Citation Nr: 21021701 Decision Date: 04/13/21 Archive Date: 04/13/21 DOCKET NO. 15-38 070 DATE: April 13, 2021 ORDER Entitlement to service connection for a left foot disorder, diagnosed as degenerative arthritis, is denied. Entitlement to service connection for a right foot disorder, diagnosed as degenerative arthritis, is denied. FINDINGS OF FACT 1. The most probative evidence reflects that the Veteran’s left foot degenerative arthritis is not related to any incident of active duty, to specifically include the in-service diagnosis of metatarsalgia. 2. 1. The most probative evidence reflects that the Veteran’s right foot degenerative arthritis is not related to any incident of active duty, to specifically include the in-service diagnosis of metatarsalgia. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a left foot disorder, diagnosed as degenerative arthritis, have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for entitlement to service connection for a right foot disorder, diagnosed as degenerative arthritis, have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from August 1983 to June 1987. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a May 2014 rating decision by the Department of Veterans Affairs (VA). In October 2018, the case came before the Board. The Board granted entitlement to service connection for tinnitus and remanded the Veteran’s service connection appeals for disabilities of the feet in order to obtain a VA examination and to obtain treatment records from Walter Reed Army Hospital. In June 2020, the Board remanded the Veteran’s appeals again for an addendum opinion in order to clarify if the Veteran had a diagnosis of bilateral pes planus. The Board’s prior remand directives have been substantially completed, and the Veteran’s appealed issues have been returned to the Board for further appellate consideration. Service Connection 1. Entitlement to service connection for a left foot disorder diagnosed as degenerative arthritis 2. Entitlement to service connection for a right foot disorder diagnosed as degenerative arthritis The Veteran contends that his bilateral foot disorder is related to his military service. In order to establish service connection for the claimed disability, there must be (1) medical evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. See Hickson v. West, 12 Vet. App. 247, 253 (1999). The requirement of a current disability is “satisfied when a claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim.” See McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). Service connection is warranted where the evidence of record establishes that a particular injury or disease resulting in disability was incurred in the line of duty in the active military service or, if pre-existing such service, was aggravated thereby. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. If a condition noted during service is not shown to be chronic, then generally a showing of continuity of symptomatology after service is required for service connection if the disability is one that is listed in 38 C.F.R. § 3.309(a). 38 C.F.R. § 3.303(b); see also Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Service connection may also be granted on the basis of a post-service initial diagnosis of a disease, where the physician relates the current condition to the period of service. 38 C.F.R. § 3.303(d). Other specifically enumerated disorders will be presumed to have been incurred in service if they manifested to a compensable degree within the first year following separation from active duty. 38 C.F.R. §§ 3.309. Lay statements may serve to support a claim for service connection by supporting the occurrence of lay-observable events or the presence of disability or symptoms of disability subject to lay observation. 38 U.S.C. § 1153 (a); 38 C.F.R. § 3.303 (a); Jandreau v. Nicholson, 492 F.3d 1372 (Fed Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). Although lay persons are competent to provide opinions on some medical issues, some medical issues fall outside the realm of common knowledge of a lay person. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). Generally, the degree of probative value which may be attributed to a medical opinion issued by a VA or private treatment provider takes into account such factors as its thoroughness and degree of detail, and whether there was review of the claims file. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000). Also significant is whether the examining medical provider had a sufficiently clear and well-reasoned rationale and a basis in objective supporting clinical data. See Bloom v. West, 12 Vet. App. 185, 187 (1999); Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998); see also Claiborne v. Nicholson, 19 Vet. App. 181, 186 (2005) (rejecting medical opinions that did not indicate whether the physicians actually examined the Veteran, did not provide the extent of any examination, and did not provide any supporting clinical data). In evaluating the evidence in any given appeal, it is the responsibility of the Board to weigh the evidence and decide where to give credit and where to withhold the same and, in so doing, accept certain medical opinions over others. Schoolman v. West, 12 Vet. App. 307, 310-11 (1999). In this regard, the Board has been charged with the duty to assess the credibility and weight given to evidence. Davidson v. Shinseki, 581 F. 3d 1313 (Fed. Cir. 2009); Jandreau, supra. Indeed, the Court has declared that in adjudicating a claim, the Board has the responsibility to do so. Bryan v. West, 13 Vet. App. 482, 488-89 (2000). In doing so, the Board is free to favor one medical opinion over another, provided it offers an adequate basis for doing so. Evans v. West, 12 Vet. App. 22, 30 (1998). Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits under the laws administered by VA. VA shall consider all information and medical and lay evidence of record. Where there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Lastly, in order to deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518 (1996). Analysis As to a current diagnosis, the Board observes that degenerative arthritis of the feet has been diagnosed during the appeal period. As to the Veteran’s lay statements, the Board notes that the Veteran contends that his in-service foot complaints have caused him to develop his present disability. The Board further notes that the Veteran essentially contends that he has experienced pain in his feet since he separated from service. As to the in-service incurrence, the Veteran was treated for metatarsalgia while on active duty. In January 2020, the Veteran attended a VA examination in connection with these appealed issues. The Veteran reported that he injured his feet while on active duty. Following the examination, the examiner found that the Veteran’s diagnosis of degenerative arthritis bilateral feet is less likely as not incurred in or otherwise related to Veteran's active military service. The examiner stated that this opinion was based on a careful consideration of the Veteran’s medical records to include STR’s, an interview with the Veteran, a medical examination, and the use of the most recent medical sources. The examiner stated that per medical literature, degenerative arthritis is degeneration of the cartilage of the joints which occurs from wear and tear over time and is a part of the natural aging process. The examiner stated that the Veteran’s STRs have evidence that the Veteran was diagnosed with metatarsalgia, which subsequently resolved. On January 26, 1987, the Veteran was with complaint of pain and tenderness over plantar (bottom) surface metatarsal heads; referral to orthopedics recommended and Veteran was seen by orthopedics WRAMC on February 5, 1987 for bilateral foot pain and he was diagnosed with metatarsalgia. The examiner stated that per the Veteran’s statement, he had pain in the balls of his feet during basic training; this is more likely than not consistent with metatarsalgia (even though he was not evaluated by medical personnel at that time). The examiner stated that the March 1987 STR showing foot pain when running was metatarsalgia more likely than not due to improper footwear. The examiner stated that the earlier foot pain reported during service (during basic training) was more likely than not metatarsalgia due to improper footwear, the two conditions being directly related. The examiner stated that the Veteran states that his foot pain started during basic training and continued throughout his military career, consistent with the two conditions being related. The examiner further stated that the Veteran's foot pain is due to degenerative arthritis bilateral feet. The examiner stated that there is no evidence in the medical literature that establishes that degenerative arthritis is due to metatarsalgia which is an acute soft tissue injury without any bone or joint involvement, especially metatarsalgia which has been adequately treated and resolved. Lastly, the examiner stated that the Veteran’s degenerative joint disease is due to natural aging process. In December 2020, an addendum opinion was obtained. The examiner explained that the Board misinterpreted the disability benefits questionnaire that he filled out in January 2020 when they determined that the Board had a diagnosis of pes planus. The examiner stated that even if Veterans do not have a flat foot condition, this is the section that is required by the raters to be completed by C&P examiners for all foot conditions for accurate rating. The examiner stated that all findings under this section are due to Veteran’s diagnosis of degenerative arthritis of both feet. The examiner stated that all medical records were reviewed and are silent for a current or past diagnosis of pes planus. The examiner stated that the Veteran’s diagnoses are degenerative arthritis of both feet and metatarsalgia, resolved. The examiner stated that the Veteran was not diagnosed with flatfoot (pes planus). The examiner stated that the Veteran’s physical examination as documented did not exhibit decreased longitudinal arch height on weight bearing, marked deformity of feet (probation, abduction), marked pronation, or the weight bearing line falling over or medial to the great toe, consistent with no diagnosis of flatfeet. Lastly, the examiner stated that the Veteran’s diagnosis is degenerative arthritis of both feet and metatarsalgia, resolved. The Board has also reviewed the Veteran’s medical treatment records. After a review of the Veteran’s records, the Board finds that the Veteran’s medical records are silent for a medical nexus between his current disabilities and his military service. In sum, the Board finds that entitlement to service connection for left and right foot degenerative arthritis is not warranted. After a review of the record, the Board finds that the most probative evidence of record is the January 2020 VA examination and the December 2020 addendum opinion. This evidence demonstrates that the Veteran’s degenerative arthritis is not caused by or related to his in-service metatarsalgia and that his degenerative arthritis is due to natural aging process. The Board has considered the Veteran’s contentions; however, the Veteran’s contentions are outweighed by the findings of the VA examiner because the VA examiner has the medical training to provide an opinion regarding the etiology of the Veteran’s disabilities. For the above stated reasons, the preponderance of the evidence is against the appealed issues, the benefit of the doubt doctrine does not apply, and the appeal to establish service connection for left and right foot degenerative arthritis, must be denied. SCOTT W. DALE Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Rescan, 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.