Citation Nr: 21039870 Decision Date: 07/01/21 Archive Date: 07/01/21 DOCKET NO. 14-00 922 DATE: July 1, 2021 ORDER Entitlement to service connection for chronic bilateral foot disabilities, to include bilateral pes planus, plant calcaneal exostosis complicated by calcaneal bursitis and plantar fasciitis, degenerative changes of the talonavicular joint and heel spurs is denied. FINDING OF FACT The medical evidence indicates that the Veteran did not have any chronic bilateral foot disabilities that are due to the or the result of service.. Any arthritis was first shown years post-service. CONCLUSION OF LAW The criteria for service connection for chronic bilateral foot disabilities have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from January 1970 to December 1973. A Board of Veterans' Appeals (Board) hearing was conducted in April 2016 via videoconference. A transcript of this hearing is contained within the claims file. In December 2017, the Board made an unfavorable determination on the Veteran's claim for bilateral pes planus. The Veteran died in January 2018. The appellant is his surviving spouse and was properly substituted in this claim. A November 2018 United States Court of Appeals for Veteran's Claims (Court) Order vacated the Board's decision and adopted a Joint Motion for Remand (JMR) for additional development and re-adjudication of the claim. In May 2019 and most recently in October 2020, the Board remanded the issue on appeal for evidentiary development. It has once again been returned to the Board for further consideration. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Service connection may be presumed for certain chronic diseases, including arthritis, where manifested to a compensable degree within 1 year following separation from qualifying service. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. Entitlement to service connection for chronic bilateral foot disabilities, to include bilateral pes planus, plantocalcaneal exostosis complicated by calcaneal bursitis and plantar fasciitis, degenerative changes of the talonavicular joint and heel spurs. The Appellant contends that the Veteran did not have pes planus when he entered service; however, since his separation examination noted that he had 1st degree pes planus, this disability must have occurred in service and is therefore service connected. The Veteran's service treatment records (STRs) indicate that his September 1969 enlistment examination notes contain a mark indicating "NORMAL" next to the box for "FEET." Next to the box for current or past "foot trouble," "NO" was entered, but then it appears "YES" was checked. He gave a history of a left foot injury in1965 but denied residuals. In his November 1973 separation examination, although it was not listed as a diagnosis, 1st degree pes planus was written in under "Notes." The Veteran's feet were otherwise checked off as "NORMAL" For the category of current or past foot trouble, "NO" was entered. No defects were listed in the "defects" section of the examination report. Between April and June 2009, the Veteran was referred by his private primary care physician to a podiatrist for pain in his right heel. It was reported that the Veteran had had heel pain for 2-3 months that had progressively gotten worse. Dr. D.G. assessed him with pain on digital pressure to the calcaneal process in the right heel in the area of the attachment of the plantar fascia. X-rays indicated plantocalcaneal exostosis in the right heel and a smaller lesion in the left heel. Dr. D.G. diagnosed the Veteran with Right Foot: Plantocalcaneal exostosis complicated by calcaneal bursitis and plantar fasciitis and prescribed low-dye adhesive immobilization, therapy and orthotics after resolution of the heel pain. In the course of several visits, the Veteran reported lessening pain. In a May 2010 general examination at Waco VA, the Veteran reported a "tingling sensation over his feet." However, it was also noted that this had been evaluated by his primary medical doctor, but he had not given a diagnosis. In September 2013, the Veteran underwent an in-person VA examination for pes planus, in which findings included pain in both feet upon manipulation. The September 2013 VA examiner noted that the Veteran had received a November 1973 separation examination "diagnosis" of 1st degree pes planus. However, in her diagnosis, she stated that the Veteran does not now have or has ever had pes planus. She remarked that the "Veteran has an essentially normal arch bilaterally." The September 2013 VA examiner opined that the claimed condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. She explained that there was no pes planus noted during her examination, nor was it found by the VA podiatrist in 2010. A January 2020 VA addendum opinion addressed whether it is at least as likely as not that any of the Veteran's foot disabilities had initial onset in service or is otherwise related to active service. The examiner acknowledged review of the service treatment records as well as all buddy lay statements, private medical records, and government medical records. The examiner notes that while a document indicates a separation examination notation of first-degree pes planus, the examiner asserts the notation has not been identified in the evidence available to that examiner. The examiner further stated that assuming that there was indeed evidence of a single notation of pes planus, the evidence does not support a record of a chronic treatment in service for bilateral pes planus, and no permanent residual or chronic disability is shown by evidence until 2009. Pursuant to the Board's October 2020 Remand, a contract examination was completed in April 2021. It was essentially noted that no chronic foot disability was shown in service, and that nay pes planus identified at separation was not chronic given the absence of subsequent findings. It was further noted that the in-service findings were not early indications of or causes for the foot pathology later identified. In this addendum medical opinion, the examiner stated it is less likely than not that the Veteran's pes planus was indicative of plantocalcaneal exostosis complicated by calcaneal bursitis and plantar fasciitis, degenerative changes to the talonavicular joint, and heel spurs because pes planus is a condition of the arches and plantocalcaneal exostosis complicated by calcaneal bursitis and plantar fasciitis, degenerative changes to the talonavicular joint, and heel spurs affect the heel. The examiner pointed to 1973 STRs that do not document pes planus nor any complaint regarding any foot pathology. Conclusion The Board finds that the RO substantially complied with the October 2020 remand directives. Turning to the record, the Veteran's STRs suggest per planus at separation, but nothing in the record reveals this to have been chronic pathology. Post-service records did not initially reveal findings of pes planus. As such the medical evidence does not support the conclusion that a persistent disability was present in service. Moreover, the preponderance of the medical evidence does not show a link between the Veteran's foot disabilities to include bilateral pes planus, plantocalcaneal exostosis complicated by calcaneal bursitis and plantar fasciitis, degenerative changes to the talonavicular joint, and heel spurs or military service. While the entrance examination notes previous trouble related to a 1965 foot injury, there was no mention of pes planus through 1969. There are no contemporaneous records following discharge that document pes planus, plantar fasciitis, osteoarthritis of the foot, calcaneal bursitis, and degenerative joint disease of the right foot until 2009, post military discharge by 37 years. In sum, the Veteran's STRs do not establish a link between the Veteran's current chronic bilateral foot disabilities and military service. The Board has considered the benefit-of-the-doubt doctrine; however, the Board does not perceive an approximate balance of positive and negative evidence. The preponderance of the evidence is against the claim, the doctrine is not applicable and the claim must be denied. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. MICHAEL D. LYON Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Omosegbon, Babalakin O. 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.