Citation Nr: 25006455 Decision Date: 05/13/25 Archive Date: 05/13/25 DOCKET NO. 15-46 820 DATE: May 13, 2025 ORDER Entitlement to service connection for left bunionectomy/bilateral hallux valgus is denied. FINDING OF FACT The Veteran's left bunionectomy/bilateral hallux valgus service and was not aggravated during service. CONCLUSION OF LAW The criteria to establish service connection for left bunionectomy/bilateral hallux valgus have not been met. 38 U.S.C. §§ 1110, 5103, 5107 (2012); 38 C.F.R. §§ 3.102, 3.306. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from May 1988 to September 1988 and September 1990 to July 1991. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In November 2018 the issues were remanded by the Board for issuance of an SOC. The matter was remanded by the Board in March 2024 and again in March 2025 to obtain a medical opinion as to whether the Veteran's preexisting status post left bunionectomy bilateral hallux valgus was aggravated by service. A new opinion was obtained in March 2025 and it is adequate. As there has been substantial compliance with the Board's remand directives, the Board will proceed with issuing a decision. See Stegall v. West, 11 Vet. App. 268 (1998). Entitlement to service connection for left bunionectomy/bilateral hallux valgus The Veteran seeks service connection for left bunionectomy/bilateral hallux valgus. The record shows a current diagnosis of bilateral hallux valgus. See March 2025 VA examination. Thus, the first element is satisfied. As a preliminary matter, the Board observes that bilateral hallux valgus was noted upon entry to service; consequently, the claim is one of entitlement to compensation based on aggravation of a preexisting disability. See 38 U.S.C. § 1153 (2012). Where a preexisting disease or injury is noted on the entrance examination, it will be considered to have been aggravated by active duty "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." See 38 U.S.C. § 1153 ; 38 C.F.R. § 3.306 (a). In March 2025 a VA examiner opined that bilateral hallux valgus clearly and unmistakably existed prior to service, and clearly and unmistakably was not aggravated by service beyond its natural progress. The examiner explained that per the service treatment record dated May 138, 1988, the Veteran entered the service with hallux valgus, a condition which is usually chronic and progressive in nature. The examiner explained that due to effects of gravity, weight, activities etc. the metatarsophalangeal deformity is likely to worsen and angulate further. The examiner explained that there is no documented measurement or radiologic evidence to show that the valgus deformity or enlargement worsened any further than or more aggressively than expected. The examiner explained that more specific evidence, namely objective measurement, is needed to show abnormal progression beyond the Veteran's expected worsening. The examiner explained that no in-service records were found to show abnormal injury or progression. The examiner explained that the Veteran's examination on March 22, 2021, shows no significant findings of unnatural aggravation. The examiner explained that the in-service complaints represent flare ups of the pre-existing condition. The examiner explained that as a result of this lack of evidence, no findings suggest unnatural aggravation or progression. The examiner cited to medical literature and explained that per the service treatment record dated, May 13, 1988, the Veteran entered the service with pes planus, a condition which is usually chronic and progressive in nature. The examiner explained that due to effects of gravity, weight, activities etc. the longitudinal arch is expected to collapse/sag further causing worsening flattening. The examiner explained that there is no documented measurement or radiologic evidence to show that the arches collapsed any further than or more aggressively than expected. The examiner explained that more specific evidence, namely objective measurement, is needed to show abnormal progression beyond the Veteran's expected worsening. The examiner explained that the Veteran's for examination done on March 22, 2021, show similar findings of pes planus without signs of unnatural aggravation. The examiner explained that the hallux valgus is due to the pes planus and represents natural progression of the condition. The examiner explained that pes planus may lead to hallux valgus because of increased forefoot abduction that creates a non-physiologic load on the plantar medial aspect of the great toe during heel rise. The examiner cited to further medical literature that regarding pes planus and hallux valgus. The examiner concluded that they had reviewed and acknowledged the Veteran's lay statement to include her assertions of worsening symptomatology dating from her military service. However, the reports of foot pain during the service represent flare-ups of the pre-existing conditions and not unnatural aggravation as claimed. The examiner concluded that as a result of this lack of evidence, no findings suggest unnatural aggravation or progression. Although the Board acknowledges that the Veteran sought treatment for her feet during service, aggravation requires a permanent worsening of the underlying condition, rather than a temporary exacerbation of symptoms. See Browder v. Brown, 5 Vet. App. 268, 271 (1993); Hunt v. Derwinski, 1 Vet. App. 292, 297 (1992); Davis v. Principi, 276 F.3d 1341, 1346 (Fed. Cir. 2002). The competent medical evidence of record, which cited to the Veteran's entrance and separation examination, clearly indicates that her bilateral feet hallux valgus was not aggravated beyond its normal progression. As such, it cannot be said that service aggravated her preexisting hallux valgus. The Veteran is certainly competent to report her foot symptoms, but she is not competent to determine whether her preexisting bilateral hallux valgus was aggravated by her period of active duty. The March 2025 VA opinion is the most probative evidence as to whether his preexisting hallux valgus was aggravated during service, and there is no competent opinion to the contrary. (Continued on the next page) ? The Veteran's bilateral hallux valgus was noted at service entrance, and the weight of the evidence overwhelmingly indicates that it did not increase in severity during service. The probative evidence of record does not show any aggravation of the preexisting bilateral hallux valgus by service; consequently, service connection must be denied. D. SMART Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R.W., Associate 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.