Citation Nr: 21008232 Decision Date: 02/12/21 Archive Date: 02/12/21 DOCKET NO. 15-10 545A DATE: February 12, 2021 ORDER Entitlement to service connection for a low back disability, to include as secondary to service-connected bilateral pes planus, is granted. FINDING OF FACT The Veteran’s low back disability has been aggravated by his service-connected bilateral pes planus. CONCLUSION OF LAW The criteria for entitlement to service connection for a low back disability, to include as secondary to service-connected bilateral pes planus, have been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from May 1979 to March 1981. He appeals a May 2011 rating decision denying entitlement to service connection for a low back disability and an April 2014 rating decision denying entitlement to service connection for an acquired psychiatric disability. The Board notes that the Veteran was awarded entitlement to service connection for an acquired psychiatric disorder, diagnosed as bipolar disorder II, during the pendency of the appeal in a July 2020 rating decision. Accordingly, that issue is no longer before the Board. Service Connection Under the relevant laws and regulations, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. §§ 3.303(a), 3.304, 3.307, 3.309, 3.310. Generally, the evidence must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); Caluza v. Brown, 7 Vet. App. 498, 505 (1995). A disability may also be found service connected on a secondary basis by demonstrating that the disability is either (1) proximately due to or the result of an already service-connected disease or injury or (2) aggravated by an already service-connected disease or injury. See Allen v. Brown, 7 Vet. App. 439, 448 (1995); 38 C.F.R. § 3.310 (2017). 1. Entitlement to service connection for a low back disability, to include as secondary to service-connected disabilities. The Veteran contends that his low back disability has been aggravated by his service-connected bilateral pes planus. After review of the evidence, the Board finds that service connection is warranted. Review of the Veteran’s service treatment record does not reveal treatment for or complaints of any low back conditions. The Veteran’s separation examination lacks any documented complaints or observed symptoms of any low back condition. In fact, the Veteran admits that he first injured his back at work in 1992, over a decade after separation from service. As such, per the Veteran’s own admission and as reflected by the medical evidence of record, continuity of symptoms since service has not been demonstrated. Thus, the evidence does not show that the Veteran has a low back disability that is the result of injury in service or is proximately due to an already service-connected disability. At his September 2019 VA examination, the Veteran was diagnosed with lumbar spondylosis with left radiculopathy. He reported that his lower back pain began in 2010 and has worsened since. The Veteran has submitted several private medical opinions indicating that his low back disability has been adversely affected by his service-connected bilateral pes planus. A December 2010 medical note opines that it is “entirely plausible” that the abnormal gait resulting from the Veteran’s foot disability has contributed to his low back pain. The private physician notes that the Veteran’s foot disability predates the onset of his low back pain by a number of years and, despite the Veteran’s admission of post-service back trauma, further opines that there is no other known cause for the pain. The Veteran submitted another positive nexus opinion from January 2011. The private examiner reiterated that the Veteran’s pes planus deformity in both feet has resulted in an altered gait that contributes to his back pain. In July 2020, a VA examiner opined that the Veteran’s low back disability was not at least as likely as not aggravated by his service-connected foot disability. However, the examiner merely pointed to a previous VA examiner’s opinion regarding direct causation rather than provide any actual rationale as to why the Veteran’s low back disability was not aggravated by his service-connected foot disability. As such, the Board affords minimal probative weight to the opinion of the July 2020 VA examiner. After review of the medical evidence of record, the Board affords more probative weight to the positive nexus opinions provided by the private physicians. Multiple examiners came to the same conclusion and at least some rationale was provided. Therefore, after resolving all doubt in favor of the Veteran, the Board finds that his low back disability has been aggravated by his service-connected foot disability and service connection is warranted on that basis. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990).   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. B.T. KNOPE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Daniel Ballinger, Associate Counsel