Citation Nr: 21033651 Decision Date: 06/02/21 Archive Date: 06/02/21 DOCKET NO. 17-16 683 DATE: June 2, 2021 ORDER Entitlement to service connection for bilateral pes planus, to include as secondary to his service-connected bilateral knee disabilities, is granted. Entitlement to service connection for hypertension, to include as secondary to his service-connected bilateral knee disabilities, is granted. FINDINGS OF FACT 1. The Veteran's bilateral pes planus is caused by his service-connected bilateral knee disabilities. 2. The Veteran's hypertension disability is due to pain associated with his service-connected bilateral knee disabilities. CONCLUSIONS OF LAW 1. The criteria for service connection for bilateral pes planus have been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. § 3.102, 3.159, 3.303, 3.310. 2. The criteria for service connection for hypertension have been met. 38 U.S.C. § 1110; 5107; 38 C.F.R. § 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from July 1989 to November 1989. These matters are before the Board of Veterans' Appeals (Board) on appeal from a December 2015 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO) in Montgomery, Alabama. The Veteran testified at a Board virtual hearing before the undersigned in July 2020. A transcript of that hearing is associated with the claims file. Service Connection Service connection generally requires (1) 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) competent evidence of a causal relationship, or nexus, between the claimed in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be established on a secondary basis for a disability if it is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). Where a service-connected disability aggravates a nonservice-connected condition, a veteran may be compensated for the degree of disability (but only that degree) over and above the degree of disability existing prior to the aggravation. Id. Temporary or intermittent flare-ups of symptoms of a condition, alone, do not constitute sufficient evidence of aggravation unless the underlying condition worsened. Cf. Davis v. Principi, 276 F. 3d 1341, 1346-47 (Fed. Cir. 2002); Hunt v. Derwinski, 1 Vet. App. 292, 297 (1991). 1. Entitlement to service connection for bilateral pes planus, to include as secondary to his service-connected bilateral knee disabilities. The Veteran asserts that he should be service connected for his bilateral pes planus disability. See Notice of Disagreement Received January 2016. During the July 2020 Board hearing, the Veteran testified that he did not experience trouble with flat feet until he had trouble with his knees. The Veteran testified that the manner in which he walked to keep the weight off of one foot and put it on the other foot caused him to walk with his feet inward, which in turn, caused his arch to drop. The Veteran also testified that when he spoke to his podiatrist about his bilateral foot disability, he indicated that the arch was crushed and further that the arch dropped on both feet. The Veteran reported that the podiatrist revealed that his issues with his knees was the cause of pes planus. Moreover, the Veteran stated that the podiatrist prescribed medications and cream for the pain and inflammation he experienced in his feet. Additionally, he testified that the issues with his feet began in October of 1992 when he had his knee surgery. The Veteran testified that as he got older his knee problems progressed and caused him to have difficulty walking which directly affected his feet. See July 2020 Hearing Transcript. The Board notes that the Veteran is currently service connected for the following bilateral knee disabilities: instability of the right knee status post meniscectomy, left knee strain, and limited motion of the right knee. See Rating Decision Codesheet Received April 2020. A medical opinion was provided by private examiner Dr. TE to assess the Veteran's bilateral pes planus disability. In an opinion dated August 2020, Dr. TE indicated that he is board-certified to practice podiatry. He noted that he personally reviewed the Veteran's medical history documentation and the circumstances and events of his military service. Dr. TE noted that the Veteran has a diagnosis of pes planus, degenerative arthritis within the midfoot, posterior tibial dysfunction and hallux abducto valgus disability involving both feet. Dr. TE made it clear that he is familiar with the Veteran who has been under his direct care. Dr. TE noted that the Veteran has no other risk factors that may have precipitated his bilateral foot conditions. In providing his medical opinion, Dr. TE stated that after reviewing pertinent medical records, his professional opinion was that it is more than likely that the Veteran's bilateral foot condition is a direct result of his military service. Dr. TE stated specifically that the Veteran's knee disabilities developed due to military service and significantly contributed to the Veteran's current bilateral foot disability. He further stated that his personal experience and medical literature provide support that the relationship of a knee disability causing bilateral foot issues is a common occurrence. The Board finds that Dr. TE thoroughly reviewed the claims file and discussed the relevant evidence, considered the contentions of the Veteran, and provided supporting rationale for the conclusions reached. Barr v. Nicholson, 21 Vet. App. 303 (2007); Stefl v. Nicholson, 21 Vet. App. 120 (2007); Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). The Board recognizes that the August 2020 opinion is the only opinion of record but clearly articulated a medical nexus related to the Veteran's bilateral pes planus disability; no additional opinion or evidence is required. Given the present diagnosis of bilateral pes planus and the positive nexus opinion by Dr. TE, the Board finds that a grant of service connection for bilateral pes planus disability as secondary to the Veteran's service-connected bilateral knee disabilities is warranted. 2. Entitlement to service connection for hypertension, to include as secondary to his service-connected bilateral knee disabilities. The Veteran asserts that he should be service connected for his hypertension disability. See Notice of Disagreement Received January 2016. The Veteran clarified that he is asserting that his hypertension disability is related to his service-connected bilateral knee disability. See Hearing transcript Received July 2020. During the July 2020 Board hearing, the Veteran testified that he began to experience a lot of stress after having surgery on his knees and he believes that the stress associated with his knee disability resulted in high blood pressure. The Veteran testified that he was diagnosed with hypertension in 2015 or 2016. He also testified that his primary care doctor inquired about what things were causing him stress and indicated that such stressors cause hypertension. The Veteran testified that his doctor informed him that he needed to calm down and use rubbing creams on his knees to decrease the stress. See July 2020 Hearing Transcript. As stated above, the Veteran is currently service connected for the following bilateral knee disabilities: instability of the right knee status post meniscectomy, left knee strain, and limited motion of the right knee. See Rating Decision Codesheet Received April 2020. An August 2019 private treatment note lists hypertension as a condition in the Veteran's problem list and amlodipine besylate among the Veteran's current medications. A medical opinion was provided by private examiner Dr. MG to assess the etiology of the Veteran's hypertension disability. In an opinion dated September 2020, Dr. MG stated that the Veteran has a current diagnosis of hypertension and is using medication to treat it. Dr. MG also stated that it is his medical opinion that the Veteran's hypertension is at least as likely as not (50 percent or greater probability) caused by chronic knee pain which is due to his service-connected bilateral knee conditions. As rationale, Dr. MG stated that there is a growing body of clinical evidence that seems to confirm that chronic pain can actually increase a person's blood pressure. Dr. MG further stated that chronic pain relentlessly stimulates the nerves responsible for regulating blood pressure causing it to rise. Moreover, he noted that many people with chronic pain who have discovered they also have high blood pressure did not suffer hypertension prior to the onset of their chronic pain. During an October 2017 VA examination to assess the Veteran's knee disabilities, the Veteran told the examiner that his right and left knee pain was constant and rated as 9/10 and 8/10, respectively. The examiner noted the Veteran has pain on examination in both knee which causes functional loss. The Board finds that the medical opinion provided by Dr. MG is well supported. It is clear that Dr. MG reviewed the claims file and discussed the relevant evidence, considered the contentions of the Veteran, and provided supporting rationale for the conclusions reached. Barr v. Nicholson, 21 Vet. App. 303 (2007); Stefl v. Nicholson, 21 Vet. App. 120 (2007); Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Given the present diagnosis of hypertension, the positive nexus opinion by Dr. MG and the documented pain associated with the Veteran's service-connected knee disabilities, the Board finds that a grant of service connection for hypertension as secondary to the Veteran's service-connected bilateral knee disabilities is warranted. Tiffany Dawson Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Dorsey-Kwansa, 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.