Citation Nr: 21015792 Decision Date: 03/18/21 Archive Date: 03/18/21 DOCKET NO. 15-40 541 DATE: March 18, 2021 ORDER Service connection for stress fracture in foot is granted. FINDING OF FACT The evidence is at least in equipoise as to whether the Veteran’s current stress fracture in his foot is related to his active service. CONCLUSION OF LAW The criteria for service connection for stress fracture in foot are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from October 1998 to June 2008. This matter is before the Board of Veterans’ Affairs (Board) on appeal from a November 2013 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In May 2019, the Veteran testified, sitting in Wichita, Kansas, before the undersigned via a Travel Board hearing. A transcript of the hearing has been associated with the virtual file and review. This case was most recently before the Board in August 2020, at which time it was remanded for further development. As the requested development has been completed, no further action to ensure compliance with the remand directives is required. Stegall v. West, 11 Vet. App. 268, 271 (1998). Additionally, an August 2019 Board decision recharacterized the claim of entitlement to service connection for stress fracture, left foot, to include service connection for stress fracture in foot, based on the medical evidence of record. Service Connection Service connection may be granted 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 (a). Service connection may also be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Establishing entitlement to direct service connection generally requires: (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 - which is the so-called “nexus” requirement. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). The Veteran is competent to report symptoms and experiences observable by his senses. See Jandreau, 492 F.3d at 1377; 38 C.F.R. § 3.159(a). VA is required to give due consideration to all pertinent medical and lay evidence in evaluating a claim for disability benefits. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed Cir. 2009).   When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case the claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Service connection for stress fracture in foot. The Veteran contends that his stress fracture in foot is due to his active service. The Veteran’s treatment records indicate that x-ray images revealed an old fracture deformity involving the distal right second metatarsal bone with malalignment with lateral position of the distal fracture component. Evidence of osteophytic lipping and loss of joint space is noted at the first met-cuneiform joint of the right foot. 11/24/2014, Medical Treatment Record –Government Facility, at 2. An August 2020 Board decision remanded the claim of service connection for stress fracture in foot and directed the Agency of Original Jurisdiction (AOJ) to obtain an addendum opinion from an appropriate clinician to determine the nature and etiology of any stress fracture in foot condition, to include residuals. This Board remand remarked that the February 2020 VA medical opinion erroneously found that the medical records are devoid of any diagnosis of a stress fracture in foot and relied on incorrect premise in reaching the medical opinion. Specifically, the treatment records indicate that x-ray images revealed an old fracture deformity involving the distal right second metatarsal bone with malalignment with lateral position of the distal fracture component. And, evidence of osteophytic lipping and loss of joint space is noted at the first met-cuneiform joint of the right foot. 08/24/2020, BVA Decision; 11/24/2014, Medical Treatment Record Government Facility. A December 2020 VA examination noted diagnoses of right foot 2nd metatarsal fracture, right midfoot cuneiform fracture, and bilateral calcaneal spurring. The examiner indicated that the right foot 2nd metatarsal fracture occurred prior to service from a prior injury. And, the examiner indicated that the bilateral calcaneal spurring is an incidental finding typical for any aging person. The examiner indicated that those condition are less likely than not related to the Veteran’s active service. However, within the rationale for the opinion, the examiner also opined that the Veteran’s right midfoot fracture at the first metatarsal cuneiform joint is at least as likely related to his period of active service. Specifically, the Veteran’s hard landings during jumps that caused him to be dazed are also hard enough to cause this type of fracture. 12/22/2020, C&P Exam. The Board finds that the evidence is at least in equipoise regarding whether the current stress fracture in foot is related to the Veteran’s active service. For example, the Board places more weight on the December 2020 VA examination because the pertinent medical history was considered, particularly the Veteran’s credible statements regarding his in-service trauma to his feet during jumps. On the other hand, the February 2020 VA medical opinion is of less weight because it relied on incorrect premise. Therefore, the Board finds that service connection for stress fracture in foot is warranted. 38 C.F.R. § 3.303. Paul Sorisio Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board David Han 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.