Citation Nr: 22001663 Decision Date: 01/12/22 Archive Date: 01/12/22 DOCKET NO. 17-05 003 DATE: January 12, 2022 ORDER Entitlement to service connection for right foot disorder, to include a skin disorder, is denied. Entitlement to service connection for left foot disorder, to include a skin disorder, is denied. FINDINGS OF FACT 1. Currently diagnosed bilateral metatarsalgia and bilateral hallux valgus of the right foot did not manifest on active-duty service or within the first post-service year, and is not otherwise related to service. 2. Currently diagnosed bilateral metatarsalgia and bilateral hallux valgus of the left foot did not manifest on active-duty service or within the first post-service year and is not otherwise related to service. 3. No currently diagnosed skin condition of the feet had its onset in service or is otherwise related to service. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a right foot disability have not been met. 38 U.S.C. § 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 2. The criteria for entitlement to service connection for a left foot disability have not been met. 38 U.S.C. § 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Air Force from December 1995 to November 1996. This case is before the Board of Veterans' Appeals (Board) on appeal from a December 2015 rating decision of the agency of original jurisdiction (AOJ) of the United States Department of Veterans Affairs (VA) denying entitlement to service connection for right and left foot conditions. These issues were previously remanded by the Board for further development. In September 2021, the Board remanded the issue for an additional VA examination on the nature and etiology of the Veteran's bilateral metatarsalgia and hallux valgus. The claim is once again before the Board. Substantial compliance with the Board's prior remand orders is demonstrated. See Dyment v. West, 13 Vet. App. 141, 146-47 (1999); Stegall v. West, 11 Vet. App. 268, 271 (1998). With respect to the Veteran's claims decided herein, VA has met all statutory and regulatory notice and duty-to-assist provisions. See 38 U.S.C. §§ 5100, 5102, 5103, 5103A, 5106, 5107, 5126; 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326. The Veteran has not advanced any procedural arguments in relation to VA's duty to notify and assist. See Scott v. McDonald, 789 F.3d 1375 (Fed. Cir. 2015). Service connection is awarded for disability that is the result of a disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131. Service connection requires competent evidence showing: (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. Shedden v. Principi, 381 F. 3d 1163 (Fed. Cir. 2004). In determining whether service connection is warranted for a disability, 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 the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded the claimant. Lay assertions may serve to support a claim for service connection by establishing the occurrence of observable events or the presence of disability or symptoms of disability that are 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, 1336 (Fed. Cir. 2006). Some chronic diseases, including arthritis, may be presumed to have been incurred in service, if they become manifest to a degree of ten percent or more within the applicable presumptive period. 38 U.S.C. §§ 1101(3), 1112(a); 38 C.F.R. §§ 3.307(a), 3.309(a). For those listed chronic conditions, a showing of continuity of symptoms affords an alternative route to service connection. 38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). The applicable presumptive period for arthritis is one year from separation. Service treatment records (STRs) complain complaints and treatment for an ingrown toenail on the right foot in January 1996; there were signs of infection. The medical provider recommended a physical profile for use of an athletic shoe. The Veteran was placed on a temporary duty restriction in January 1996 and limited with no running, no physical conditioning, no confidence course, no drill/march, no push-ups, no sit-ups, and athletic shoes only. In October 1996, the Veteran's report of medical assessment indicated the Veteran reported no change since his last medical assessment, no injury, no treatment by a health care provider, no injury in which he did not seek medical care, no conditions that limited his ability to work in his military specialty, and no concerns about his health. The Veteran reported that he had not suffered from any injury or illness while on active duty for which he did not seek medical care. The Veteran's October 1996 separation examination indicated the Veteran's health at separation was normal. No skin condition of either foot was noted at any time during service. In July 2012, private medical records show that the Veteran was diagnosed with and treated for intertrigo and tinea pedis in both feet, and his symptoms "greatly" improved after one week of treatment. The Veteran reported to his doctor that he believed his foot conditions started in service when he began wearing closed-toe shoes. The Veteran reported currently wearing closed-toe shoes as required by his employer. The Veteran submitted a July 2015 private medical opinion. The report is silent as to whether or not the examiner reviewed the Veteran's STRs. The examiner states that while the Veteran was in service, he was diagnosed with exfoliative dermatitis "or something substantially similar" in both feet and was treated with a variety of topical medications. The Veteran reported his symptoms have continued since leaving service, including pain, itching, flaking of the skin, and odor. The examiner reported that the Veteran had a current prescription to treat his feet for exfoliative dermatitis. Upon examination, the examiner confirmed the diagnosis of exfoliative dermatitis. The examiner concluded that the Veteran's diagnosis was most likely mycotic in nature and a permanent condition with onset during service. The examiner did not provide any rationale to support his conclusions. In October 2019, the Veteran was afforded a VA examination for his feet, including a skin examination. The Veteran reported that he had no injuries to his feet before service. The Veteran reported treatment of an ingrown right toenail in service. The Veteran reported that he developed exfoliative dermatitis while in service. The Veteran reported that he was not currently being treated for a foot condition, but that he experienced foot pain all the time. Upon examination, the Veteran's right foot was "normal." The examiner stated that the Veteran had diagnoses of bilateral metatarsalgia, bilateral hallux valgus, and exfoliative dermatitis. The examiner opined that the Veteran's exfoliative dermatitis and ingrown toenail of his right foot are not anatomically due to the foot bones or the foot structure. In October 2020, the Veteran was afforded another VA examination for foot conditions. The examiner reported that the Veteran stated he did not have a left foot disorder. The examiner also stated that the Veteran's available medical records did not show a foot disorder. The examiner cited several medical articles that conclude foot disorders are not a known sequela of exfoliative dermatitis and are not a known sequela of right ingrown toenail removal. In June 2021, the Veteran was afforded another VA examination for foot conditions. The examiner stated that the Veteran's STRs do not show treatment tinea pedis nor exfoliative dermatitis. The examiner concludes that because the Veteran's foot conditions were not diagnosed until 16 years after service, they are not a result of service. In October 2021, the Veteran was afforded another VA examination for his foot conditions. The examiner reviewed the Veteran's records and concluded that because metatarsalgia happens with overuse and was not diagnosed until many years after service, "overuse happened closer to the time of diagnosis instead of several years prior in service." In August 2021, the VA examiner completed an addendum opinion to clarify whether the Veteran's bilateral foot conditions had their onset in or was related to service. The examiner added hallux valgus to his diagnosis list and stated that he could not "attribute it to any in service event without pure speculation." The Veteran asserts there is a nexus between his currently diagnosed bilateral foot conditions and service. While a lay person is competent to testify about their symptoms, or to report what a doctor has told him, only a medical professional is competent to provide a diagnosis. As a lay person, the Veteran is not competent to render an opinion as to the etiology of his claimed bilateral foot conditions as he is a layperson lacking the necessary training and knowledge to do so. Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). Additionally, the Board finds the July 2015 private medical opinion to have little probative value. While the opinion found the Veteran's bilateral foot condition of exfoliative dermatitis to be caused by service, there is no indication the examiner reviewed the Veteran's STRs, which do not contain treatment records for exfoliative dermatitis. To the extent the doctor relied on the Veteran's reports of in-service treatment and diagnosis, such accounts are contradicted by the contemporaneous records. Reonal v. Brown, 5 Vet. App. 458, 460 (1993). Further, the examiner does not diagnosis the Veteran with bilateral metatarsalgia or bilateral hallux valgus. The only competent evidence in the record that addresses the issue of whether there is a nexus to service is the October 2020 and October 2021 VA examinations and medical opinions, which stated that the Veteran's bilateral foot conditions were not related to his service. Notably, to support her conclusion that the Veteran's foot conditions were not related to service, the October 2020 examiner provided several medical articles stating that foot disorders are not a known sequela of exfoliative dermatitis and are not a known sequela right ingrown toenail removal. As the July 2015 private medical opinion is not persuasive, and the October 2020 and October 2021 VA medical opinions were based on a full review of the record as well as an interview and examination of the Veteran, the Board finds them to be probative. The first documented indication of bilateral foot conditions in treatment records occurred approximately 16 years after Veteran's separation from service. STRs do not indicate any related complaints; Veteran's separation exam noted no problems regarding his feet. After a careful review of the record, the Board finds that the evidence does not support a determination that the Veteran's diagnosed bilateral metatarsalgia and bilateral hallux valgus, or his current tinea pedis/exfoliative dermatitis, is etiologically related to his active-duty service. Because there is no competent evidence which links the Veteran's bilateral foot conditions to service, direct service connection is not warranted, and as there is no diagnosis within one-year post-separation, presumptive service connection is not warranted. As there is no evidence to support any finding of a nexus between service and Veteran's current of bilateral foot conditions, service connection is not warranted. In reaching this conclusion, the Board has considered the doctrine of reasonable doubt; however, as the preponderance of the evidence is against the Veteran's claim for service connection for bilateral foot conditions, the doctrine is not applicable. 38 C.F.R. § 5107 (b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 56 (1990). WILLIAM H. DONNELLY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Lauren Barletta 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.