Citation Nr: 24029744 Decision Date: 09/04/24 Archive Date: 09/04/24 DOCKET NO. 20-03 130 DATE: September 4, 2024 ORDER Entitlement to service connection for multi-level lumbar disc degeneration, secondary to service-connected bilateral pes planus, on a causation basis, is granted. Entitlement to service connection for bilateral lower extremity neuropathy, secondary to service-connected bilateral pes planus, on a causation basis, is granted. FINDINGS OF FACT 1. The Veteran's multi-level lumbar disc degeneration is caused by his service-connected bilateral pes planus. 2. The evidence is approximately evenly balanced as to whether the Veteran's bilateral lower extremity neuropathy is caused by his service-connected bilateral pes planus. CONCLUSIONS OF LAW 1. The criteria for service connection for multi-level lumbar disc degeneration, secondary to service-connected bilateral pes planus, on a causation basis, are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 2. With reasonable doubt resolved in favor of the Veteran, the criteria for service connection for bilateral lower extremity neuropathy, secondary to service-connected bilateral pes planus, on a causation basis, are 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 March 1969 to October 1970, which includes service in the Republic of Vietnam. His awards include the Army Commendation Medal. These matters come before the Board of Veterans' Appeals (Board) from a January 2019 rating decision, in which the agency of original jurisdiction (AOJ) denied entitlement to a rating in excess of 30 percent for bilateral pes planus. In August 2023, the Board awarded an increased (50 percent) rating for bilateral pes planus. The Veteran appealed the Board's decision to the United States Court of Appeals for Veterans Claims (Court). In July 2024, the Court set aside the Board's August 2023 decision to the extent that it did not address the issues of entitlement to service connection for lower back disability and lower extremity neuropathy, both as secondary to service-connected bilateral pes planus. See Bailey v. Wilkie, 33 Vet. App. 188 (2021) (38 C.F.R. § 3.155 (d)(2) requires that, when entitlement to secondary service connection is raised, a formal claim for secondary service connection need not be filed, rather, VA must consider those "complications" in connection with the claim on appeal). The Court remanded these matters to the Board for adjudication in compliance with directives specified in a July 2024 Joint Motion filed by counsel for the Veteran and VA. Entitlement to service connection for multi-level lumbar disc degeneration and bilateral lower extremity neuropathy, both as secondary to service-connected bilateral pes planus Service connection is warranted for disability that is proximately due to or the result of service-connected disease or injury. 38 C.F.R. § 3.310 (a). Secondary service connection under 38 C.F.R. § 3.310 (a) is warranted where a non service-connected disability would have been less severe but for a service-connected disability, either because there is an etiological link (to include worsening of functionality) between the two, or because the service-connected disability resulted in the inability to treat the non-service-connected disability. Spicer v. McDonough, 61 F.4th 1360, 1366 (Fed. Cir. 2023). In this case, the Board finds, for the following reasons, that the Veteran has multi-level lumbar disc degeneration and bilateral lower extremity neuropathy, that the back disability is caused by his service-connected bilateral pes planus, and that the evidence is approximately evenly balanced as to whether the bilateral lower extremity neuropathy is caused by the service-connected bilateral pes planus. As noted by the parties to the Joint Motion, a medical professional reported in an August 2021 statement (VA Form 21-4138) that upon clinical examination of the Veteran, it was determined that he had significant pes planus (especially of the left foot) which directly led to pelvic imbalance. This created chronic lower back pain. The pes planus was also directly related to chronic neuropathy of the lower extremities. Overall, there was a direct 100 percent correlation of the dysfunction of the Veteran's feet to his back pain and neuropathy of the lower extremities. In September 2021, a VA physician reviewed the Veteran's claims file and explained that the pain in his distal lower extremities was due to neuropathy. The neuropathy was likely multifactorial, but was unrelated to any service-connected disability. There was no further explanation or rationale provided for this opinion. In a June 2024 statement, J. Huffman, D.C., CCSP (the Veteran's treating physician) explained that the Veteran had chronic pes planus which was directly related to misalignment of the ankle, knee, hip, and pelvis. As these misalignments travel up the kinetic chain of function, it eventually leads to pelvic unleveling, which further created lumbar spine segmental dysfunction. Chronic lumbar segmental dysfunction creates lumbar osteoarthritis and degenerative disc disease. Overall, Dr. Huffman opined that the Veteran's pes planus likely ("more likely than not") led to multi-level lumbar spine disc degeneration. The August 2021 back opinion and Dr. Huffman's June 2024 opinion are based upon examination/treatment of the Veteran and consideration of his reported history, and they are accompanied by specific rationales that are consistent with the evidence of record. Therefore, these opinions are entitled to substantial probative weight. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (most of the probative value of a medical opinion comes from its reasoning). Moreover, although the August 2021 neuropathy opinion and the September 2021 opinion are not accompanied by detailed rationales, reading the opinions as a whole and in the context of the other evidence of record, they reflect conclusions about the etiology of the Veteran's bilateral lower extremity neuropathy based upon examination of the Veteran and/or review of his records and consideration of his reported history. These opinions are therefore entitled to some probative weight. See Monzingo v. Shinseki, Vet. App. 97, 106 (2012) (the fact that the rationale provided by an examiner "did not explicitly lay out the examiner's journey from the facts to a conclusion," did not render the examination inadequate); Acevedo v. Shinseki, 25 Vet. App. 286, 294 (2012) (medical reports must be read as a whole and in the context of the evidence of record). (CONTINUED ON NEXT PAGE) Overall, in light of the above medical opinions, the Board finds that the Veteran has current multi-level lumbar disc degeneration and bilateral lower extremity neuropathy, that the back disability is caused by his service-connected bilateral pes planus, and that the evidence is approximately evenly balanced as to whether the bilateral lower extremity neuropathy is caused by the service-connected bilateral pes planus. Therefore, service connection for multi-level lumbar disc degeneration and bilateral lower extremity neuropathy, both as secondary to service-connected bilateral pes planus, on a causation basis, is warranted. Jonathan Hager Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. Elwood, 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.