Citation Nr: 21014988 Decision Date: 03/16/21 Archive Date: 03/16/21 DOCKET NO. 15-31 329A DATE: March 16, 2021 ORDER Entitlement to service connection for bilateral cold foot sensation, as a disability separate and distinct from the service-connected diabetic neuropathy of the right and left lower extremities, is denied. FINDING OF FACT The weight of the evidence is against finding that the Veteran has a diagnosis of a bilateral foot disability that is separate and distinct from his service-connected diabetic neuropathy of the right and left lower extremities. CONCLUSION OF LAW The criteria for entitlement to service connection for a bilateral foot disability, as a disability separate and distinct from the service-connected diabetic neuropathy of the right and left lower extremities, have not been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.310 (2020). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran, who is the appellant in this case, served on active duty from June 1967 to April 1970. This matter comes before the Board of Veterans’ Appeals (Board) from a December 2013 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The case was last before the Board in August 2020 and has returned to the Board for further appellate review. The Board has limited the discussion below to the relevant evidence required to support its finding of fact and conclusion 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); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016). 1. Entitlement to service connection for bilateral cold foot sensation. The Veteran seeks service connection for bilateral cold foot sensation (hereinafter “bilateral foot disability”), as a separate and distinct disability from his service-connected bilateral lower extremity diabetic neuropathy. In January 2013 statement, the Veteran reported swelling, pain, and cold sensitivity affecting his feet as a result of nerve damage related to his service-connected diabetes. Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Generally, to prove service connection there must be: (1) 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 in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Service connection may also be established for a disability which is proximately due to or the result of a service-connected disability. 38 C.F.R. § 3.310(a). Further, a disability which is aggravated by a service-connected disability may be service-connected to the degree that the aggravation is shown. Allen v. Brown, 7 Vet. App. 439 (1995). However, VA will not concede that a nonservice-connected disease or injury was aggravated by a service-connected disease or injury unless the baseline level of severity of the nonservice-connected disease or injury is established by medical evidence created before the onset of aggravation or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity of the nonservice- connected disease or injury. 38 C.F.R. § 3.310. Upon review of the record, the Board finds that the weight of the evidence does not demonstrate the Veteran has a diagnosed bilateral foot disability that is separate and distinct from his already service-connected bilateral lower extremity diabetic neuropathy. Throughout the period on appeal, VA and private treatment records do not reveal treatment for or a diagnosis of a bilateral foot disability that is separate and distinct from the service-connected bilateral lower extremity diabetic neuropathy. Additionally, while the Veteran reported tingling pain in his feet during an August 2019 VA examination, the examiner found that the Veteran did not have a separate diagnosis of a bilateral foot disability. The examiner explained that the Veteran has diabetic peripheral neuropathy in both feet; however, there are no other exam findings that would suggest any other foot disabilities. The examiner indicated that some tenderness was noted over the metatarsals of the Veteran’s left foot; however, this is not a specific exam finding and cannot be directly linked to the diabetic peripheral neuropathy of his feet or to his military service. Moreover, the examiner explained that “cold feet” is not a specific medical diagnosis, but can best be described as a subjective symptom described by the Veteran. As such, the examiner concluded that “cold feet” would be considered a symptom, caused by the diabetic neuropathy in both feet, but not a distinct medical condition. The Board notes that Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability. In the absence of proof of a present disability there can be no valid claim. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Accordingly, without evidence of a current diagnosed bilateral foot disability that is separate and distinct from his service-connected bilateral lower extremity diabetic neuropathy, service connection is not warranted, and the Veteran’s claim must be denied. To the extent Veteran believes he suffers from a bilateral foot disability that is separate and distinct from his diabetic neuropathy, he has not been shown to have the requisite medical knowledge and expertise sufficient to render such an opinion. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis). In this regard, the diagnosis and etiology foot disabilities are matters not capable of lay observation and require medical expertise to determine. In sum, the preponderance of the evidence is against the claim, and service connection is denied. In reaching the above conclusion, the Board considered the doctrine of reasonable doubt; however, as the preponderance of the evidence is against the claim, the doctrine is not for application. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990). Megan R. Thomas Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Lance, 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.