FOOT IMPAIRMENT OF

B. MULLINS · 2026 · Case ID: 26003681

DENIED

Summary

The Veteran, an Air Force Veteran who served from December 1984 to April 1988, appealed the denial of service connection for a bilateral foot condition and for numbness and tingling of the hands due to radiation exposure. The Veteran also appealed the denial of Total Disability based on Individual Unemployability (TDIU). The Board denied service connection for the bilateral foot condition, finding no current diagnosis and that the Veteran failed to cooperate with ordered examinations. For the hand condition, the Board found that while the Veteran has carpal tunnel syndrome and was exposed to radiation in service, the evidence persuasively weighed against a service connection, relying on a VA examiner's opinion that it was less likely than not due to service. The TDIU claim was deemed moot because the Veteran already received a 100 percent disability rating for the period on appeal. The Board noted that the Veteran's TBI symptoms, while causing some occupational impairment, did not render him unemployable, and the evidence did not support a higher rating or special monthly compensation.

Rationale

Veteran failed to attend ordered VA examinations; No current diagnosis of foot disability found; Evidence weighs against finding of disability

Service Branch

AIR FORCE

Special Benefit

TDIU

Docket No.

13-06 354

Full Decision Text

Citation Nr: 26003681
Decision Date: 03/23/26 Archive Date: 03/23/26

DOCKET NO. 13-06 354
DATE: March 23, 2026

ORDER

Entitlement to service connection for a bilateral foot condition is denied.

Entitlement to service connection for numbing and tingling of both hands due to radiation exposure is denied.

Entitlement to a total disability rating based on individual unemployability (TDIU) is denied.

FINDINGS OF FACT

1. The evidence of record persuasively weighs against finding that the Veteran has had a bilateral foot condition at any time during or approximate to the pendency of the claim.

2. The evidence of record persuasively weighs against finding that bilateral tingling and numbness of the hands began during active service or is otherwise related to an in-service injury or disease.

3. Entitlement to TDIU is moot as the Veteran was in receipt of a total disability rating for the entire period on appeal.

CONCLUSIONS OF LAW

1. The criteria for service connection for a bilateral foot condition are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

2. The criteria for service connection for numbness and tingling of the hands are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

3. The issue of entitlement to TDIU is moot. 38 U.S.C. § 1155; C.F.R. § 4.16.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had honorable active-duty service in the United States Air Force from December 1984 to April 1988.

The Veteran appealed a July 2012 rating decision by the Agency of Original Jurisdiction (AOJ).

A Board of Veterans' Appeals (Board) hearing was held in January 2016 before a Veterans Law Judge (VLJ) who has since retired from the Board. A transcript is of record.

The matters were most recently remanded in a February 2024 Board decision. The claims are back before the Board and the Board finds there has been substantial compliance with the remand directives.

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, 1131, 5107; 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).

1. Entitlement to service connection for a bilateral foot condition is denied.

The Veteran contends that he has a bilateral foot disability that is related to injuries incurred while serving. See November 2009 Claim. Alternatively, the Veterna contends he has a bilateral foot disability that is secondary to his service-connected knee disability. See January 2016 Hearing Transcript.

Service connection may be established on a secondary basis for a disability resulting from a service-connected disease or injury. 38 U.S.C. §§ 1110, 1131. Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability results from the service-connected disability. 38 U.S.C. §§ 1110, 1131; Spicer v. McDonough, 61 F.4th 1360, 1364 (Fed. Cir. 2023) (holding that section 1110 "requires compensation when a service-connected disease or injury is a but-for cause of a present-day disability"). The but-for causation standard in a secondary service-connected case is not limited to a single cause and effect, but rather contemplates multi-causal links, including action and inaction. See Spicer, supra.

In March 2024, the Board noted that the Veteran's August 2020 examination found no bilateral foot disability diagnosis. The Board noted that treatment records indicated foot sores diagnosed in March 2017. Therefore, a remand was considered warranted for an examination to consider the March 2017 bilateral foot sores.

On remand, a January 2025 examination was scheduled. That same month, the examination was noted to be cancelled as the Veteran was a "no show." A
-for cause of a present-day disability"). The but-for causation standard in a secondary service-connected case is not limited to a single cause and effect, but rather contemplates multi-causal links, including action and inaction. See Spicer, supra.

On remand, a January 2025 examination was scheduled. That same month, the examination was noted to be cancelled as the Veteran was a "no show." A second examination was scheduled for the Veteran in February 2025 and the Veteran again was reported as a "no show." As the Veteran did not report for either examination and there is no evidence of "good cause," the Board finds he did not cooperate and assist in developing evidence that would have assisted the VA in developing his claim.

Consequently, the Board proceeds with adjudication of this claim based upon the extant evidence of record. To be clear, the Court has held specifically that the duty to assist a claimant is not a one-way street, and in the instant case, the Veteran has failed to cooperate to the full extent in the development of his claim. Wood v. Derwinski, 1 Vet. App. 406 (1991).

The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease.

The Board concludes that the Veteran does not have a current diagnosis of a foot disability and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007).

VA treatment records show no current diagnosis of a foot condition. In March 2017, the Veteran presented with complaints of foot pain. Scrapings of the skin were taken and the Veteran was noted to have tinea pedis, or athlete's foot and was prescribed fungal treatment cream.

The Veteran presented for a VA examination in August 2020. Current symptoms were noted to be paresthesias and numbness bilaterally in the feet. The examiner noted that the Veteran developed lower extremity radiculopathy and that was likely causing foot symptoms. It was noted the Veteran denied a separate foot condition as he denied pain or any functional loss or impairment of his feet. The examiner did not find any other pertinent physical findings, complications, conditions, signs, symptoms, or scars.

While the Veteran believes there is a current diagnosis of a foot disability, [the Veteran is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires knowledge of the musculoskeletal system. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence.

2. Entitlement to service connection for numbing and tingling of both hands due to radiation exposure is denied.

The Veteran contends that he has numbing and tingling in his hands that is due to or related to exposure to radiation while in service. See January 2016 Hearing Transcript.

The Board remanded the claim for consideration for service connection as to exposure to radiation.

On remand, a February 2025 examination was scheduled. That same month, the examination was noted to be cancelled as the Veteran was a "no show." As the Veteran did not report for his examination and there is no evidence of "good cause," the Board finds he did not cooperate and assist in developing evidence that would have assisted the VA in developing his claim.

The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease.

The Board concludes that, while the Veteran has a current diagnosis of carpal tunnel syndrome, and evidence shows that there was exposure to radiation in-service occurred, the evidence of record persu
based upon the extant evidence of record. To be clear, the Court has held specifically that the duty to assist a claimant is not a one-way street, and in the instant case, the Veteran has failed to cooperate to the full extent in the development of his claim. Wood v. Derwinski, 1 Vet. App. 406 (1991).

The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease.

The Board concludes that, while the Veteran has a current diagnosis of carpal tunnel syndrome, and evidence shows that there was exposure to radiation in-service occurred, the evidence of record persuasively weighs against finding that the Veteran's diagnosis of carpal tunnel syndrome began during service or is otherwise related to an in-service injury, event, or disease.

A left-hand disability is not noted by medical evidence until March 2011 when the Veteran was diagnosed with a left-hand wound infection and until March 2014 when he reported right hand numbness. March 2017 VA treatment records show the Veteran reported pain from his right elbow, causing his ring finger and 5th finger to go numb and he was diagnosed with carpal tunnel. 2018 VA treatment notes show a diagnosis of left-hand arthritis.

In August 2020, the Veteran presented for a VA examination for his bilateral hand condition. He reported symptoms began in 1990 when he developed bilateral hand tingling after starting to milk cows post service. The examiner opined that the bilateral carpal tunnel syndrome was less likely than not due to service. In support of the opinion, the examiner noted that symptoms did not present until 1990 per the Veteran's reports of symptoms during milking of cows post service. Therefore, based on the Veteran's lay statements and available medical evidence, the examiner noted the bilateral carpal tunnel syndrome was less likely than not incurred in or caused by service, to include in service exposure to radiation. The Board finds the opinion probative as it considers the Veteran's lay statements and the available medical evidence. There is no medical opinion or competent and credible evidence in significant conflict with the VA medical opinion.

As noted above, the matter was remanded to afford the Veteran an opportunity for another VA examination. However, as he failed to report to the examination, there is no other evidence in conflict with the August 2020 VA examination.

While the Veteran believes the claimed tingling and numbness of the hands is related to an in-service injury, to include exposure to radiation, he does not, in this case have the knowledge or ability to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires knowledge of nervous system and its relation, if any, to toxic exposures such as radiation. Therefore, it is outside of the competence of the Veteran in this case because the record does not show that the Veteran has the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the August 2020 VA examination than the Veteran's assertions that he developed tingling and numbness of the hands after radiation exposure.

3. Entitlement to a total disability rating based on individual unemployability (TDIU) is moot.

The Veteran asserts he is unable to secure and follow a substantially gainful occupation as a result of his service-connected disabilities.

VA will grant a total rating for compensation purposes based on unemployability when the evidence shows a veteran is precluded from obtaining or maintaining any gainful employment consistent with his education and occupational experience, by reason of his service-connected disabilities. 38 C.F.R. §§ 3.340, 3.341, 4.16. In reaching such a determination, the central inquiry is "whether the Veteran's service-connected disabilities alone are of sufficient severity to produce unemployability." Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). In arriving at a conclusion, consideration may be given to the veteran's level of education, special training, and previous work experience, but not to his age or the impairment caused by nonservice-connected disabilities. See 38 C.F.R. §§ 3.341, 4.16, 4.19.

The United States Court of Appeals for Veterans Claims (Court) has held that the term "unable to secure and follow a substantially gainful occupation" in 38 C.F.R. § 4.16 has two components. First, there is an economic component which essentially cont
produce unemployability." Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). In arriving at a conclusion, consideration may be given to the veteran's level of education, special training, and previous work experience, but not to his age or the impairment caused by nonservice-connected disabilities. See 38 C.F.R. §§ 3.341, 4.16, 4.19.

The United States Court of Appeals for Veterans Claims (Court) has held that the term "unable to secure and follow a substantially gainful occupation" in 38 C.F.R. § 4.16 has two components. First, there is an economic component which essentially contemplates an occupation earning more than marginal income (outside of a protected environment) as determined by the U.S. Department of Commerce as the poverty threshold for one person. Second, there is a non-economic component dealing with the individual veteran's ability to "follow and secure" employment. For the second component, attention must be given to: (a) the veteran's history, education, skill and training, (b) the veteran's physical ability (both exertional and non-exertional) to perform the type of activities (e.g., sedentary, light, medium, heavy or very heavy) required by the occupation at issue, with relevant factors such as lifting, bending, sitting, standing, walking, climbing, grasping, typing, reaching, auditory and visual, and (c) whether the Veteran has the mental ability to perform the type of activities required by the occupation at issue, with relevant factors such as memory, concentration, and ability to adapt to change, handle work place stress, get along with coworkers and demonstrate reliability and productivity. Ray v. Wilkie, 31 Vet. App. 58, 73 (2019). As "sedentary" is defined as "[r]equiring or marked by much sitting <a sedentary desk job>" the Board finds that sedentary employment is a job where the worker primarily sits down. WEBSTER'S II NEW COLLEGE DICTIONARY 999 (1999).

If there is only one service-connected disability, it must be rated at least 60 percent disabling to qualify for TDIU benefits; if there are two or more such disabilities, there shall be at least one disability ratable at 40 percent or more, and sufficient additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. § 4.16(a). Here, the issue of TDIU is moot as the Veteran has a total disability rating of 100 percent through the period on appeal.

However, in an August 2023 Informal Hearing Presentation (IHP), the Veteran, through his representative, argued that if the Veteran has been rendered TDIU solely due to his service-connected TBI, he may be entitled to additional special monthly compensation (SMC). See Bradley v. Peake, 22 Vet. App. 280 (2008) (explaining that, although no additional disability compensation may be paid when a total schedular disability rating is already in effect, a separate award of a TDIU predicated on a single disability may form the basis for an award of special monthly compensation); see also 38 U.S.C. § 1114 (s)(1).

On remand, the AOJ sent a subsequent development letter to the Veteran requesting his post service employment history and provided him with an application for increased compensation based on unemployability. To date, the AOJ has not received a completed form. Therefore, the Board finds he did not cooperate and assist in developing evidence that would have assisted the VA in developing his claim.

SMC at the "housebound" rate is payable where a Veteran has a single service-connected disability rated as 100 percent and (1) has additional service-connected disability or disabilities independently ratable at 60 percent, separate and distinct from the 100 percent service-connected disability and involving different anatomical segments or bodily systems, or (2) is permanently housebound by reason of service-connected disability or disabilities. 38 U.S.C. § 1114(s). A TDIU rating can satisfy the need for a rating of 100 percent if it is based on a single disability. See Buie v. Shinseki, 24 Vet. App
. Derwinski, 1 Vet. App. 406 (1991).

During the period on appeal, the Veteran is not in receipt of nor does the evidence show a single disability rated at 100 percent nor is he in receipt of a TDIU. 38 U.S.C. § 1114(s); Buie, 24 Vet. App. at 250. Therefore, further consideration of SMC is not warranted.

As the Veteran contends that his TBI has rendered him completely unemployable by itself, the Board will only consider the evidence of record for a TBI. VA treatment records show the Veteran has a history of labor jobs. In March 2011, he endorsed training as a mechanic. In March 2017, the Veteran endorsed that he builds cars, even with the difficulty of pain in his hands.

In August 2020, the Veteran presented for a VA examination for his service-connected TBI. He reported that he has post-concussive migraines, short term memory loss, and irritability with verbal aggression. The examiner noted the symptoms would make it difficult for the Veteran to focus on his tasks, but that sedentary work would not be limited. The examiner deferred to a psychiatrist for evaluation of any co-existing separate psychiatric condition.

At a July 2020 VA examination for a psychiatric disorder, the examiner found memory loss was most consistent with the TBI. It was noted that the Veteran had to write important things down and all other symptoms were attributable to psychiatric disorders. The Veteran's symptoms were occupational and social impairment with deficiencies in most areas. Symptoms such as neglect of personal appearance and hygiene, grossly inappropriate behavior, intermittent inability to perform activities of daily living, and disorientation to time and place were not endorsed. The Veteran was found to be competent to manage his financial affairs.

As the evidence reflects a 100 percent total evaluation, but fails to show evidence to warrant SMC, the claim of entitlement to TDIU is deemed moot.

B. MULLINS

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Jarman, Timothy

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.

Analyze in VA Law Explorer