Citation Nr: 21013031 Decision Date: 03/08/21 Archive Date: 03/08/21 DOCKET NO. 17-20 963 DATE: March 8, 2021 ORDER Service connection for bilateral pes planus is granted. FINDING OF FACT Competent medical evidence establishes that the Veteran has bilateral pes planus and that it is likely etiologically related to his service. CONCLUSION OF LAW Service connection for bilateral pes planus is warranted. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303, 3.304. REASONS AND BASES FOR FINDING AND CONCLUSION The appellant is a Veteran who served on active duty from June 2007 to June 2011. This matter is before the Board of Veterans’ Appeals (Board) on appeal of an April 2015 Department of Veterans Affairs (VA) rating decision. In November 2020, a virtual hearing was held before the undersigned; a transcript is in the record. Service connection may be established for disability due to disease or injury that was incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. To establish service connection for a claimed disability, there must be evidence of: (i) a present claimed disability; (ii) incurrence or aggravation of a disease or injury in service; (iii) and a causal relationship between the present disability and the disease or injury in service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Secondary service connection is warranted for a disability which is caused or aggravated by a service-connected disease or injury. 38 C.F.R. § 3.310. To substantiate a claim of secondary service connection there must be evidence of: (1) a disability for which service connection is sought; (2) a disability that is already service connected; and (3) the already service connected disability caused or aggravated the disability for which service connection is sought. See Shedden, 381 F.3d 1163. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a layperson. 38 C.F.R. § 3.159 (a)(2). Competent medical evidence is necessary where the determinative question requires medical knowledge. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Competent medical evidence means evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions. Competent medical evidence may also mean statements conveying sound medical principles found in medical treatises. Competent medical evidence may also include statements contained in authoritative writings, such as medical and scientific articles and research reports or analyses. 38 C.F.R. § 3.159 (a)(1). When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. A claim will be denied only if the preponderance of the evidence is against the claim. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 56 (1990). The Veteran contends that his bilateral pes planus is due to physical training in service or, in the alternative, secondary to his service-connected bilateral ankle disability. On August 2006 service entrance examination, the Veteran’s feet were normal on clinical evaluation; normal arches were noted. In a March 2011 separation report of medical history, the Veteran endorsed foot trouble and reported he sprained both feet during PT sessions; it was noted that pain increases with running. In a (contemporaneous) separation report of medical assessment foot pain was noted. On January 2012 VA flatfoot examination, bilateral pes planus with posterior tibialis tendon dysfunction and pronation was diagnosed. The examiner noted the onset date as “2007+”. The Veteran reported that after playing basketball, he presented with painful feet secondary to pes planus. Decreased longitudinal arch height was noted on physical examination. The examiner indicated that examination found pes planus with posterior tibialis tendon dysfunction and pronation associated with instability of the right and left ankles. An April 2012 rating decision awarded service connection for bilateral ankle instability and peroneal tendon complex dysfunction. On April 2015 VA foot conditions examination, bilateral pes planus with posterior tibialis tendon was diagnosed. The examiner opined that the foot disability is less likely related to service, noting he was unable find definitive documentation in his service treatment records that bilateral pes planus developed during his military service. A June 2015 private treatment record notes the Veteran’s report that foot pain developed while he was in service. He indicated that the pain was initially tolerable in the first year but increased in his second year after deployment to a ship on the Mediterranean. He reported hr underwent extensive training and purchased over-the-counter (OTC) support inserts, which provided some relief but still experienced pain. The provider opined that, based on examination and history, that the bilateral foot disability is service connected. In his April 2017 VA Form 9, the Veteran alleges that his foot strains and continuous physical training sessions in service played a vast role in development of his current bilateral pes planus, and that his pes planus is related to his bilateral ankle disability. He reported in his last year [in service], his unit would run 3.5 miles to the main side of Camp Lejuene and on one run he lost feeling in his right foot. At the November 2020 hearing, the Veteran testified that he ran 3 miles in 2008 with flat arches and his condition deteriorated. He was granted a 90-day abeyance for submission of a medical provider’s opinion that pes planus, diagnosed in 2012, is related to service. On November 10, 2020, the Veteran submitted a statement by a private provider in support of the claim. The statement notes the Veteran reported he had no foot issues prior to service, and that pain in his feet gradually increased to a non-tolerable degree during his deployment to the Mediterranean deployment in 2009, which included extensive training sessions on the ship. He reported some relief with from OTC-purchased inserts, but the bilateral foot complaints increased during deployment to Haiti in 2010, and the OTC inserts no longer provided relief. Bilateral pes planus and bilateral painful feet were assessed. The provider opined, that based on the Veteran’s history and clinical findings, the present, ongoing bilateral foot complaints are directly related to the cumulative injury he sustained from 2007-2010 while deployed and training with the Marines. The provider opined that it is likely with a high degree of probability that the present bilateral foot complaints were directly caused by his active duty service in the Marines from 2007 through 2011. It is not in dispute that the Veteran currently has bilateral pes planus. It is also not in dispute that foot pain was noted at his separation from service. There are conflicting medical opinions regarding the etiology of the Veteran’s bilateral pes planus disability. Against the claim is the April 2015 VA examiner’s opinion (indicating that it is less likely than not that the bilateral pes planus disability is related to the complaints in service, noting there was no definitive [emphasis added, as that imposes a standard of proof greater than the “as likely as no” that is required] evidence that the disability manifested in service). The opinion lacks adequate rationale and does not reflect consideration of the January 2012 VA examiner’s opinion that the bilateral pes planus is associated with his service-connected bilateral ankle disability or cite to supporting medical text or treatise. Therefore, the Board finds it somewhat lacking in probative value. In support of his claim, the Veteran has submitted June 2015 and November 2020 opinion statements by private providers, indicating that his bilateral pes planus is related to physical activities and injuries sustained during service. The Board finds the opinions by the private providers to be the more probative evidence in this matter. They reflect familiarity with the record, and the Veteran’s lay accounts, and include rationale that cites to accurate factual data, which were not considered in the opinion to the contrary. Therefore, the Board finds the June 2015 and November 2020 medical opinions cumulatively supporting the Veteran’s claim persuasive. Considering the foregoing, the Board finds the probative value of the evidence supporting the Veteran’s claim is, at least, in equipoise with the evidence weighing against the claim. In such circumstances, governing law (38 U.S.C. § 5107; 38 C.F.R. § 3.102) requires that the matter must be resolved in his favor. Therefore, the criteria for establishing service connection are met; service connection for bilateral pes planus is warranted. GEORGE R. SENYK Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Naumovich, 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.