Citation Nr: 21039816 Decision Date: 07/01/21 Archive Date: 07/01/21 DOCKET NO. 14-38 899 DATE: July 1, 2021 ORDER Service connection for a left foot disability, to include as secondary to service-connected bilateral knee disabilities, is granted. FINDING OF FACT The Veteran's left foot disability is aggravated beyond its natural progression by her service-connected bilateral knee disabilities. CONCLUSION OF LAW The criteria for service connection for a left foot disability as secondary to service-connected bilateral knee disabilities are met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.310 (2020). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active duty in the United States Army from August 1990 to August 1992. This matter comes before the Board of Veterans' Appeals (Board) from a November 2010 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran submitted a Notice of Disagreement (NOD) in October 2011 and a Statement of the Case (SOC) was issued in July 2014. The Veteran perfected an appeal by submitting a timely VA Form 9 in September 2014. The issue was previously before the Board. In September 2020, the Board remanded the appeal to the agency of original jurisdiction (AOJ) for additional development. Specifically, the Board directed the AOJ to obtain pertinent medical records and schedule the Veteran for an appropriate VA foot examination. The AOJ associated the Veteran's VA Medical Center medical records and asked the Veteran to identify pertinent medical records in September 2020. The Veteran did not identify any private medical facilities in her VA Form 21-4142. The Veteran was also afforded a VA examination in November 2020. Thus, the Board finds that the AOJ substantially complied with the remand directives and no further action is necessary in this regard. Stegall v. West, 11 Vet. App. 268 (1998). Before the matter was certified to the Board, in a November 2020 rating decision, the RO granted service connection for degenerative arthritis of the right foot and assigned an initial 0 percent rating, effective August 9, 2010. The award of service connection for right foot degenerative arthritis constitutes a complete grant of the benefit sought on appeal. See Grantham v. Brown, 114 F.3d 1156, 1158 (Fed. Cir. 1997) (holding that a separate notice of disagreement must be filed to initiate appellate review of downstream elements such as the disability rating or effective date assigned). The VA Appeals Management Center (AMC) continued the previous denial of service connection for a left foot disability in a supplemental statement of the case (SSOC) issued in December 2020. The Veteran's VA claims file has been returned to the Board for further appellate proceedings. Service Connection Service connection may be granted for a disability resulting from personal injury suffered or disease contracted in the line of duty. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.304. Service connection may also be granted for a disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Establishing service connection generally requires (1) evidence of a current disability; (2) evidence of in-service incurrence or aggravation of a disease or injury; and (3) evidence of a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may be established on a secondary basis for a disability that is proximately due to, or the result of, a service-connected disease or injury. 38 C.F.R. § 3.310(a). Additional disability resulting from the aggravation of a nonservice-connected condition is also compensable under 38 C.F.R. § 3.310(a). The standard of proof to be applied in decisions on claims for VA benefits is set forth in 38 U.S.C. § 5107(b). Under that provision, VA shall consider all information and lay and medical evidence of record in a case before the Secretary with respect to benefits under laws administered by the Secretary. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. Id.; see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). "It is in recognition of our debt to our veterans that society has [determined that,] [b]y tradition and by statute, the benefit of the doubt belongs to the veteran." Gilbert, 1 Vet. App. at 54. Service connection for a left foot disability, to include as secondary to service-connected bilateral knee disabilities After weighing the evidence of record, the preponderance of the evidence supports a causal link between the Veteran's left foot disability and her service-connected bilateral knee disabilities. In November 2020, a VA examiner found no causative relationship between the knees and left foot, but in effect opined that the Veteran's bilateral feet disability was at least as likely as not aggravated beyond its natural progression by a service-connected condition. As rationale, the examiner stated that it was possible that the Veteran's bilateral knee patellofemoral pain syndrome and degenerative joint disease have aggravated her current bilateral foot diagnoses as her knees diagnoses could affect mechanical joint loading and ultimately weight bearing to her bilateral feet. The Board assigns greater probative weight to the November 2020 VA examination than the July 2018 VA examination that was found inadequate in the prior September 2020 Board decision as the November 2020 VA medical opinion is supported by rationale. There are no other medical opinions contrary to the November 2020 VA medical opinion. For the foregoing reasons, service connection for left foot disability as secondary to service-connected bilateral knee disabilities, is granted. J.W. FRANCIS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board H. Yun, 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.