Citation Nr: 21011756 Decision Date: 03/02/21 Archive Date: 03/02/21 DOCKET NO. 17-05 513 DATE: March 2, 2021 ORDER Service connection for a right foot disorder is denied. Service connection for a left foot disorder is denied.   FINDINGS OF FACT 1. The Veteran’s bilateral hallux valgus and degenerative arthritis of the feet did not have their onset during service and are not otherwise related. 2. The Veteran’s pre-existing bilateral pes planus and hammer toe disorders were not aggravated during service. CONCLUSIONS OF LAW 1. The criteria for service connection for a right foot disorder have not been met. 38 U.S.C. §§ 1110, 1131, 1153, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.306. 2. The criteria for service connection for a left foot disorder have not been met. 38 U.S.C. §§ 1110, 1131, 1153, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.306. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1950 to November 1952 and from December 1953 to November 1956. The case is on appeal from a September 2015 rating decision. In November 2018, the Veteran testified at a Board hearing. Most recently in October 2020, the Board remanded the case for further development. Additional evidence was received following the issuance of the December 2020 supplemental statement of the case (SSOC), including a December 2020 lay statement from the Veteran. However, the evidence is duplicative to that already of record and therefore, the Board may proceed with adjudication of the appeal. See 38 C.F.R. § 20.1305(c) The Board has limited the discussion below to the relevant evidence required to support its findings of fact and conclusions of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008). 1. Service connection for a right foot disorder. 2. Service connection for a left foot disorder. Legal Criteria Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. A veteran seeking compensation under these provisions must establish three elements: “(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.” Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). A preexisting injury or disease will be considered to have been aggravated by active service where there is an increase in disability during that service, unless there is a specific finding that the increase in disability is due to the natural progress of the disease. 38 U.S.C. § 1153; 38 C.F.R. § 3.306. Analysis The Veteran contends his bilateral foot disorders, including cold residuals are related to service. He states the boots he wore during service were too small and led to a foot disability. Alternatively, he asserts that a preexisting foot condition was aggravated by service. The Veteran’s service personnel records (SPRs) reflect service in Korea, as he was awarded the Korean Service Medal. The Veteran’s service treatment records (STRs) do not include complaints or treatment for cold residuals or frostbite of the feet. However, his STRs include complaints and treatment related to the feet, to include pes planus. His June 1950 enlistment examination noted pes planus and hammer toes. A September 1952 STR indicated a diagnosis of 2nd degree pes planus and a December 1953 record similarly noted bilateral flat feet. An April 1954 STR indicated pes planus and a September 1954 STR noted the Veteran was placed on temporary duty due to his flat feet disorder. Additionally, a May 1955 STR reported he had painful feet, flat feet, short heel cords and severe pronation and calcaneovalgus. The record stated the Veteran “gets along alright when he doesn’t have to work on hard surfaces and should be utilized in some other manner than standing from 4 AM to 7 PM on concrete which he is now doing in the mess hall.” His profile prevented prolonged standing, walking or marching due to his feet disorder. The Veteran’s November 1956 separation examination also noted 2nd degree pes planus. The Veteran submitted a March 2015 claim and thereafter, was afforded a November 2018 Board hearing. He testified that the boots he was issued were too small and too narrow and this was the onset of his feet problems. The Veteran also stated his flatfeet preexisted service and was aggravated by such. The Veteran reported when he entered the Marines, during his second service period, he did not complain about his feet trouble so that he would not be turned away. The Veteran further indicated that there may have been STRs which are unavailable. The claim was remanded by the Board in December 2018 for further development, including a VA examination to determine the etiology of the Veteran’s bilateral feet disorders. The Veteran was afforded an April 2019 VA examination in which he was diagnosed with bilateral pes planus, hammer toes, hallux valgus and degenerative arthritis. The examiner opined the Veteran’s feet disorders are not related to service. With regard to his hallux valgus and degenerative arthritis, she stated the STRs are negative for complaints or treatment related to these two disorders. She indicated these conditions are most likely the result of the normal aging process, as well as occupations the Veteran performed after service which involved prolonged standing, such as his reported duties for the U.S. Postal Service and on an assembly line at Ford Motor Company. With regard to the Veteran’s pes planus and hammer toe conditions, the examiner stated these disorders preexisted service and were not aggravated or worsened by such. She noted the Veteran had a permanent profile for his pes planus during service and required arch supports. She indicated following service, the Veteran’s jobs with the U.S. Postal Service and Ford Motor Company put him in positions which required prolonged standing and he continued to require arch supports. With regard to the Veteran’s preexisting hammer toes, the examiner indicated his STRs are negative for complaints related to this disorder. She stated there is no credible medical evidence to support aggravation of his bilateral hammer toe defects beyond the natural progression during service. For his pes planus, the examiner found the disorder was not aggravated beyond the natural progression by active service, as symptoms of pes planus “wax and wane” and are commonly worsened by standing for extended periods of time. She further noted review of the relevant medical literature does not support aggravation of pes planus or hammer toe defects by ill-fitting shoes. The Veteran’s representative submitted an August 2019 appellate brief which challenged the April 2019 examiner’s opinion. He indicated the Veteran was given an in-service profile for his pes planus which supports that the preexisting disorder was aggravated by service. The claims came before the Board in October 2019 and it determined the April 2019 VA opinion was adequate with regard to the Veteran’s diagnosed hallux valgus, degenerative arthritis and the preexisting condition of hammer toe defects. However, with regard to the Veteran’s bilateral pes planus, the Board determined an additional opinion was required and remanded the claim. The examiner found the Veteran’s bilateral pes planus preexisted service, but she did not provide adequate rationale as to whether the preexisting disorder was aggravated by service. An October 2019 VA opinion was obtained from the examiner that provided the prior April 2019 VA examination report. She again opined the Veteran’s preexisting feet disorders were not aggravated by service. She indicated the Veteran’s STRs are negative for evidence demonstrating permanent worsening of his bilateral hammer toes or pes planus and there is no evidence to suggest that the disorders were aggravated beyond the natural progression by service. She noted the Veteran experienced pain with standing, and this is not uncommon with hammer toes or pes planus diagnoses. The claims came before the Board in October 2020 and it determined remand was necessary for an additional VA opinion from a VA physician to determine whether the Veteran’s preexisting bilateral pes planus and hammertoes were aggravated by his first or second periods of service. Thereafter, a December 2020 VA opinion was submitted from a physician who took note of the Veteran’s in-service treatment, including his initial June 1950 enlistment examination which noted hammer toes and pes planus, and provided a negative nexus opinion. She indicated the Veteran’s feet conditions which clearly and unmistakably preexisted service, were clearly and unmistakably not aggravated beyond the natural progression by service. The examiner opined the Veteran’s STRs are negative for complaints related to bilateral hammer toes. She stated however, the Veteran did seek out treatment for pes planus during service. However, she reported the Veteran’s November 1956 separation examination listed pes planus, 2nd degree, and which was “NCD” (not currently disabling). The examiner indicated the Veteran worked following service at the U.S. Postal Service for approximately 7 years, standing for most of an eight hour workday, and he also worked on an assembly line at Ford Motor plant for approximately 27 years and reported standing for most of his eight hour workdays. Thus, the examiner opined it is less likely than not that the Veteran’s preexisting pes planus and hammertoes increased in severity beyond a temporary flare-up during either period of service and a nexus to service has not been established for the disorders. The Board notes the Veteran submitted a December 2020 statement in which he reiterated his belief that the cause of his foot disorders was the boots issued during service which did not fit properly and were too small and narrow. He stated the “shoe packs” issued in service were not adequate for the harsh winters he faced, and it was difficult for him to “avoid freezing.” In consideration of the evidence of record, including the VA opinions against the claim, the Board determines the Veteran’s bilateral feet disorders did not have their onset during service and are not otherwise related. Additionally, the Veteran’s preexisting bilateral hammer toes and pes planus were not aggravated by service. In reaching this conclusion, the Board accords great probative weight to the April 2019 VA examination report, as well as the December 2020 VA physician’s opinion with regard to the foot disorders that preexisted the Veteran’s service. These opinions were adequate to address the etiology of the Veteran’s feet diagnoses of bilateral pes planus, hammer toes, hallux valgus and degenerative arthritis. Such opinions discussed the Veteran’s contentions and determined his hallux valgus and degenerative arthritis are not directly related to service, and also that his preexisting pes planus and hammer toes were not aggravated by service. Although the December 2020 opinion was phrased in terms of the presumption of soundness language, that is a higher standard than the as likely as not increase in severity service aggravation standard. The Board determines the opinions are clear and unequivocal and based on the evidence of record, including the STRs, as well as relevant medical literature in support. Moreover, the opinions are found to be highly persuasive as they are consistent with the evidence of record and supported by a detailed rationale. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). The Board notes there are no medical opinions of record supporting that the Veteran’s bilateral feet disorders are related service or that a preexisting foot disorder was aggravated by service. The Board acknowledges the Veteran’s lay contentions, including that his current feet symptoms are causally related to service. Further, the Board acknowledges the Veteran’s in-service treatment, including being placed on temporary duty due to his flat feet disorder. However, while the Veteran as a lay person is competent to report experiencing pain and other symptoms related to his feet during service, he lacks the requisite expertise to render a medical opinion as to the etiology of his bilateral feet disorders. This is a complex medical question which falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1977 (Fed. Cir. 2007). Therefore, the Veteran’s lay statements as to the etiology of his feet disorders are afforded less probative weight than the April 2019 and December 2020 VA opinions. In sum, the preponderance of the evidence is against the claims. The Board determines the Veteran’s foot disorders are not related to service and his preexisting bilateral pes planus and hammer toes were not aggravated by service. The preponderance of the evidence is against the claims and the benefit of the doubt doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Therefore, service connection for right and left foot disorders is not warranted. RYAN T. KESSEL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. Isaacs, 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.