Citation Nr: 22010488 Decision Date: 02/23/22 Archive Date: 02/23/22 DOCKET NO. 11-09 824 DATE: February 23, 2022 ORDER Entitlement to service connection for a bilateral foot disability, other than skin rash, is denied. FINDING OF FACT The Veteran's bilateral foot disabilities, other than skin rash, is not etiologically related to service. CONCLUSION OF LAW The criteria for service connection for a bilateral foot disability, other than a skin rash have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active military service from April 1972 to April 1974. This case comes before the Board of Veterans' Appeals (Board) on appeal from a December 2010 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). In December 2013 and January 2015, the Board remanded the claim to the agency of original jurisdiction (AOJ) for further development. The case was returned to the Board in February 2016, when the Board denied the claim. The Veteran appealed the Board's denial to the United States Court of Appeals for Veterans Claims (the Court). In January 2017, the Court granted a Joint Motion for Partial Remand (JMPR), which vacated the Board's denial and remanded the claim in order to afford the Veteran an adequate VA examination. In April 2017, January 2021, and May 2021, the Board again remanded the claim to the AOJ to obtain additional medical opinions. The appeal has since been returned to the Board for appellate review. 1. Bilateral feet, other than skin rash The Veteran asserts that he has a bilateral foot disability related to his active service. In this regard, the Veteran stated that he began to have blisters on his feet during basic training. Additionally, the Veteran asserted that he developed foot pain associated with cold exposure. Service treatment records (STRs) include a September 1971 enlistment physical examination. The Veteran's feet were clinically examined and deemed normal. However, on the accompanying medical history report, the Veteran endorsed having a history of foot trouble. STRs dated in May 1972 included treatment for right foot folliculitis. Further, it appears the clinician prescribed a pad to wear with his boots. An entry two days later showed that the clinician recommended continuing the previous treatment. In March 1974, the Veteran had a separation examination. His feet were clinically examined and deemed normal. The Veteran's post-service treatment record note multiple diagnoses for his bilateral feet. However, there is no indication that any of the Veteran's bilateral foot disabilities, other than skin rash, have been related to his active service. Initially, the Board notes that the Veteran had previously been provided with multiple VA examinations and opinions. In that regard, there are VA examination reports and opinion from April 2011, April 2014, May 2014, July 2015, August 2015, May 2017, November 2017, June 2019, January 2020, and September 2020. Those examinations have all previously been found to be inadequate to decide the appeal. Indeed, the Board finds that these examination reports and medical opinions either do not include relevant supplementary information or are inadequate for adjudication purposes. As such, the Board will afford those opinions no probative value. The Veteran was more recently afforded a VA examination in January 2021. At that time, the examiner opined that the Veteran's claimed condition was less likely than not caused by the claimed in-service injury. In that regard, the examiner stated that the Veteran's STR's are silent for left degenerative joint disease (DJD) of the toes, left calcaneal heel, right below the knee amputation (BKA) or onychomycosis of the feet. The examiner opined these disabilities began after service, and that it takes many years to develop degenerative arthritis and calcaneal heel spurs. Moreover, the Veteran developed degenerative arthritis due to his advanced age, and again is well known to be the main component in developing degenerative arthritis. The examiner stated that DJD and calcaneal heel of the left foot was due to daily walking which caused overuse of the foot. Moreover, it has been greater than 30 years since service when these disabilities presented and would have shown up in service had they been an acute condition. Further, the examiner stated that left foot onychomycosis was due to a fungal infection which occurs due to poor nail grooming, being immunosuppressed with diabetes and his advanced age. Shortly thereafter, in May 2021, the Board noted that the January 2021 VA examiner provided an opinion on the Veteran's left foot, but did not address the Veteran's disabilities of the right foot prior to his January 2017 below the knee amputation. Additionally, the Board noted that the examiner did not address the Veteran's assertion that he had foot pain as a result of a cold injury. Thus, the Board requested that an addendum opinion be obtained. Shortly thereafter, in November 2021, a VA addendum opinion was obtained. At that time, the VA examiner opined that it was less likely than not that the Veteran's claimed conditions were incurred in or caused by the claimed in-service injury, event, or illness. In that regard, the examiner stated that the STRs were negative for degenerative arthritis of the right and left foot, calcaneal spurs of the right and left foot, and onychomycosis of the right and left foot during active service. Further, there was no evidence of a cold injury to the feet or toes found in the Veteran's STRs and no objective findings in the claims file consistent with a cold injury to the toes and feet. Further, the examiner noted that the Veteran was diagnosed with arthritis of the bilateral feet over 40 years after separation from service. The examiner also stated that the Veteran's right foot amputation resulted from a bone infection after a penetrating trauma in 2017. The Board finds that the January 2021 and November 2021 VA examinations and medical opinions are adequate, when read in conjunction with one another, as the examiners thoroughly reviewed and discussed the relevant evidence, considered the contentions of the Veteran, and provided thorough supporting rationales 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). Additionally, there are no medical opinions of record to the contrary. As a result, the Board finds the opinions provided by the VA examiners to be the most probative evidence of record. While the Veteran is competent to report observable symptoms of foot pain, he is not competent to provide an opinion linking his diagnosed foot disabilities to active service, as that requires medical expertise and is outside the realm of common knowledge of a layperson. Kahana v. Shinseki, 24 Vet. App. 428 (2011); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Therefore, the Veteran is not competent to provide an etiology opinion in this case. (Continued on the next page) Accordingly, the Board finds that the benefit-of-the-doubt rule is not applicable as the evidence is not in approximate balance, and entitlement to service connection for a bilateral foot disability, other than skin rash is not warranted. 38 U.S.C. § 5107 (b) (2018); Lynch v. McDonough, 2021 U.S. App. LEXIS 37307, No. 2020-2067 (Fed. Cir., Dec. 17, 2021). Cory M. Picton Veterans Law Judge Board of Veterans' Appeals Attorney for the Board I. Cannaday, 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.