Citation Nr: 21015636 Decision Date: 03/18/21 Archive Date: 03/18/21 DOCKET NO. 15-43 373 DATE: March 18, 2021 ORDER Entitlement to service connection for bilateral pes planus (claimed as flat feet) is denied. FINDING OF FACT Pes planus existed prior to active duty and did not permanently increase in severity during active duty. CONCLUSION OF LAW Pes planus existed prior to active duty and was not aggravated during such service. 38 U.S.C. §§ 1131 , 1153; 38 C.F.R. §§ 3.303 , 3.304, 3.306. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from September 1989 to March 1990 and November 1990 to July 1991. In August 2020, the Board remanded the case for further development in order to obtain any outstanding private treatment records. An August 2020 correspondence requested any private treatment records and included an authorization to disclose information and a general release to allow VA to obtain the records on behalf of the Veteran. To date the Veteran has not responded. As such, the Board finds that the development required upon remand has been completed. Stegall v. West, 11 Vet. App. 268, 271 (1998). 1. Entitlement to service connection for bilateral pes planus The Veteran claims his preexisting condition of bilateral pes planus was aggravated during active service. He contends that he had callouses and warts in service due to his feet rubbing his footwear in an unusual way resulting in a worsening of his pes planus. Every veteran shall be taken to have been in sound condition when examined, accepted, and enrolled for service, except as to defects, infirmities, or disorders noted at the time of the examination, acceptance, and enrollment, or where clear and unmistakable evidence demonstrates that the injury or disease existed before acceptance and enrollment and clear and unmistakable evidence demonstrates that the injury or disease was not aggravated by service. 38 U.S.C. § 1111 (2012); 38 C.F.R. § 3.304 (b) (2017); Wagner v. Principi, 370 F.3d 1089 (Fed. Cir. 2004) (outlining the presumption of soundness). However, if, a preexisting disorder is noted upon entry into service, the Veteran cannot bring a claim for service incurrence for that disorder, but he may bring a claim for service-connected aggravation of that disorder. Paulson v. Brown, 7 Vet. App. 466, 468 (1995). A preexisting disorder will be considered to have been aggravated by service where there is an increase in disability during such service, unless there is a specific finding that the increase in disability is due to the natural progression of the disease. 38 U.S.C. § 1153 (2012); 38 C.F.R. § 3.306 (a) (2017). It is the Veteran who bears the burden of establishing aggravation under 38 U.S.C. § 1153. Jensen v. Brown, 19 F.3d 1413 (Fed.Cir.1994). The Veteran must submit, or the record must contain, some evidence demonstrating that the preexisting disability increased in severity during service for the presumption of aggravation to attach. Wagner v. Principi, 370 F.3d 1089 (Fed. Cir 2004); Verdon v. Brown, 8 Vet. App. 529 (1996). Once the presumption attaches, it may be rebutted only by clear and unmistakable evidence demonstrating that any increase in disability was due to the natural progress of the disease, which burden is on the government. Wagner v. Principi, 370 F.3d 1089 (Fed. Cir 2004); Cotant v. Principi, 17 Vet. App. 116 (2003); 38 C.F.R. § 3.306 (b) (2017). The Veteran’s enlistment examination dated July 22, 1989 notated a diagnosis of asymptomatic moderate pes planus. As the Veteran’s pes planus was recorded at the time of induction, a preexisting condition is established. 38 C.F.R. § 3.304 (b) Therefore, the burden is on the Veteran to demonstrate that pes planus was aggravated in service. The July 1989 enlistment examination reported asymptomatic moderate pes planus and under the Army rating system, the Veteran received a one for physical (“P”) indicating no limitations at the time of enlistment. In February 1990 the Veteran complained of a callus on the left foot and was diagnosed with plantar wart, which was trimmed with no indication of further complaints or treatment. In November 1990 the Veteran underwent a periodic examination and reported no foot trouble and described his health as good and the clinician noted no significant interval history. At the separation examination in March 1991 the Veteran again denied foot trouble and reported no changes in his health or physical condition since mobilization. The Veteran attended a VA examination in February 2011. The examiner noted that the current diagnosis of pes planus is the same diagnosis noted on the Veteran's entrance examination to active service but concluded that there was no objective evidence of aggravation. As the examiner failed to provide a rationale no weight is given to this opinion. A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. See Nieves- Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). In November 2019 the Veteran underwent another VA examination and reported foot pain in basic training and seeing a podiatrist since 2005. The examiner concluded that pes planus preexisted service but was not aggravated by service noting that the service treatment records reveal that the Veteran denied foot trouble at the periodic examination in November 1990, which was after basic training, and at separation the Veteran reported no changes in his health or physical condition since mobilization again marking no next to foot trouble. The examiner explained that the only foot complaint in the service treatment records was for a plantar wart, which is unrelated to the condition of pes planus. The examiner also noted that at the examination the Veteran reported seeing a podiatrist many years after service and after complaining of foot pain, seven years after active service, in 1997 he received a diagnosis of plantar fascitis. Review of the medical records confirm complaints of foot pain from approximately 1997 with a diagnosis of plantar fascitis and gout in addition to pes planus. There is no competent evidence linking either plantar fasciitis or gout to active duty. The Board notes the Veteran claimed service connection for flat feet. The Board finds that the Veteran has not met the burden of establishing aggravation as the record does not contain evidence demonstrating that pes planus increased in severity during service. 38 U.S.C. § 1153. The opinion of the November 2019 VA examiner is persuasive as it was conducted by a health care professional who reviewed the record, conducted a physical examination and provided an opinion supported by an adequate rationale. The examiner considered and addressed the medical and lay evidence of record to include the in-service complaint of a plantar wart, which the Veteran asserted is indicative of his condition worsening. Furthermore, the medical records are consistent with the examiner’s opinion as they do not contain any additional complaints, treatments or follow ups related to the feet during service. While the Veteran believes his pes planus was aggravated beyond its natural progression due to wearing boots and shoes with flat feet in service, there is no competent medical evidence that pes planus increased in severity while he was on active duty. The Veteran is not competent to offer an opinion on a medically complex issue, which requires specialized medical knowledge and training. Therefore, greater weight is given to the findings of the November 2019 VA examiner. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Thus, after considering all the evidence of record, the Board finds the weight of the evidence is against entitlement to service connection for pes planus. As the preponderance of the evidence is against the claim, the benefit of the doubt rule is inapplicable. See 38 U.S.C. § 5107 (b). The claim is denied. G. A. WASIK Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. A. Prinsen 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.