FLATFOOT BILATERAL ACQUIRED

JIMMY L. BARDIN · 2026 · Case ID: 26004799

MIXED

Summary

The veteran, who served from January 2002 to August 2008, including Persian Gulf War service, appeals the denial of service connection for bilateral foot disability, bilateral ankle disability, stomach disability, and ulcer disability, but was granted service connection for hemorrhoids with rectal bleeding. The Board found that the veteran's pre-existing bilateral pes planus was not aggravated by service beyond its natural progression, as there was no in-service treatment or evidence of increased disability, and the April 2024 VA examiner found no aggravation. The Board also denied service connection for bilateral ankle disability, noting that while the veteran reported pain and limitation of motion, the evidence persuasively weighed against a service connection, with the December 2024 addendum opinion finding the left ankle sprain resolved without complications and attributing current pain to pes planus or radiculopathy. For hemorrhoids with rectal bleeding, the Board granted service connection, finding it was aggravated by medication prescribed for service-connected psychiatric disabilities, despite the April 2024 VA examiner's opinion that it was not related to service or TERA participation. For stomach and ulcer disabilities, the Board denied service connection, finding the evidence weighed against a service connection to an in-service event or condition, noting the resolved ulcer and the examiner's opinion that GERD was not related to service or TERA, with obesity also noted as a risk factor.

Rationale

Pre-existing pes planus noted on enlistment; No evidence of aggravation beyond natural progression; No competent evidence of in-service aggravation

Special Benefit

NO SPECIAL BENEFIT

Docket No.

18-49 981A

Full Decision Text

Citation Nr: 26004799
Decision Date: 04/21/26 Archive Date: 04/21/26

DOCKET NO. 18-49 981A
DATE: April 21, 2026

ORDER

Service connection for bilateral foot disability is denied.

Service connection for bilateral ankle disability is denied.

Service connection for hemorrhoids with rectal bleeding is granted.

Service connection for stomach disability is denied.

Service connection for ulcer disability is denied.

FINDINGS OF FACT

1. The Veteran's bilateral pes planus pre-existed service and was not aggravated by his military service or a service-connected disability.

2. The evidence of record persuasively weighs against finding that a bilateral ankle disability began during active service or is otherwise related to an in-service injury or disease.

3. The Veteran's hemorrhoids with rectal bleeding were aggravated by the medication prescribed to treat his service-connected psychiatric disabilities; specifically, he incurred increased rectal bleeding.

4. The Veteran's stomach disability and/or ulcer disability are not secondary to a service-connected disability and are not otherwise related to an in-service injury or disease.

CONCLUSIONS OF LAW

1. The criteria for service connection for bilateral foot disability are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.306, 3.310.

2. The criteria for bilateral ankle disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

3. The criteria for hemorrhoids with rectal bleeding as secondary to service-connected disability are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

4. The criteria for service connection for stomach disability due to service or service-connected disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

5. The criteria for service connection for ulcer disability due to service or service-connected disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from January 2002 to August 2008. He is a Persian Gulf War Veteran.

This matter comes to the Board of Veterans' Appeals (Board) on appeal from a March 2016 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO).

The September 2024 Board decision, in relevant part, denied service connection for bilateral foot disability and remanded the issues of service connection from bilateral ankle condition, hemorrhoids with rectal bleeding, stomach disability, and ulcer disability for further development. The Veteran appealed that decision to the U.S. Court of Appeals for Veterans Claims (Court). In November 2025 the Court granted a joint motion for partial remand (JMR) of the Veteran and the Secretary of Veterans Affairs (the Parties), vacated the September 2024 Board decision's denial of service connection for bilateral foot disability and remanded that claim to the Board for action consistent with the terms of the JMR.

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).

Generally, a veteran is presumed to be in sound condition, except for defects, infirmities or disorders noted when examined, accepted, and enrolled for service. 38 U.S.C. §§ 1111, 1137; 38 C.F.R. § 3.304 (b). This presumption can only be rebutted by clear and unmistakable evidence both that the disease or injury existed prior to service and that the disease or injury was not aggravated by service. See Wagner v. Principi, 370 F.3d 1089 (Fed. Cir. 2004). The record does not include an entrance exam prior to the Veteran's second period of active-duty service. Absent such an examination, the presumption of soundness does not attach. See Smith v. Shinseki, 24 Vet. App. 40, 44-46 (2010). Thus, the evidence is sufficient to establish a pre-existing condition.

A pre-existing injury or disease will be considered to have been aggravated by active military, naval, or air service, where there is an increase in disability during such service, unless 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 (a). Aggravation may not be conceded where the disability underwent no increase in severity during service on the basis of all the evidence of record pertaining to the manifestations of the disability prior to, during, and subsequent to service. 38 U.S.C. § 1153; 38 C.F.R. § 3.306 (b).

1. Service connection for bilateral foot disability

The Veteran was granted service connection for bilateral foot muscle pain and numbness in the September 2024 Board decision. He is seeking service connection for a bilateral foot disability other than bilateral foot muscle pain and numbness.

The May 2019 and April 2024 disability benefits questionnaires (DBQs) show current bilateral pes planus.

The November 2001 enlistment examination shows moderate asymptomatic pes planus. As such, this was noted on entry and, therefore, pre-existed his active-duty service. In other words, the presumption of soundness does not attach as to this diagnosis. The question then becomes whether the Veteran's pre-existing pes planus was aggravated during active duty. Here, the Veteran reports multiple injuries due to road marches, runs, and airborne jumps. See April 2016 notice of disagreement. Additionally, at the time of his April 2024 foot conditions disability benefits questionnaire (DBQ), the Veteran reported foot pain. The Veteran is competent to report lay observable symptoms such as in-service foot pain. He is not, however, competent to find that this foot pain is evidence of aggravation of his pre-existing bilateral pes planus beyond its normal progression. The Veteran's entrance examination noted moderate pes planus as does the April 2024 foot conditions DBQ. The question before the Board is whether the Veteran's reported symptom of foot pain shows aggravation beyond the natural progress of this disability, which was noted to be asymptomatic in his November 2001 enlistment examination. The Board finds that it does not.

The Veteran did not seek treatment for his bilateral pes planus during service or immediately upon separation. There is no medical evidence to suggest that the Veteran's foot pain associated with pes planus is greater than expected with the normal progression of that disability. Indeed, the April 2024 examiner found that the Veteran's pre-existing pes planus was not aggravated beyond its natural progression by an in-service event, injury, or illness. The rationale was that there was no treatment during or after active duty for foot condition. The Veteran's pain, as described by the Veteran, as pain in the bilateral feet and ankles after prolonged standing and weightbearing, is a common finding in the general population, especially those that have untreated moderate pes planus bilaterally, in this age group. As such symptoms are commonplace, there is nothing to suggest that the Veteran's pre-existing moderate pes planus was aggravated beyond its natural progression by his active-duty service, to include his lay reports of in-service foot pain associated with his pes planus. The record does not contain any competent evidence of in-service aggravation. Thus, the record does not support a finding of in-service aggravation of his pre-existing bilateral pes planus beyond the natural progression.

Alternately, the Board notes that the Veteran is a Persian Gulf War Veteran with presumed toxic exposure. VA's sub-regulatory guidance
bearing, is a common finding in the general population, especially those that have untreated moderate pes planus bilaterally, in this age group. As such symptoms are commonplace, there is nothing to suggest that the Veteran's pre-existing moderate pes planus was aggravated beyond its natural progression by his active-duty service, to include his lay reports of in-service foot pain associated with his pes planus. The record does not contain any competent evidence of in-service aggravation. Thus, the record does not support a finding of in-service aggravation of his pre-existing bilateral pes planus beyond the natural progression.

Alternately, the Board notes that the Veteran is a Persian Gulf War Veteran with presumed toxic exposure. VA's sub-regulatory guidance indicates a TERA opinion is generally not required for claims based on physical trauma such as the Veteran's service connection claim for bilateral foot disability. Accordingly, a TERA opinion is not necessary regarding this issue unless the Veteran submits competent medical or scientific evidence of an association between the claimed disability and the in-service TERA. See VBA Letter 20-22-10, Exception to TERA Examination and Medical Opinion Requirement (December 22, 2022). Here, no such submission was received and the Board may decide the claim based on the evidence of record.

Finally, service connection may be granted for a disability that is due to, or aggravated by, service-connected disease or injury. 38 C.F.R. § 3.310.

Here, the Veteran asserts that his post-service MCL surgery for his service-connected left knee disability made his foot pain worse.

The question for the Board is whether the Veteran's bilateral pes planus was aggravated by his service-connected left knee disability.

As noted above, the April 2024 DBQ found that the Veteran's bilateral pes planus remained moderate, as noted on his enlistment examination, and his current symptoms were consistent with the natural progression of this disability. As such, no aggravation is conceded.

To the extent that the Veteran believes the claimed pes planus is aggravated by a service-connected disability, he is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires knowledge of the natural progression of pes planus and the ability to differentiate foot pain associated with this disability from the foot pain already associated with his service-connected bilateral foot muscle pain and numbness. There is no indication that the Veteran possesses the skills or medical training to make such a determination. Therefore, it is outside the competence of the Veteran. See 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 medical evidence of record.

Accordingly, the evidence is persuasively against the claim. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and service connection for bilateral foot disability is not warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

2. Service connection for bilateral ankle disability

The Veteran is seeking service connection for a bilateral ankle disability.

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 record does not show a current bilateral ankle diagnosis. The Board has considered Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018), in which the Federal Circuit held that "pain alone, without an accompanying diagnosis of a present disease, can qualify as a disability" if it "reaches the level of a functional impairment of earning capacity." Id. at 1367-69. Here, the Veteran reports bilateral ankle pain and limitation of motion of the ankles has been shown. See April 2024 ankle conditions DBQ.

Additionally, the record shows that the Veteran sprained his left ankle while running in December 2003.

Nevertheless, the evidence of record persuasively weighs against finding that the Veteran's bilateral ankle pain began during service or is otherwise related to an in-service injury, event, or disease.

In a December 2024 addendum opinion, the April 2024 examiner found that the December 2003 left ankle sprain resulted in restriction for five days and the subsequent records indicate that this injury was acute and resolved without any complications of sequelae.

To the extent that the Veteran's reported ankle pain has been attributed to his pes planus, entitlement to service connection for that disability is addressed above. See January 2025 addendum opinion.

Altern
, the record shows that the Veteran sprained his left ankle while running in December 2003.

Alternately, the Veteran's reported ankle pain has been attributed to his already service-connected radiculopathy. See September 2019 VA opinion. The Veteran is currently service connection for left femoral nerve radiculopathy, right sciatic nerve radiculopathy, and left and right foot muscle pain and numbness and the ratings assigned for these disabilities contemplate pain as part of the determination of the severity of the incomplete nerve paralysis. Thus, he is already being compensated for this symptom.

The record does not show that the Veteran possesses the skills or medical training to differentiate between his claimed ankle pain from that attributed to pes planus and/or radiculopathy. Therefore, the issue is outside the competence of the Veteran in this case. 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 medical evidence of record.

Accordingly, the evidence is persuasively against the claim. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and service connection for bilateral ankle disability is not warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

3. Service connection for hemorrhoids with rectal bleeding

The Veteran is seeking service connection for hemorrhoids with rectal bleeding.

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.

Here, the September 2016 colonoscopy shows a diagnosis of hemorrhoids with rectal bleeding. This is confirmed in later records, including the April 2024 rectum and anus conditions DBQ, which notes hemorrhoids with occasional bright red blood per rectum when constipated.

The Veteran's service treatment records do not show and the Veteran does not allege an in-service onset of hemorrhoids with rectal bleeding. Nevertheless, the record does show that the Veteran participated in a toxic risk exposure activity (TERA) during service.

The Board concludes that, while the Veteran has a current diagnosis and evidence shows in-service TERA participation, the evidence of record persuasively weighs against finding that the Veteran's diagnosis of hemorrhoids with rectal bleeding began during service or is otherwise related to an in-service injury, event, or disease.

The April 2024 VA examiner opined that the Veteran's hemorrhoids with rectal bleeding are not at least as likely as not related to an in-service injury, event, or disease, including in-service TERA participation. The rationale was that hemorrhoids are common in the general population and he had no gastrointestinal complaints in service. The examiner's opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008).

Alternately, service connection may be granted for a disability that is due to, or aggravated by, service-connected disease or injury. 38 C.F.R. § 3.310.

The question for the Board is whether the Veteran has a current disability that is due to, the result of, or aggravated by service-connected disability.

In his April 2016 notice of disagreement, the Veteran attributed his hemorrhoids to the medications he used to treat chronic pain, headaches, stomach pain, diarrhea, tightness or burning in his chest, muscle cramps, or low back pain.

In a September 2016 statement, the Veteran attributed his hemorrhoids to his service-connected eating disorder.

In this case, the Board concludes that the Veteran's hemorrhoids with rectal bleeding were aggravated by medication prescribed to treat his service-connected psychiatric disabilities.

The medical opinions of record repeatedly establish that the Veteran's hemorrhoids with rectal bleeding are not at
The question for the Board is whether the Veteran has a current disability that is due to, the result of, or aggravated by service-connected disability.

In a September 2016 statement, the Veteran attributed his hemorrhoids to his service-connected eating disorder.

In this case, the Board concludes that the Veteran's hemorrhoids with rectal bleeding were aggravated by medication prescribed to treat his service-connected psychiatric disabilities.

The medical opinions of record repeatedly establish that the Veteran's hemorrhoids with rectal bleeding are not at least as likely as not related to a service-connected disability itself, noting they are more likely related to aging because the tissues that support the veins in the rectum and anus can weaken and stretch due to age, pregnancy, straining during bowel movements, sitting for long periods of time on the toilet, chronic diarrhea or constipation, obesity, anal intercourse, and low-fiber diet. See June 2019 rectum and anus conditions DBQ and November 2019 addendum opinion. The examiner's opinions are probative, because they are based on an accurate medical history and provide an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez, 22 Vet. App. 295, 304.

Nevertheless, a February 2016 VA treatment record first suggested that the Veteran's rectal bleeding could be related to medication used to treat these disabilities as this bleeding ceased after discontinuing medication, although it was not common side effect. The November 2024 addendum opinion stated that the psychiatric medications that the Veteran was briefly prescribed could increase the risk of the Veteran's existing hemorrhoids bleeding but the hemorrhoids themselves were the more likely responsible for the rectal bleeding. Based on this, the Board finds that the Veteran's hemorrhoids with rectal bleeding were aggravated by the medication prescribed to treat his service-connected psychiatric disabilities. To that extent this appeal is granted.

4. Service connection for stomach disability

5. Service connection for ulcer disability

The Veteran is seeking service connection for a stomach and/or ulcer disability.

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.

Here, the March 2013 private treatment record shows an ulcer in the prepyloric area. The Veteran treated this condition and it resolved. Despite this, the Veteran continues to take over-the-counter medication for his subjective symptoms. More recently, the April 2024 stomach and duodenal conditions DBQ found a history of gastric ulcer and gastroesophageal reflux disease (GERD).

The Veteran's service treatment records do not show an in-service onset of or treatment for stomach and/or ulcer disability. Nevertheless, the Veteran reports stomach symptoms during service and the record shows that the Veteran participated in a toxic risk exposure activity (TERA) during service.

The Board concludes that, while the Veteran has a current diagnosis and evidence shows in-service TERA participation and lay-reported stomach symptoms, the evidence of record persuasively weighs against finding that a stomach and/or ulcer disability began during service or is otherwise related to an in-service injury, event, or disease.

The April 2024 VA examiner noted that the peptic ulcer disease diagnose in 2013 had resolved with treatment. This examiner then opined that the Veteran's GERD is not at least as likely as not related to an in-service injury, event, or disease, including in-service TERA participation. The rationale was that peptic ulcer disease and GERD are common in the general population and the Veteran had no documented gastrointestinal complaints or treatment in service. In a November 2024 addendum, this examiner also noted that the Veteran's obesity was also a risk factor in developing peptic ulcer disease and GERD. The examiner's opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008).

Alternately, service connection may be granted for a disability that is due to, or aggravated by, service-connected disease or injury. 38 C.F.R. § 3.310.

The question for the Board is whether the Veteran has a current disability that is due to, the result of, or aggravated by service-connected disability.

In his April 2016 notice of disagreement, the Veteran attributed his ulcer to his degenerative disc disease and migraines. Alternately, he attributed his ulcer to overuse of medications to treat chronic pain, headaches, stomach
explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008).

Alternately, service connection may be granted for a disability that is due to, or aggravated by, service-connected disease or injury. 38 C.F.R. § 3.310.

The question for the Board is whether the Veteran has a current disability that is due to, the result of, or aggravated by service-connected disability.

In his April 2016 notice of disagreement, the Veteran attributed his ulcer to his degenerative disc disease and migraines. Alternately, he attributed his ulcer to overuse of medications to treat chronic pain, headaches, stomach pain, diarrhea, tightness or burning in his chest, muscle cramps, or low back pain.

In his July 2015 statement, the Veteran stated that he had developed an ulcer due to stress and painkillers associated with his migraines.

The Board concludes that, while the Veteran has a current disability, the evidence of record persuasively weighs against finding that the Veteran has a stomach and/or ulcer disability that is due to, the result of, or aggravated by service-connected disability. 38 U.S.C. §§ 1110, 1131; Allen v. Brown, 7 Vet. App. 439 (1995) (en banc); 38 C.F.R. § 3.310(a).

In the December 2024 medical opinion, the VA examiner opined that there was no objective evidence of current stomach or ulcer disability with a 2016/2017 gastrointestinal consult indicating that the Veteran's reported symptoms were due to lumbosacral dermatome etiology. Additionally, there was no evidence to indicate that the peptic ulcer disease in 2013 was secondary to over-the-counter medication used at that time.

The record does not show that the Veteran possesses the skills or medical training to determine an etiological link between his claimed stomach and/or ulcer disability and the medication used to treat his service-connected disabilities. Therefore, the issue is outside the competence of the Veteran in this case. 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 medical evidence of record.

Accordingly, the evidence is persuasively against the claim. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and service connection for a stomach and/or ulcer disability is not warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

JIMMY L. BARDIN

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Houbeck, Bridgid

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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