Citation Nr: 21009316 Decision Date: 02/22/21 Archive Date: 02/22/21 DOCKET NO. 09-04 795 DATE: February 22, 2021 ORDER Service connection for a low back disorder is granted. Service connection for a left foot disorder is granted. FINDINGS OF FACT 1. The Veteran served on active duty from November 1980 to August 1984, with periods of verified service with the National Guard and the United States Army Reserve from August 1984 to August 1990, August 1994 to January 2000, and January to December 2002. 2. Low back and left foot complaints were noted in service; the current low back and left foot disorders have been related to in-service incurrences. CONCLUSIONS OF LAW 1. A low back disorder was incurred in service. USC citation for all: 38 U.S.C. §§ 1131, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 3.303 (2020). 2. A left foot disorder was incurred in service. 38 U.S.C. §§ 1131, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 3.303 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS In April 2010, the Veteran testified before the undersigned Veterans Law Judge. A copy of the transcript has been associated with the claims file. In June 2018, the Board remanded the appeal for additional development. The case has now been returned to the Board for further appellate action. Turning to the relevant laws and regulations, service connection may be granted on a direct basis as a result of disease or injury incurred in service based on nexus using a three-element test: (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 in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). Low Back Disorder As to a current disorder, the Veteran was diagnosed with degenerative joint disease (DJD) and degenerative disc disease (DDD) in 1994. Thus, a current disorder is shown, and the first element of service connection is met. As to an in-service incurrence, the service treatment records (STRs) reflect that the Veteran was diagnosed with a low back strain for which he received treatment. Thus, the second element of service connection, an in-service incurrence, is met. As to a medical nexus, a November 2020 VA examiner, after conducting a physical examination of the Veteran and reviewing the claims file, opined it was at least as likely as not that the Veteran’s low back disorder was related to service. The examiner reasoned that the Veteran reported chronic back pain since the early 1980s while stationed in Germany, where he described a specific episode of falling while wearing his gear and full pack as an armored carrier. He reported mid and low back pain and throbbing for the next few months, associated with spasm and guarding. The examiner noted that the Veteran described an aching in the back which worsened during marching and training and with repeated flexion based duties. The examiner indicated that the Veteran was diagnosed with a low back strain in August 1989 for which he sought continuous treatment and was re-evaluated at VA in 1994, undergone X-ray imaging, and participated in physical therapy. The examiner related that based upon the Veteran’s military occupational specialty (MOS), examination, diagnostics, and STRs, the low back disorder was at least as likely as not related to service. The examiner concluded that there was well-documented peer-reviewed literature on the incidence and natural history of this condition in service members and veterans with risk factors correlating with the job and duty description. The examiner concluded that there were imaging findings that aligned with the examination and symptomatology and there was no better explanation that would suggest otherwise. Left Foot Disorder As to a current diagnosis, the Veteran was diagnosed with left foot hallux valgus, hammertoes, and hallux rigidus as early as 1994. Thus, a current diagnosis is shown, and the first element of service connection is met. As to an in-service incurrence, the STRs show complaints for foot pain, and a diagnosis of hallux valgus. Thus, the second element of service connection, an in-service incurrence, is met. As to a medical nexus, a November 2020 VA examiner, after conducting a physical examination and reviewing the medical records, opined that it was at least as likely as not that the Veteran’s foot disorders were related to service. The examiner reasoned that the Veteran’s disorder began in the early 1980s in which he started to develop left great toe pain with marching in boots. This pain then progressed to pain when standing in boots, and walking barefoot, particularly in the toe-off phase of gait which caused a sharp pain in the toe. The examiner noted that, according to the Veteran, he later started to develop calluses on the left toes 2-5, as well as a large bunion on the great toe. The examiner noted that the left foot evaluation in January 1994 at VA was conducted with noted bilateral hallux valgus deformities and an evaluation in 1998 described a symptomatic left hallux valgus. The examiner reflected that the Veteran underwent an Austin bunionectomy with extensor hallucis brevis tenotomy in December 2004, along with arthoplasty of toes 2-4 to address hammertoe deformities. The examiner noted that the current symptoms included stiffness and pain with ambulation. The examiner opined that based upon the Veteran’s MOS, service history, examination, diagnostics, and STRs, the left foot disorder was at least as likely caused by service. The examiner noted that there was well-documented peer-reviewed literature of the incidence and natural history of this condition in service members and Veterans with risk factors correlating with the job and duty description. The examiner stated that hallux valgus and deformity was significantly more prevalent in veterans versus non-veterans in the United States. Bunion deformity was also noted to be significantly more prevalent in the male veterans. The examiner reflected that there were imaging findings which align with the symptomatology and there was no better explanation that suggests otherwise. With respect to both claims, great probative weight is assigned to the November 2020 VA examination because it was based on a full review of the Veteran’s medical history, STRs, and a full examination. It is clear that the examiner considered the Veteran’s assertions of his in-service injuries, and corroborated that with the STRs. Further, there is no other medical opinion which tends to contradict it. Thus, the evidence has shown a current diagnosis, an in-service incurrence, and a medical nexus and the appeals are granted. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board’s consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). L. HOWELL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Yacoub, Associate 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.