Citation Nr: 25005287 Decision Date: 04/18/25 Archive Date: 04/18/25 DOCKET NO. 20-18 167 DATE: April 18, 2025 ORDER Entitlement to service connection for bilateral pes planus is granted. FINDING OF FACT The Veteran's bilateral pes planus (flatfeet) condition was presumed aggravated by service, and there is no clear and unmistakable evidence that the increase in the condition was due to the natural progression of the disability. CONCLUSION OF LAW The criteria for establishing entitlement to service connection for bilateral flatfeet are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.306. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had honorable active service with the United States Army from July 1970 to February 1972, after which time he entered the United States Army Reserves. This matter is before the Board of Veterans' Appeals (Board) on appeal from an August 2017 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a virtual hearing before the undersigned Veterans Law Judge (VLJ) in September 2022. A written transcript of the hearing has been prepared and is associated with the claims file. The September 2023 and October 2024 Board decisions remanded the claim for additional development. The Board notes that additional records were received and new opinions. After a supplemental statement of the case (SSOC), the claims are back before the Board for adjudication. Service Connection Every veteran shall be taken to have been in sound condition when examined, accepted, and enrolled for service, except as to defects, infirmities, or disorders noted at the time of the examination, acceptance, and enrollment, or where clear and unmistakable evidence demonstrates that the injury or disease existed before acceptance and enrollment and was not aggravated by such service. 38 U.S.C. § 1111; 38 C.F.R. § 3.304(b). Determinations should not be based on medical judgment alone as distinguished from accepted medical principles, or on history alone without regard to clinical factors pertinent to the basic character, origin and development of such injury or disease. 38 C.F.R. § 3.304(b)(1). A preexisting injury or disease will be considered to have been aggravated by service where there is an increase in disability during such service, unless there is a specific finding that the increase in disability is due to the natural progress of the disease. 38 U.S.C. § 1153; 38 C.F.R. § 3.306. Clear and unmistakable evidence (obvious or manifest) is required to rebut the presumption of aggravation where the preservice disability underwent an increase in severity during service. 38 C.F.R. § 3.306. Entitlement to service connection for bilateral flat feet First, the Board finds that the Veteran's pes planus (flatfeet) condition was identified on his examination during entrance to service. The Veteran was found to be qualified for service, and his condition was determined to be asymptomatic. Considering the evidence, the Board finds that there is clear and unmistakable evidence that the Veteran's pes planus pre-existed service. Therefore, the presumption of soundness does not attach to the Veteran's flatfeet condition. Next, there is evidence of in-service worsening. The Veteran reported that marching in service worsened his foot pain symptoms. See C&P Examination received August 2017. Additionally, records from the United States Army Reserves indicated that the Veteran had decreased arches in his feet. See STR-Medical- Photocopy received October 2016. Therefore, the Board finds that the presumption of aggravation applies to the Veteran's bilateral pes planus condition. Since the presumption of aggravation attaches to the Veteran's bilateral flatfoot condition, the main question before the Board is whether there is clear and unmistakable evidence that there was no increase in the condition or that any increase was due to the natural progression of the disability. The opinion obtained in December 2024 stated that pes planus (flatfeet) was a chronic and progressive condition, which due to gravity, weight, and activities could cause the longitudinal arch to collapse or sag further. The examiner stated that no objective measurements or radiologic evidence from the service period or immediately after discharge documented a worsening of the condition beyond its natural course. The examiner stated that while the Veteran reported foot pain and difficulty ambulating during service, these symptoms are commonly associated with flatfeet and do not alone constitute evidence of aggravation beyond the condition's natural progression. As a result of the lack of evidence, the examiner stated that no findings suggested unnatural aggravation or progression. This opinion misapprehends the inquiry. Here, once the Veteran rebuts the presumption of soundness with evidence that the condition worsened in service, the presumption of aggravation attaches and there needs to be clear and unmistakable evidence that the condition was not aggravated thereby or that any change in the condition is due to the natural progression. The examiner has not cited any evidence to show that the worsening was no more than the natural progression. In fact, he has stated that there is no objective evidence at all from service. Moreover, the Board cannot categorically ignore evidence of worsening just because it is not objective. The Board finds that the VA examiner did not clearly and unmistakably rebut the presumption of aggravation. Since the presumption of aggravation has not been rebutted, the presumption of aggravation remains. Accordingly, entitlement to service connection for flatfeet, due to aggravation of a pre-existing condition, is granted. B. MULLINS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Parnell, C. E. 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.