ANKLE IMPAIRMENT OF

MARCUS N. FULTON · 2025 · Case ID: A25106647

GRANTED

Summary

The Veteran, who served from June 1985 to November 1991, appeals the denial of service connection for a left ankle condition, sleep apnea, a lower back condition, and a right hip condition, all claimed as secondary to his service-connected bilateral pes planus, bilateral hallux valgus, degenerative joint disease of the right knee, and right ankle calcaneal spur. The Board reviewed the evidence, including multiple VA examinations and a private medical opinion from physician assistant M.K. The VA examiners provided unfavorable opinions for the left ankle, sleep apnea, lower back, and right hip conditions, citing less likely than not nexus or lack of specific findings. However, the Board found the private opinion from M.K. to be more probative. M.K. provided a detailed rationale, citing medical literature, to support a secondary service connection for all four claimed conditions, explaining how the service-connected foot and knee issues biomechanically contributed to the subsequent development of the ankle, sleep apnea (via obesity), lower back, and hip conditions. The Board found M.K.'s opinion persuasive and the VA opinions less so due to their limited scope or lack of detailed analysis. Consequently, the Board granted service connection for the left ankle, sleep apnea, lower back, and right hip conditions as secondary to the established service-connected conditions.

Rationale

Private opinion from M.K. found probative; VA opinions found less probative due to limited scope; Medical literature supports biomechanical link

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250619-555870

Full Decision Text

Citation Nr: A25106647
Decision Date: 12/10/25 Archive Date: 12/10/25

DOCKET NO. 250619-555870
DATE: December 10, 2025

ORDER

Entitlement to service connection for a left ankle condition as secondary to bilateral pes planus, bilateral hallux valgus, degenerative joint disease of the right knee, and right ankle calcaneal spur is granted.

Entitlement to service connection for sleep apnea as secondary to the Veteran's service-connected bilateral pes planus, bilateral hallux valgus, degenerative joint disease of the right knee, and right ankle calcaneal spur is granted.

Entitlement to service connection for a lower back condition as secondary to bilateral pes planus, bilateral hallux valgus, degenerative joint disease of the right knee, and right ankle calcaneal spur is granted.

Entitlement to service connection for a right hip condition as secondary to bilateral pes planus, bilateral hallux valgus, degenerative joint disease of the right knee, and right ankle calcaneal spur is granted.

FINDINGS OF FACT

1. The most probative evidence of record persuasively weighs in favor of a finding that the Veteran's left ankle condition is secondary to bilateral pes planus, bilateral hallux valgus, degenerative joint disease of the right knee, and right ankle calcaneal spur.

2. The most probative evidence of record persuasively weighs in favor of a finding that the Veteran's sleep apnea is secondary to bilateral pes planus, bilateral hallux valgus, degenerative joint disease of the right knee, and right ankle calcaneal spur, with obesity as an intermediate step.

3. The most probative evidence of record persuasively weighs in favor of a finding that the Veteran's lower back condition is secondary to bilateral pes planus, bilateral hallux valgus, degenerative joint disease of the right knee, and right ankle calcaneal spur.

4. The most probative evidence of record persuasively weighs in favor of a finding that the Veteran's right hip condition is secondary to bilateral pes planus, bilateral hallux valgus, degenerative joint disease of the right knee, and right ankle calcaneal spur.

CONCLUSIONS OF LAW

1. The criteria for service connection for a left ankle condition, secondary to service-connected bilateral pes planus, bilateral hallux valgus, degenerative joint disease of the right knee, and right ankle calcaneal spur on a causation basis, have been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.303, 3.304, 3.310.

2. The criteria for service connection for sleep apnea, secondary to service-connected bilateral pes planus, bilateral hallux valgus, degenerative joint disease of the right knee, and right ankle calcaneal spur on a causation basis, with obesity as an intermediate step, have been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.303, 3.304, 3.310.

3. The criteria for service connection for a lower back condition, secondary to service-connected bilateral pes planus, bilateral hallux valgus, degenerative joint disease of the right knee, and right ankle calcaneal spur, have been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.303, 3.304, 3.310.

4. The criteria for service connection for a right hip condition, secondary to service-connected bilateral pes planus, bilateral hallux valgus, degenerative joint disease of the right knee, and right ankle calcaneal spur, have been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.303, 3.304, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from June 1985 to November 1991.

This appeal is being processed under the modernized review system, commonly referred to as the "AMA," as established by the Veterans Appeals Improvement and Modernization Act of 2017. 115 Pub. L. No. 55, 131 Stat. 1105.

This matter comes before the Board of Veterans' Appeals (Board) on appeal of a July 2024 and an August rating decision issued by a Department of Veterans Affairs (VA) regional office, an agency of original jurisdiction (AOJ).

The Veteran initiated his appeal to the Board by submitting a June 2025 VA Form
AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from June 1985 to November 1991.

The Veteran initiated his appeal to the Board by submitting a June 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement) (NOD), and elected the Evidence Submission docket. Therefore, the Board may only consider the evidence of record that the AOJ was permitted to consider at the time it issued the July 2024 rating decisions on appeal, as well as any evidence submitted by the Veteran or their representative with or within 90 days from the Board's receipt of the VA Form 10182. 38 C.F.R. § 20.303.

If evidence was submitted either (1) during the period after the AOJ issued the July 2024 rating decisions and prior to the date the Board received the VA Form 10182, or (2) more than 90 days following the date the Board received the VA Form 10182, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.303, 20.801.

Service Connection

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004).

Further, service connection may be established on a secondary basis for a disability that is caused or aggravated by a service-connected disease or injury. 38 U.S.C. § 1110; 38 C.F.R. § 3.310(a), (b). Establishing service connection on a secondary basis requires competent and credible evidence demonstrating (1) the existence of a current disability; (2) a service-connected disability; and (3) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. 38 C.F.R. § 3.310 (a), (b); see also Spicer v. McDonough, 61 F.4th 1360, 1366 (Fed. Cir. 2023).

VA General Counsel has interpreted that obesity may act as an "intermediate step" to establish proximate causation between a service-connected disability and a current disability that may be service connected on a secondary basis under 38 C.F.R. § 3.310(a). To establish that a service-connected disability proximately caused a current disability through obesity, the adjudicator must determine: (1) whether the service-connected disability caused the Veteran to become obese; (2) if so, whether the obesity as a result of the service-connected disability was a substantial factor in causing the current disability; and (3) whether the current disability would not have occurred but for obesity caused by the service-connected disability. If all of these questions are answered in the affirmative, then the current disability may be service connected on a secondary basis. The Court of Appeals for Veterans Claims (Court) recently held that obesity as an "intermediate step" in a causal chain for service connection can be established on either a causal or aggravation basis. Walsh v. Wilkie, 32 Vet. App. 300 (2020).

1. Entitlement to service connection for a left ankle condition, to include as secondary to service-connected bilateral pes planus, bilateral hallux valgus, degenerative joint disease of the right knee, and right ankle calcaneal spur.

The Veteran contends that his left ankle condition is due to his service, to include as secondary to his service-connected bilateral pes planus, bilateral hallux valgus, degenerative joint disease of the right knee, and right ankle calcaneal spur. See March 2023 VA Form 20-0995, Supplemental Claim Application.

In December 2022, the Veteran underwent a VA examination. The examiner diagnosed the Veteran with a left ankle
Vet. App. 300 (2020).

In December 2022, the Veteran underwent a VA examination. The examiner diagnosed the Veteran with a left ankle strain and noted his current symptoms of swelling, pain, and instability, and that the current x-ray of the left ankle was normal. The examiner opined that the Veteran's right heel bone spur can cause tendonitis of the affected foot, commonly seen with plantar fasciitis, but there was no evidence to suggest the bone spur of the right heel would cause ankle strain of the left ankle, as ankle strains are most often caused by direct injury to the affected ankle. Therefore, the examiner concluded that the Veteran's left ankle strain was less likely than not proximately due to or the result of the Veteran's right heel bone spur.

In July 2023, a VA examiner reviewed the Veteran's record and opined that the Veteran had no diagnosis of a left ankle condition, as there was no evidence of ligamentous laxity, swelling, discoloration, or calor, and his ankle x-rays were normal. The examiner noted that the Veteran experienced significant foot tenderness and some altered sensation near the great toes due to his bunionectomies, and as a result, has an antalgic gait; however, the examiner opined that this does not result in ankle injury. The examiner concluded that the left ankle condition was less likely than not proximately due to or the result of the Veteran's bilateral pes planus, right ankle calcaneal spur, and left hallux valgus.

In September 2025, the Veteran submitted a report from M.K., a board-certified physician assistant, who reviewed the Veteran's record and rendered a nexus opinion. M.K. noted that both VA examiners documented pain with weight-bearing, flare-ups, and occupational limitations consistent with a functional ankle disability. M.K. concluded that, by failing to address these functional impairments, the prior denials did not adequately evaluate the causal relationship between the Veteran's service-connected foot deformities and his current left ankle disability.

M.K. noted that the relevant medical literature supported that pes planus reduces medial arch stability, produces excessive pronation, and increases hindfoot valgus, while hallux valgus reduces first-ray push-off efficiency and alters forefoot loading, and that knee degenerative joint disease and malalignment have been shown to shift abnormal loads to the contralateral ankle, while calcaneal spurs disrupt normal dorsiflexion and further destabilize gait through repetitive vertical compression and fascial traction. These combined deformities disrupt gait mechanics and transmit abnormal torsional and shear forces into the subtalar and tibiotalar joints, resulting in chronic overload of the ankle stabilizers. Studies have demonstrated that such compensatory mechanics lead to increased joint strain, impaired balance, and a higher risk of recurrent flare-ups or missteps on uneven surfaces. M.K. further opined that the Veteran's foot and knee pathology preceded and biomechanically contributed to the gradual onset of his chronic left ankle pain, recurrent flare-ups, and functional instability. Based on the foregoing, M.K. opined that the Veteran's diagnosed left ankle strain is secondarily related to his service-connected bilateral pes planus, bilateral hallux valgus, degenerative joint disease of the right knee, and right ankle calcaneal spur.

The Board notes that the September 2025 private opinion was based on a review of the Veteran's claims file and gave a thorough rationale based on the relevant medical literature, and therefore finds it to be probative nexus evidence. See Guerrieri v. Brown, 4 Vet. App. 467, 473 (1993) ("the probative value of medical opinion evidence is based on the medical expert's personal examination of the patient, the physician's knowledge and skill in analyzing the data, and the medical conclusion the physician reaches . . . . As is true with any piece of evidence, the credibility and weight to be attached to these opinions [are] within the province of the [Board as] adjudicators . . . ."). The Board also notes that the December 2022 VA examiner only addressed the effect of the Veteran's right ankle condition, and did not consider his other service-connected conditions. Furthermore, the July 2023 VA examiner
See Guerrieri v. Brown, 4 Vet. App. 467, 473 (1993) ("the probative value of medical opinion evidence is based on the medical expert's personal examination of the patient, the physician's knowledge and skill in analyzing the data, and the medical conclusion the physician reaches . . . . As is true with any piece of evidence, the credibility and weight to be attached to these opinions [are] within the province of the [Board as] adjudicators . . . ."). The Board also notes that the December 2022 VA examiner only addressed the effect of the Veteran's right ankle condition, and did not consider his other service-connected conditions. Furthermore, the July 2023 VA examiner did not address the literature addressed by the September 2025 private examiner. The Board therefore affords these opinions less probative weight.

The Board therefore finds that the evidence of record persuasively weighs in favor of a finding that the Veteran has a current left ankle condition due to his service-connected bilateral pes planus, bilateral hallux valgus, degenerative joint disease of the right knee, and right ankle condition.

Accordingly, entitlement to service connection for a left ankle condition, secondary to the Veteran's service-connected bilateral pes planus, bilateral hallux valgus, degenerative joint disease of the right knee, and right ankle condition, is warranted.

2. Entitlement to service connection for sleep apnea to include as secondary to service-connected bilateral pes planus, bilateral hallux valgus, degenerative joint disease of the right knee, and right ankle calcaneal spur.

The Veteran contends that his sleep apnea is due to his service, to include as secondary to his service-connected right knee, bilateral pes planus, right hallux valgus, degenerative joint disease of right metatarsophalangeal joint, right ankle, and left foot hammer toes, with obesity as an intermediate step. See April 2024 VA Form 20-0995, Supplemental Claim Application.

In the July 2024 rating decision on appeal, the AOJ made a favorable finding that the Veteran has a current diagnosis of sleep apnea, and that the claimed primary disability is service-connected. 38 C.F.R. § 3.104(c). No clear and unmistakable error has been shown; therefore, the Board is bound by this favorable finding. Id. Thus, the Board's analysis will focus on the nexus element of service connection.

In July 2021, the Veteran underwent a VA examination. The examiner noted the Veteran's statement that his condition was due to weight gain secondary to inactivity from his various foot and knee injuries. The examiner then opined that, while obesity is a recognized risk factor for sleep apnea, the Veteran's BMI is 29, placing him at the upper limit of the overweight category, but not at the obese category, and stated that obesity is a function of excessive caloric intake, independent of ability to exercise. Based on the foregoing, the examiner concluded that the Veteran's sleep apnea is less likely than not proximately due to or the result of his service-connected disabilities.

In May 2023, the Veteran underwent another VA examination. The examiner noted the Veteran's statement that he began snoring in the military, which continued after he got married, and experiences daytime somnolence even with the use of a CPAP. The examiner noted that the Veteran was not taking medications that would affect relaxation of the tongue, and that there is no pathophysiologic mechanism for an unspecified depressive disorder to be the proximate cause of obstructive sleep apnea. The examiner noted the Veteran's sleep study demonstrates an absence of obstruction while on his side and severe obstruction while supine. Therefore, the examiner opined that the Veteran's sleep apnea is less likely than not proximately due to or the result of his unspecified depressive disorder. The examiner did not address whether obesity could be considered as an intermediate step.

In September 2025, the Veteran submitted an opinion from M.K., a board-certified physician assistant, who reviewed the Veteran's record and rendered a nexus opinion. M.K. noted that VA examination findings document that the Veteran is unable to stand for more than a few minutes, requires assistive devices, and prolonged standing consistently aggravates his pain. Over the years, the cumulative effect of these service-connected conditions caused a sedentary lifestyle that predisposed him to progressive weight gain. By the time of his obstructive sleep apnea diagnosis, his weight had risen to 200 pounds, corresponding to a BMI of 34.3, which meets the criteria for clinical obesity.

M.K. documented medical literature which supports that obesity is a risk factor for upper airway collapse, primarily due to excess adipose tissue in the neck and pharyngeal structures that narrows the airway and impairs airflow during
M.K. noted that VA examination findings document that the Veteran is unable to stand for more than a few minutes, requires assistive devices, and prolonged standing consistently aggravates his pain. Over the years, the cumulative effect of these service-connected conditions caused a sedentary lifestyle that predisposed him to progressive weight gain. By the time of his obstructive sleep apnea diagnosis, his weight had risen to 200 pounds, corresponding to a BMI of 34.3, which meets the criteria for clinical obesity.

M.K. documented medical literature which supports that obesity is a risk factor for upper airway collapse, primarily due to excess adipose tissue in the neck and pharyngeal structures that narrows the airway and impairs airflow during sleep. Individuals with chronic orthopedic conditions and reduced physical activity are at elevated risk for weight gain because of mobility limitations, persistent pain, and decreased energy expenditure. Obesity contributes to anatomical narrowing of the airway, and research has found that even a modest 10% increase in weight can equate to a six-fold increase in OSA risk. Based on the foregoing, M.K. opined that the Veteran's service-connected orthopedic limitations have significantly reduced his physical activity, which contributed to progressive weight gain from a healthy BMI at enlistment to clinical obesity by the time of his sleep apnea diagnosis. M.K. included an analysis of relevant medical literature and concluded that was at least as likely as not that the Veteran's sleep apnea was secondary to his service-connected right knee degenerative joint disease, hallux valgus, cervical spine degenerative joint disease, and right ankle calcaneal spur, with obesity as the intermediate factor.

The Board therefore finds that the evidence of record persuasively weighs in favor of a finding that the Veteran's sleep apnea is due to his service-connected bilateral pes planus, bilateral hallux valgus, degenerative joint disease of the right knee, and right ankle condition, with obesity as an intermediate step.

Accordingly, entitlement to service connection for sleep apnea, secondary to the Veteran's service-connected bilateral pes planus, bilateral hallux valgus, degenerative joint disease of the right knee, and right ankle condition, with obesity as an intermediate step, is warranted.

3. Entitlement to service connection for a lower back condition to include as secondary to include as secondary to service-connected bilateral pes planus, bilateral hallux valgus, degenerative joint disease of the right knee, and right ankle calcaneal spur.

The Veteran contends that his lower back condition is due to his service, to include as secondary to his service-connected right knee, bilateral pes planus, right hallux valgus, degenerative joint disease of right metatarsophalangeal joint, right ankle, and left foot hammer toes. See April 2024 VA Form 20-0995, Supplemental Claim Application.

In the July 2024 rating decision on appeal, the AOJ made a favorable finding that the Veteran has current diagnoses of mild facet arthrosis L3-4 and L4-5, moderate facet arthrosis, and that the claimed primary disability is service-connected. 38 C.F.R. § 3.104(c). No clear and unmistakable error has been shown; therefore, the Board is bound by this favorable finding. Id. Thus, the Board's analysis will focus on the nexus element of service connection.

In July 2021, the Veteran underwent a VA examination. The examiner listed risk factors associated with back pain complaints include smoking, obesity, age, female sex, physically strenuous work, sedentary work, psychologically strenuous work, low educational attainment, workers' compensation insurance, job dissatisfaction, and psychological factors such as somatization disorder, anxiety, and depression. The examiner opined that the Veteran's condition was a very early manifestation of osteoarthritis and, in the absence of a clear and discrete injury, is most likely secondary to age and is independent of acute or chronic conditions which may alter gait. Therefore,
favorable finding. Id. Thus, the Board's analysis will focus on the nexus element of service connection.

In July 2021, the Veteran underwent a VA examination. The examiner listed risk factors associated with back pain complaints include smoking, obesity, age, female sex, physically strenuous work, sedentary work, psychologically strenuous work, low educational attainment, workers' compensation insurance, job dissatisfaction, and psychological factors such as somatization disorder, anxiety, and depression. The examiner opined that the Veteran's condition was a very early manifestation of osteoarthritis and, in the absence of a clear and discrete injury, is most likely secondary to age and is independent of acute or chronic conditions which may alter gait. Therefore, the examiner concluded that the Veteran's lower back condition was less likely than not related to his other physical conditions.

In May 2023, the Veteran underwent another VA examination. The examiner opined that, while heel spurs often coexist with plantar fasciitis, it is unclear whether they have a causal role, and that the minimal findings on the Veteran's lumbar MRI are most consistent with aging. The examiner then concluded that the Veteran's back condition was less likely than not proximately due to or the result of his right ankle calcaneal spur. The examiner did not address the Veteran's contention that his service-connected foot, ankle, and knee conditions were related to his lower back condition.

In June 2025, the Veteran submitted an opinion from Dr. S.T.S., who is board-certified in internal medicine and has been treating the Veteran since October 2020. Dr. S.T.S. reviewed the Veteran's record and noted the Veteran's statement that he underwent a right bunionectomy in 1990 on active duty, and subsequently developed focal neuralgia. Dr. S.T.S. noted the lack of sensation in the Veteran's right foot has led to difficulty with ambulation and repositioning of his right knee to compensate for the decreased position sense, causing him to experience low back pain. Based on the foregoing, Dr. S.T.S. concluded that the Veteran's lower back pain is more likely than not a result of the complications sustained from his right bunionectomy during service.

In September 2025, the Veteran submitted an opinion from M.K., a board-certified physician assistant, who reviewed the Veteran's record and rendered a nexus opinion. The examiner noted the Veteran's report of a gradual onset of mechanical low back pain after years of painful flatfoot, hallux valgus surgery with sensory loss in the toes, right knee degenerative changes, and right ankle pathology. The Veteran further described sharp pain and episodic spasm with reaching, with flare-ups precipitated by prolonged standing and routine household tasks such as washing dishes. He uses a cane regularly for balance and support, as needed. M.K. noted that bilateral pes planus reduces medial arch stability and produces chronic over-pronation and hindfoot valgus, while hallux valgus compromises first-ray push-off and alters forefoot loading. The Veteran's right knee and right ankle further restrict normal ankle dorsiflexion and encourage asymmetrical loading. Together, these service-connected conditions generate persistent tibial internal rotation, pelvic obliquity, and compensatory trunk lean during stance and gait. This consequently necessitates cane use, and further increases abnormal trunk and pelvic compensations. M.K. explained that this mechanism explained the Veteran's symptom pattern, citing relevant medical literature, and opined that the previous VA examiners failed to address the medically recognized pathway by which distal deformities and malalignment produce abnormal lumbar loading, facet joint stress, and degenerative progression. Based on the foregoing, M.K. concluded that the Veteran's lumbar spine disability was secondarily related to his service-connected bilateral pes planus, bilateral hallux valgus, right knee degenerative joint disease, and right ankle calcaneal spur.

The Board notes that M.K.'s opinion was based on a review of the Veteran's claims file and the relevant medical literature, and therefore finds it to be probative nexus evidence. Furthermore, Dr. S.T.S's opinion was based on a history of treating the Veteran and a review of the Veteran's record. See Guerrieri, 4 Vet. App. at 473. The Board also notes that the May 2023 VA opinion failed to address the Veteran's contention that his service-connected foot, ankle, and knee conditions were related to his lower back condition. Furthermore, the July 2021 VA opinion did not give sufficient rationale of how the noted risk factors applied in the Veteran's case, and did not take into account the studies cited by M.K.; thus, the Board affords the July 2021 and May 2023 VA opinions low probative weight.

The Board therefore finds that the evidence of record persuasively weighs
's opinion was based on a history of treating the Veteran and a review of the Veteran's record. See Guerrieri, 4 Vet. App. at 473. The Board also notes that the May 2023 VA opinion failed to address the Veteran's contention that his service-connected foot, ankle, and knee conditions were related to his lower back condition. Furthermore, the July 2021 VA opinion did not give sufficient rationale of how the noted risk factors applied in the Veteran's case, and did not take into account the studies cited by M.K.; thus, the Board affords the July 2021 and May 2023 VA opinions low probative weight.

The Board therefore finds that the evidence of record persuasively weighs in favor of a finding that the Veteran's lower back condition is due to his service-connected bilateral pes planus, bilateral hallux valgus, degenerative joint disease of the right knee, and right ankle condition.

Accordingly, entitlement to service connection for a lower back condition, secondary to the Veteran's service-connected bilateral pes planus, bilateral hallux valgus, degenerative joint disease of the right knee, and right ankle condition, is warranted.

4. Entitlement to service connection for right hip condition, to include as secondary to right ankle condition, right knee condition, bilateral pes planus, and bilateral hallux valgus

The Veteran contends that his right hip condition is due to his service, to include as secondary to his service-connected right knee, bilateral pes planus, right hallux valgus, degenerative joint disease of right metatarsophalangeal joint, right ankle, and left foot hammer toes. See April 2024 VA Form 20-0995, Supplemental Claim Application.

In the July 2024 rating decision on appeal, the AOJ made a favorable finding that the Veteran has current diagnoses of trochanteric pain syndrome, femoral acetabular impingement syndrome, degenerative arthritis of the right hip, and that the claimed primary disability is service-connected. 38 C.F.R. § 3.104(c). No clear and unmistakable error has been shown; therefore, the Board is bound by this favorable finding. Id. Thus, the Board's analysis will focus on the nexus element of service connection.

In May 2023, the Veteran underwent a VA examination. The examiner noted diagnoses of osteoarthritis of the right hip and femoral acetabular impingement syndrome, and that osteoarthritis is often referred to as a "wear and tear" disease and causes changes in the bone, deterioration of the connective tissues, and inflammation of the joint lining, with risk factors including age, sex, obesity, joint injuries, and repeated stress in the joint. The examiner further noted that femoral acetabular impingement is caused by abnormal contact between the head and socket as the hip goes through a range of motion, and can be caused by overcoverage of the socket. Based on the foregoing, the examiner concluded that the Veteran's right hip condition was less likely than not caused by his right ankle spur and bilateral pes planus.

In September 2025, the Veteran submitted an opinion from M.K., a physician assistant who noted that the Veteran's foot deformities, recurrent ankle pain, and knee arthritis have produced long-standing gait disturbance of the lower extremities. M.K. noted flare-ups with prolonged standing, weightbearing, or activity, as well as difficulty navigating stairs and uneven terrain, and opined that the deformities caused by pes planus and hallux valgus, compounded by right knee degenerative joint disease and a right calcaneal spur, disrupt a normal gait that transmits stress through the hip joint. M.K. concluded that the Veteran's pattern of hip pathology, including trochanteric pain, impingement, and degenerative arthritis, is consistent with long-term compensatory overload from his service-connected pes planus, hallux valgus, knee degenerative joint disease, and calcaneal spur. M.K. also opined that the May 2023 VA opinion failed to address cited medical literature which shows that chronic pes planus, hallux valgus, knee malalignment and osteoarthritis, and chronic ankle dysfunction alter gait strategy, increase proximal joint stress, load the hip repeatedly in flexion, adduction, and internal rotation, consistent with the Veteran's right hip pain.

Based on the foregoing, M.K. concluded that it was at least as likely as not that the Veteran's right hip condition was secondary to his service-connected bilateral pes planus, bilateral hallux valgus, degenerative joint disease of the right knee, and right ankle condition.

The Board notes that M.K.'s opinion was based on a review of the Veteran's claims file and the relevant medical literature, and therefore finds
literature which shows that chronic pes planus, hallux valgus, knee malalignment and osteoarthritis, and chronic ankle dysfunction alter gait strategy, increase proximal joint stress, load the hip repeatedly in flexion, adduction, and internal rotation, consistent with the Veteran's right hip pain.

The Board notes that M.K.'s opinion was based on a review of the Veteran's claims file and the relevant medical literature, and therefore finds it to be probative nexus evidence. See Guerrieri, 4 Vet. App. at 473. The Board also notes that, although the May 2023 VA opinion noted the risk factors of the Veteran's diagnoses, it failed to give an explanation of how these risk factors applied in the Veteran's case, and did not take into account the studies cited by M.K.; thus, the Board affords this opinion low probative weight.

The Board therefore finds that the evidence of record persuasively weighs in favor of a finding that the Veteran's right hip condition is due to his service-connected bilateral pes planus, bilateral hallux valgus, degenerative joint disease of the right knee, and right ankle condition.

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Accordingly, entitlement to service connection for right hip condition, secondary to the Veteran's service-connected bilateral pes planus, bilateral hallux valgus, degenerative joint disease of the right knee, and right ankle condition, is warranted.

Marcus N. Fulton

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Marshall, J.

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.

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