 Board hearing, the Veteran again asserted that her hallux valgus resulted in her current leg disabilities, stating that her altered gait resulted in secondary issues, including leg pain. The Veteran also reported that her doctors did not call it peripheral neuropathy, but they did state that she has degenerative disc disease and osteoarthritis. In a January 2020 VA lumbar spine examination, the examiner reported that the Veteran had guarding that resulted in abnormal gait of spinal contour. The examiner noted that the Veteran reported nerve pain over the buttock down the back of the thigh to the calf three to four times a week and lasting several hours, which is relieved by rest. The examiner opined that it was less likely than not that the Veteran’s left and right leg disabilities resulted from the Veteran’s service-connected hallux valgus. The examiner explained that the Veteran has degenerative joint disease of all the weight-bearing joints and the lumbar spine. Citing medical literature, the examiner explained that radiculopathy describes a series of symptoms produced by the pinching of a nerve root in the spinal column, which can occur at any level of the spine, such as cervical, thoracic or lumbar. The examiner stated that symptoms may vary and include nerve pain, weakness, numbness and tingling. The examiner also explained that osteoarthritis becomes more common with age, unless the result of a joint injury, a joint malformation, or a genetic defect in joint cartilage. The examiner stated that it is also more likely to occur in people who are overweight and in those with jobs that stress joints. The examiner stated that the Veteran’s thigh and leg disabilities are caused by lumbar radiculopathy, and not the hallux valgus. The examiner further stated that, regrettably, documented correlation between service-connected hallux valgus and the leg disabilities is lacking. The examiner also opined that the current severity of the left and right leg disabilities was not greater than the baseline. The Board notes that the totality of the opinion indicates that the examiner found that the medical evidence does not show aggravation of the left and right leg disabilities by the hallux valgus. The Board finds this opinion to be highly probative in nature due to the use of medical literature and the Veteran’s medical history regarding the Veteran’s leg disabilities and service-connected hallux valgus. After review of the record, the Board finds that the probative evidence of record does not establish service connection for the left and right leg disabilities, to include as secondary to service-connected hallux valgus. The evidence indicates that the Veteran’s left and right leg disabilities are not related to, the result of or aggravated by the Veteran’s service-connected hallux valgus. Moreover, evidence indicated that the Veteran’s leg disabilities are due to the non-service-connected low back disability. As such, service connection for left and right leg disabilities is not warranted. The Board has also considered presumptive service connection under 38 C.F.R. § 3.309(a) for arthritis and service connection based on a continuity of symptomatology under 38 C.F.R. § 3.303(b); however, the probative evidence does not indicate that the disability manifested within a year of separation of service or that it occurred continuously since discharge from service. Therefore, presumptive service connection and service connection based on continuity of symptomatology are not warranted. While the Veteran believes that her left and right leg disabilities are related to her service-connected disability, the Veteran is not competent to provide an etiology opinion on leg disabilities, as this is a complex medical matter. The Board reiterates that the preponderance of the evidence weighs against findings that her left and right leg disabilities are due to or the result of her active duty service or to a service-connected disability. 7. Service connection for a left ankle disability, to include as secondary to service-connected hallux vulgus 8. Service connection for a right ankle disability, to includes as secondary to service-connected hallux valgus The Veteran contends that her left and right ankle disabilities are due to her service-connected hallux valgus. The question for the Board is whether the Veteran has a current disability that began during active duty service or is at least as likely as not related to an in-service injury, event, or disease or to a service-connected disability. The Board concludes that, while there is evidence of a current diagnosis of bilateral ankle strain, the preponderance of the evidence weighs against finding that the left and right ankle disabilities began during service or are otherwise related to an active duty service injury, event, or disease or a service-connected disability. The Veteran’s service treatment records are silent on complaint of or treatment for a left or right ankle injury during the Veteran’s active duty service. As the second element of service connection on a direct basis has not been met, analysis will turn to service connection on a secondary basis. In an April 2014 lay statement, the Veteran asserted that, due to her foot condition, other members of her body manifested, to include her ankles. In a February 2019 private medical opinion, the examiner opined that the Veteran’s bilateral ankle disability was secondary to her service-connected hallux valgus. The Board notes that while the examiner provided an opinion, no reasons or bases were given in support of the opinion. As such, the medical opinion is afforded low probative weight. In a February 2019 Board hearing, the Veteran again asserted that her left foot hallux valgus resulted in her current ankle disabilities, stating that her altered gait resulted in secondary issues, including ankle pain. In a January 2020 VA ankle examination, the examiner opined that it was less likely than not that the Veteran’s left and right ankle disabilities resulted from the Veteran’s service-connected hallux valgus. The examiner explained that, the Veteran has degenerative joint disease of all the weight-bearing joints and the lumbar spine. The examiner stated that the Veteran’s bilateral ankle strains are most likely due to aging and increased weight on the weight-bearing joints. The examiner stated that, regrettably, documented correlation between service-connected hallux valgus and the ankle disabilities is lacking. The examiner also opined that the current severity of the left and right ankle disabilities was not greater than the baseline. The Board notes that the totality of the opinion indicates that the examiner found that the medical evidence does not show aggravation of the left and right ankle disabilities by the hallux valgus. The Board finds this opinion to be highly probative in nature due to the use of medical literature and the Veteran’s medical history regarding the Veteran’s ankle disabilities and service-connected hallux valgus. After review of the record, the Board finds that the probative evidence of record does not establish service connection for the left and right ankle disabilities, to include as secondary to service-connected hallux valgus. The evidence indicates that the Veteran’s left and right ankle disabilities are not related to, the result of or aggravated by the Veteran’s service-connected hallux valgus. As such, service connection for left and right ankle disabilities is not warranted. While the Veteran believes that her left and right ankle disabilities are related to her service-connected disability, the Veteran is not competent to provide an etiology opinion on ankle disabilities, as this is a complex medical matter. The Board reiterates that the preponderance of the evidence weighs against findings that her left and right ankle disabilities are due to or the result of her active duty service or to a service-connected disability. JENNIFER HWA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Ford 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.