Citation Nr: 21012751 Decision Date: 03/05/21 Archive Date: 03/05/21 DOCKET NO. 15-33 417 DATE: March 5, 2021 ORDER Entitlement to service connection for bilateral pes planus is granted. Entitlement to service connection for degenerative joint disease of the right knee is granted. Entitlement to service connection for left knee replacement is granted. Entitlement to service connection for cervical strain, cervical degenerative spondylosis, and degenerative disc disease with stenosis and myelopathy (cervical spine disability) is granted. Entitlement to service connection for right shoulder calcific bursitis secondary to service-connected cervical spine disability is granted. Entitlement to service connection for left shoulder degenerative arthritis secondary to service-connected cervical spine disability is granted. Entitlement to service connection for right cervical radiculopathy secondary to service-connected cervical spine disability is granted. Entitlement to service connection for left cervical radiculopathy secondary to service-connected cervical spine disability is granted. Entitlement to service connection for right wrist strain secondary to service-connected cervical spine disability is granted. Entitlement to service connection for left wrist strain secondary to service-connected cervical spine disability is granted. Entitlement to service connection for right hand strain secondary to service-connected cervical spine disability is granted. Entitlement to service connection for left hand strain secondary to service-connected cervical spine disability is granted. REMANDED Entitlement to service connection for a foot disorder, other than bilateral pes planus, is remanded. Entitlement to service connection for a back disorder is remanded. Entitlement to a total rating based on individual unemployability due to service-connected disabilities (TDIU) is remanded. FINDINGS OF FACT 1. The Veteran’s bilateral pes planus had its onset in service. 2. The Veteran’s right knee degenerative joint disease had its onset in service. 3. The Veteran’s left knee replacement had its onset in service. 4. The Veteran’s cervical spine disability, diagnosed as cervical strain, cervical degenerative spondylosis, and degenerative disc disease with stenosis and myelopathy, had its onset in service. 5. The Veteran’s right shoulder calcific bursitis is proximately due to his service-connected cervical spine disability. 6. The Veteran’s left shoulder degenerative arthritis is proximately due to his service-connected cervical spine disability. 7. The Veteran’s right cervical radiculopathy is proximately due to his service-connected cervical spine disability. 8. The Veteran’s left cervical radiculopathy is proximately due to his service-connected cervical spine disability. 9. The Veteran’s right wrist strain is proximately due to his service-connected cervical spine disability. 10. The Veteran’s left wrist strain is proximately due to his service-connected cervical spine disability. 11. The Veteran’s right hand strain is proximately due to his service-connected cervical spine disability. 12. The Veteran’s left hand strain is proximately due to his service-connected cervical spine disability. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for bilateral pes planus are met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for entitlement to service connection for right knee degenerative joint disease are met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for entitlement to service connection for left knee replacement are met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303. 4. The criteria for entitlement to service connection for a cervical spine disorder are met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303. 5. The criteria for entitlement to service connection for right shoulder calcific bursitis on a secondary basis are met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.310. 6. The criteria for entitlement to service connection for left shoulder degenerative arthritis on a secondary basis are met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.310. 7. The criteria for entitlement to service connection for right cervical radiculopathy on a secondary basis are met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.310. 8. The criteria for entitlement to service connection for left cervical radiculopathy on a secondary basis are met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.310. 9. The criteria for entitlement to service connection for right wrist strain on a secondary basis are met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.310. 10. The criteria for entitlement to service connection for left wrist strain on a secondary basis are met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.310. 11. The criteria for entitlement to service connection for right hand strain on a secondary basis are met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.310. 12. The criteria for entitlement to service connection for left hand strain on a secondary basis are met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from May 1974 to May 1976, with additional National Guard and Reserve service. This matter comes before the Board of Veterans’ Appeals(Board) on appeal from August 2010 and June 2011 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO). In February 2017, the Veteran testified before the undersigned Veterans Law Judge. In December 2017, the Board remanded the appeal for additional development. In October 2020, the Board erroneously sent the Veteran a letter which invited him to amend his outstanding request for a Travel Board hearing in favor of a video teleconference hearing. In November 2020, the Board sent the Veteran a letter to clarify whether he would like to attend an additional hearing before the Board and was given 30 days to respond. The Veteran has not responded to the Board’s December 2020 letter. Thus, the Veteran’s appeal may proceed to readjudication without prejudice. Service Connection Service connection may be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred or aggravated in active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Establishing service connection on a direct basis requires evidence demonstrating: (1) the existence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the claimed in-service disease or injury. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Hickson v. West, 12 Vet. App. 247, 253 (1999); Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff’d per curiam, 78 F. 3d 604 (Fed. Cir. 1996) (table). 1. Entitlement to service connection for bilateral pes planus is granted. The Veteran has a current diagnosis of bilateral pes planus. See March 2019 VA examination report. Thus, the first element of service connection is established. Regarding the second element of service connection, the Veteran’s complete service treatment records (STRs) were determined to be unavailable. The Veteran reports that he was treated for foot problems on active duty in 1975. See November 2009 written statement; March 2013 DRO Pre-Conference Brief. The Veteran testified that he frequently participated in infantry training while carrying heavy backpacks and weapons. See February 2017 Board Hearing at 8-9. The Board finds the Veteran’s report of foot pain surrounding his duties that included infantry training is credible and consistent with the circumstances of his service. 38 U.S.C. § 1154(a). Thus, the second element of service connection is established. As to element three, nexus, an opinion from the April 2019 VA examiner substantiates the claim. Specifically, the April 2019 VA examiner opined that it was as at least as likely as not that the Veteran’s bilateral pes planus was related to his active military service. In providing the positive opinion, the examiner noted that three months following his separation from active service, an August 1976 National Guard enlistment evaluation documented pes planus. See also April 2020 VA medical nexus opinion. Thus, the examiner reasoned that the current bilateral pes planus first onset during active duty. There is no contrary competent medical opinion of record. Accordingly, all necessary elements are met, and service connection is warranted. 38 U.S.C. §§ 1110; 38 C.F.R. § 3.303. 2. Entitlement to service connection for a right knee disorder is granted. 3. Entitlement to service connection for a right knee disorder is granted. The Veteran has current diagnoses of left knee replacement and degenerative joint disease of the right knee. See March 2019 VA examination report. Thus, the first element of service connection is established. Regarding the second element of service connection, the Veteran reported in-service bilateral knee swelling as a result of overuse as it relates to his military occupational specialty (MOS) of an infantryman. The Veteran’s limited available STRs of record do not identify any complaints, treatment, or diagnoses of any knee conditions. His DD Form 214 lists his MOS as an infantryman. The Board finds that his reports of in-service bilateral knee injuries and overuse are consistent with the circumstances of his service and his MOS as an infantryman. 38 U.S.C. § 1154(a). Thus, the second element of service connection is established. As to element three, nexus, an opinion from the March 2019 VA examiner substantiates the claim. The March 2019 VA examiner opined that it was at least as likely as not that the Veteran’s current bilateral knee disorder was the result of his active duty activities. The examiner noted that the Veteran’s MOS required long road marches while carrying heavy weight, which was determined to affect the Veteran’s knees and cause damage over time. There is no contrary competent medical opinion of record. Accordingly, all necessary elements met, and service connection for a bilateral knee disorder is warranted. 38 U.S.C. §§ 1110; 38 C.F.R. § 3.303. 4. Entitlement to service connection for a cervical spine disorder is granted. The Veteran asserts in written statements and in his February 2017 Board hearing testimony that his neck disorder is the result of the rigors of service as an infantryman. VA and private treatment records include diagnoses of cervical strain, cervical degenerative spondylosis, and degenerative disc disease with stenosis and myelopathy. See March 2019 VA examination report. The Veteran’s service treatment records do not identify any complaints, treatment for, or diagnoses related to the cervical spine. However, the Veteran has reported that his neck disorder is the result of riding in an all-terrain military vehicle (ATV) over rough terrain and as a result of a fall during a rifle test and obstacle course. See October 2010 VA Form 21-4142; February 2017 hearing Tr. at 3, 8-9. The Board finds that his reports of in-service neck injuries are consistent with the circumstances of his service and his MOS as an infantryman. 38 U.S.C. § 1154(a). Accordingly, the first and second elements of service connection are established. Thus, this appeal turns on whether there is a nexus between the Veteran’s cervical spine disorder and service. In February 2017, the Veteran’s private treating physician, Dr. R.G. opined that the Veteran’s cervical spondylosis was caused and accelerated by his military service. However, Dr. R.G. utilized speculative language that was not supported by adequate rationale. In March 2019, a VA examiner opined that is at least as likely as not that the Veteran’s cervical spine disorder is the result of his active duty activities. In providing a positive opinion, the examiner noted that the Veteran’s MOS required long road marches while carrying heavy gear. There is no contrary competent medical opinion of record. Accordingly, all necessary elements met, and service connection for a cervical spine disorder is warranted. 38 U.S.C. §§ 1110; 38 C.F.R. § 3.303. 5. Entitlement to service connection for a right shoulder disorder is granted. 6. Entitlement to service connection for a left shoulder disorder is granted. 7. Entitlement to service connection for a right arm disorder is granted. 8. Entitlement to service connection for a left arm disorder is granted. 9. Entitlement to service connection for a right wrist disorder is granted. 10. Entitlement to service connection for a left wrist disorder is granted. 11. Entitlement to service connection for a right hand disorder is granted. 12. Entitlement to service connection for a left hand disorder is granted. The Veteran asserts that his bilateral shoulder, arm, wrist, and hand disorders are secondary to his neck disorder. See February 2017 hearing Tr. at 24. In addition to the elements of direct service connection, service connection may also be granted on a secondary basis for a disability if it is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). The Veteran has current diagnoses of bilateral wrist strain, bilateral cervical radiculopathy, right calcific bursitis, left shoulder degenerative arthritis, and bilateral hand strain. See July 2019 VA examination report. He is also now service-connected for a cervical spine disability. Accordingly, the first two elements of secondary service connection are established. Further, the July 2019 VA examiner opined that the Veteran’s bilateral shoulder, arm, wrist, and hand disorders were as least as likely as not proximately due to or the result of the Veteran’s service-connected cervical spine disability. In providing a positive nexus opinion, the examiner noted that medical literature supports the association of the Veteran’s neck disability to his bilateral shoulder, arm, wrist, and hand disorders based on proximity and the fact that the disorders began subsequent to the neck disability. Further, the examiner explained that cervical radiculopathy occurs when a nerve root in the neck becomes inflamed or compression, causing tingling, numbness, and/or weakness in the shoulder, arm, and hand. There is no contrary medical opinion of record. Thus, service connection for the Veteran’s bilateral shoulder, arm, wrist, and hand disorders is warranted on a secondary basis. See 38 C.F.R. § 3.310(a). REASONS FOR REMAND 13. Entitlement to service connection for a foot disorder, other than bilateral pes planus, is remanded. The Veteran has current diagnoses of bilateral degenerative joint disease of the first metatarsophalangeal joint, calcaneal spur, bilateral hallux valgus, and bilateral plantar fasciitis. See February 2010 VA x-ray and April 2019. As noted above, the Board has found that the Veteran’s report of foot injuries during active duty are consistent with the circumstances of his service and MOS. See 38 U.S.C. § 1154(a). However, the April 2019 VA examiner failed to provide a nexus opinion regarding the Veteran’s diagnosed foot disorders, other than bilateral pes planus. Accordingly, the Board finds that an addendum opinion should be obtained on remand. 14. Entitlement to service connection for a back disorder is remanded. The July 2019 VA examination report includes a diagnosis of degenerative arthritis of the spine with bilateral lower extremity radiculopathy. Based on a review of the evidence of record, the Board expands the scope of the Veteran’s claim to include consideration of service connection on a direct basis. Accordingly, the Board finds that an addendum opinion should be obtained on remand. 15. Entitlement to a TDIU is remanded. Deferment of this issue is required. The issues of bilateral pes planus, bilateral knee, cervical spine, bilateral shoulder, bilateral arm, bilateral wrist, and bilateral hand disabilities have been granted in this decision, disability ratings must be assigned, and thereafter TDIU will be readjudicated. The matters are REMANDED for the following action: 1. Obtain any outstanding VA treatment records. 2. With any necessary assistance from the Veteran, obtain all outstanding private treatment records. If any records are unavailable, notify the Veteran pursuant to 38 C.F.R. § 3.159(e). 3. Then obtain an addendum opinion regarding the etiology of the Veteran’s foot and back disorders. No additional examination of the Veteran is necessary, unless the reviewing examiner deems otherwise. Following a review of the claims file, the examiner should address the following: (a) Is it at least as likely as not (50 percent probability or greater) that the Veteran’s back and foot disorders other than bilateral pes planus, had its onset in or are otherwise related to service, to include as the result of the cumulative impact of his duties that included long road marches while wearing heavy backpacks and weapons related to his MOS as an infantryman? In addressing this question please discuss: (1) the Veteran’s testimony as to foot problems starting during service attributed to running seven to eleven miles while carrying backpacks and a water canteen; (2) his report of treatment for foot problems in 1975; (3) the December 2013 written statement by a fellow servicemember indicating that the Veteran walked with a limp following a squad test; and (4) the Veteran’s reports of continuous foot pain since service. In addressing this question, the examiner must assume items 1-4 as true, even despite the absence of “objective documentation.” (b) Please state whether a nexus between the Veteran’s degenerative arthritis of the spine with bilateral lower extremity radiculopathy, bilateral degenerative joint disease of the first metatarsophalangeal joint, calcaneal spur, bilateral hallux valgus, and bilateral plantar fasciitis (see April and July 2019 VA examination reports) and military service is medically consistent with the symptomatology reported by the Veteran in items (1)-(4) above. (c) For each back and bilateral foot disability identified, please opine as to whether it is at least as likely as not that such disability is (1) proximately due to or (2) aggravated (worsened) by the Veteran’s service-connected disabilities. In addressing secondary service connection, please note that the service-connected disability need not be diagnosed or service-connected at the time the secondary condition (foot and back disorders) are incurred to establish secondary service connection, and reliance on this fact will render any secondary opinion inadequate. A complete rationale shall be given for all opinions and conclusions expressed. 4. If following the above directives, the schedular requirements for a TDIU are not met, refer to the Director of Compensation Service the matter of whether a TDIU is warranted on an extraschedular basis pursuant to 38 C.F.R. § 4.16(b). S. BUSH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Forde, 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.