ADJUSTMENT DISORDER

B. D. WATSON · 2025 · Case ID: A25067448

DENIED

Summary

The Veteran served from January 1998 to March 2003, receiving an honorable discharge. He appealed the denial of service connection for an acquired psychiatric disorder (adjustment disorder with anxiety and depressed mood), erectile dysfunction (ED), and lumbar spine spondylosis secondary to bilateral pes planus. The Board denied all claims. For the psychiatric disorder, the Board found no current diagnosis of adjustment disorder, depression, or anxiety, as subsequent examinations diagnosed PTSD and attributed the Veteran's symptoms to it. Service treatment records showed no in-service mental health complaints, and post-service stressor reports were not service-related. Regarding ED, the Board found the Veteran had no current diagnosis of ED, despite a private chiropractor's opinion suggesting a link to hypertension, as the chiropractor did not diagnose the condition. For lumbar spondylosis secondary to pes planus, the Board found no in-service injury or illness related to the back, noting the Veteran's consistent reports of no back issues during service and conflicting statements about the onset of pain post-service. The Board found the contemporaneous service records more probative than later recollections, especially given potential memory impairment. The Board also found no credible medical evidence establishing a link between pes planus and the lumbar condition, giving more weight to a VA examination that noted no gait impairment or marked deformity, over a private opinion that relied on inaccuracies. The benefit of the doubt doctrine was found inapplicable as the evidence persuasively weighed against the Veteran's claims.

Rationale

No current diagnosis of adjustment disorder, depression, or anxiety.; Symptoms attributed to PTSD, not standalone disorders.; No in-service mental health complaints documented.; Post-service stressors not service-related.

Special Benefit

NO SPECIAL BENEFIT

Docket No.

230321-332613

Full Decision Text

Citation Nr: A25067448
Decision Date: 08/08/25 Archive Date: 08/08/25

DOCKET NO. 230321-332613
DATE: August 8, 2025

ORDER

Entitlement to service connection for an acquired psychiatric disorder of adjustment disorder with anxiety and depressed mood is denied.

Entitlement to service connection for erectile dysfunction (ED), to include as secondary to an acquired psychiatric disability, is denied.

Entitlement to service connection for spondylosis lumbar spine, to include as secondary to bilateral pes planus, is denied.

FINDINGS OF FACT

1. The Veteran does not have a current and separate disability of adjustment disorder with anxiety and depressed mood.

2. The Veteran has not been diagnosed with ED.

3. The persuasive weight of the evidence weighs against a finding that there was a causal connection between lumbar spondylosis and the Veteran's active-duty service on a direct basis or secondary to his service-connected pes planus.

CONCLUSIONS OF LAW

1. The criteria for service connection of an acquired psychiatric condition of adjustment disorder with anxiety and depressed mood have not been met. 38 U.S.C. § 7105; 38 C.F.R. § 20.205.

2. The criteria for service connection for ED, to include as secondary to an acquired psychiatric disability, have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

3. The criteria for service connection for lumbar spine spondylosis, to include as secondary to pes planus, have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from January 1998 to March 2003. He was honorably discharged.

This matter comes before the Board of Veterans' Appeals (Board) from a July 2022 rating decision issued by a Department of Veterans Affairs (VA) agency of original jurisdiction (AOJ), which denied entitlement to service connection for low back pain and a December 2022 rating decision which denied entitlement to service connection for ED and adjustment disorder with anxiety and depression.

In March 2023, the Veteran filed a timely VA Form 10182, Notice of Disagreement (NOD) requesting the evidence submission docket.

Therefore, the Board may only consider the evidence of record at the time of the July 2022 and December 2022 respective AOJ decisions on appeal, as well as any evidence submitted by the Veteran with, or within 90 days from 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 decision on appeal 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.

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim[s], considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

1. Entitlement to service connection for an acquired psychiatric disorder of adjustment disorder with anxiety and depressed mood is denied.

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 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). Disorders diagnosed after discharge will still be service connected if all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d
U.S.C. §§ 1110, 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). Disorders diagnosed after discharge will still be service connected if all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

During the pendency of this appeal, a January 2024 rating decision granted service connection for PTSD with a 70 percent evaluation effective April 17, 2023. The effective date was the date the Veteran filed a new claim for PTSD. This was a full grant of the benefit sought.

The Veteran had filed previous claims for an adjustment disorder with anxiety and depression, so in addition to service connection for anxiety, depression and an adjustment disorder with anxiety and depressed mood, the Board will consider whether an earlier effective date for the PTSD claim was warranted.

The Veteran first filed a claim for anxiety in April 2018 which was denied in July 2018. The Veteran did not appeal this decision within one year, so it became final. 38 U.S.C. § 7105; 38 C.F.R. § 3.104. In February 2022 the Veteran filed a supplemental claim for depression and anxiety secondary to tinnitus and hypertension and in September 2022, the Veteran filed another supplemental claim asserting anxiety and depression secondary to all service-connected disabilities. The December 2022 rating decision denied the September 2022 supplemental claim which the Veteran appealed in the March 2023 NOD. The denial of the September 2022 claim is the claim currently before the Board.

The first element of service connection is a current disability. In the February and September 2022 supplemental claims, the Veteran contended he should be service connected for anxiety and depression. The March 2022 VA mental disorder examiner diagnosed adjustment disorder with anxiety and depressed mood. Accordingly, the Veteran has not been diagnosed with depression nor anxiety as a standalone diagnosis. The Board notes that subsequent examiners diagnosed PTSD and not an adjustment disorder, depression or anxiety. Neither the Veteran's March 2023 private psychologist nor the May 2023 VA PTSD examiner diagnosed adjustment disorder with anxiety and depressed mood but rather determined that the anxiety and depressed mood were part of the PTSD. Accordingly, the persuasive weight of the evidence weighs against a finding that the Veteran had a separate and current disability of adjustment disorder, depression or anxiety.

The second element of service connection is an inservice injury or illness. The Veteran's service treatment records did not have any reporting or treatment for any mental health condition. Moreover, the October 2022 VA examiner noted that the Veteran reported multiple sources for his anxiety which were post service events and not related to his service-connected disabilities. Examples of the Veteran's stress included his current job, family and marital issues, and a recent relocation to Georgia. The Veteran had not sought any mental health treatment. The examiner further opined that accordingly, the persuasive weight of the evidence weighs against a finding that the Veteran incurred a standalone condition of adjustment disorder, depression, or anxiety in service or due to events in service. Additionally, the October 2022 nexus examiner concluded that the record did not reflect that any mental health condition the Veteran had was secondary to his service-connected disabilities to include flat feet, hypertension and tinnitus. Accordingly, the second element of service connection has not been met.

The last element of service connection is a nexus between the first two elements. As the first two elements were not satisfied, there is no need to discuss the nexus element. Nonetheless, the Board notes that the nexus examiner opined that the Veteran's adjustment disorder was not causally related to service.

As the three elements of service connection have not been met, the persuasive weight of the evidence weighs against the finding of service connection for adjustment disorder with anxiety and depressed mood.

The Board has considered the benefit of the doubt doctrine and determined it is not applicable. As the evidence is persuasively against the Veteran's claim for an adjustment disorder, or standalone conditions of depression and anxiety, the evidence is not in approximate balance and the benefit of the doubt rule does not apply. Therefore, the claim for service connection for an adjustment disorder must be denied. See 38 U.S.C. § 5107(b); 38 CFR § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

As the claim for adjustment disorder
the persuasive weight of the evidence weighs against the finding of service connection for adjustment disorder with anxiety and depressed mood.

As the claim for adjustment disorder with anxiety and depressed mood (including depression and anxiety) is denied, an earlier effective date for PTSD is not warranted. The Board notes that in April 2023, the Veteran filed a claim for PTSD. Prior to the April 2023 claim, the Veteran had not asserted that he had PTSD or identified any traumatic stressor. He was not diagnosed with PTSD until the May 2023 VA PTSD examination. A March 2023 private psychological examination noted that based on a Minnesota Multiphasic Personality Inventory (MMPI), PTSD was a possible diagnosis. This examination was conducted by a licensed psychologist. The private psychologist, however, did not render the possible PTSD diagnosis based on an evaluation pursuant to the Diagnostic Statical Manual (fifth edition) as required by 38 C.F.R. 4.125. While the psychologist concluded the opinion with the DSM V diagnosis, PTSD, the evaluation was based on the MMPI. In any event, PTSD was not claimed nor indicated in any of the Veteran's prior VA claims and psychological examinations., an earlier effective date is not warranted for the PTSD evaluation.

Additionally, while the May 2023 PTSD examiner noted the Veteran's symptoms of anxiety, depressed mood, difficulty adapting in a worklike or stressful settings, and disturbances of mood and motivation, the examiner attributed these symptoms to PTSD and not to depression, anxiety or any other psychological disorder. As the PTSD claim was effective April 17, 2023, and the Veteran's September 2022 supplemental claim for depression and anxiety (to include adjustment disorder with anxiety and depressed mood) is denied, an earlier effective date for PTSD is not warranted.

Entitlement to service connection for ED, to include secondary to an acquired psychiatric disability is denied.

The Veteran's July 2018 VA male reproductive system examination specifically noted the Veteran did not have ED. An April 2023 private chiropractor (Dr. M.T.) opinion stated that it was at least as likely as not that the Veteran's ED was the result of his service-connected hypertension. (The opinion did not address ED secondary to a psychiatric disability). This opinion began with the premise that the Veteran stated he had ED. The chiropractor did not diagnose ED. The Veteran has not advised that he has sought treatment for ED or provided any medical evidence to reflect that he has a diagnosis of ED. The claimant has the responsibility to present and support a claim for benefits. 38 U.S.C. § 5107(a). As there is no medical diagnosis of ED, the first element of service connection, a current ED disability, has not been satisfied.

As the first element has not been satisfied, there is no need to discuss the remining service connection elements.

As the three elements of service connection have not been met, the persuasive weight of the evidence weighs against the finding of service connection for ED. The Board has considered the benefit of the doubt doctrine and determined it is not applicable. As the evidence is persuasively against the Veteran's ED claim, the evidence is not in approximate balance and the benefit of the doubt rule does not apply. Therefore, the claim for ED must be denied. See 38 U.S.C. § 5107(b); 38 CFR § 3.102; Lynch v. McDonough, 21 F.
, has not been satisfied.

As the first element has not been satisfied, there is no need to discuss the remining service connection elements.

2. Entitlement to service connection for spondylosis lumbar spine, including as secondary to bilateral pes planus is denied.

Secondary service connection may be granted for a disability which is proximately due to or the result of an established service-connected disease. 38 C.F.R. §§ 3.310 (a)-(b); 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a); Allen v, Brown, 7 Vet. App. 439 (1995). When service connection is established for a secondary condition, the secondary condition shall be considered part of the original condition. Id. A medical nexus opinion must state whether the claimed condition was caused by or aggravated by the service-connected condition. El-Amin v. Shinseki, 26 Vet. App. 136 (2013); 38 U.S.C. § 1110. Secondary aggravation exists when the non-service-connected disability was not caused by a service-connected disability but would be less severe were it not for a service-connected disability. Spicer v. McDonough, 61 F.4th 1360, 1364 (Fed. Cir. 2023).

Certain chronic diseases may be service-connected on a presumptive basis if manifested to a compensable degree within a specified period following separation from service (generally one year). 38 U.S.C. §§ 1112, 1137; 38 C.F.R. §§ 3.307, 3.309. For chronic diseases listed in 38 C.F.R. § 3.309(a), nexus to service may be established by showing continuity of symptomatology since service. Walker v. Shinseki, 708 F.3d 1331, 1338-40 (Fed. Cir. 2013). Arthritis is considered a "chronic disease" under 38 C.F.R. § 3.309 (a). Spondylosis is defined as degenerative spinal changes due to osteoarthritis (Dorland's Illustrated Medical Dictionary, 32nd ed., 2012). Therefore, the presumptive provisions of 38 C.F.R. § 3.303 (b) for "chronic" in-service symptoms and "continuous" post-service symptoms apply. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013).

For a showing of a chronic disease in service, the mere use of the word "chronic" will not suffice; rather, there is a required combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings. 38 C.F.R. § 3.303(b). Continuity of symptomatology after service is required where a condition noted during service is not, in fact, chronic, or where a diagnosis of chronicity may be legitimately questioned. Id. The presumptive service connection provisions based on "chronic" in-service symptoms and "continuity of symptomatology" after service under 38 C.F.R. § 3.303(b) have been interpreted as an alternative to
a chronic disease in service, the mere use of the word "chronic" will not suffice; rather, there is a required combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings. 38 C.F.R. § 3.303(b). Continuity of symptomatology after service is required where a condition noted during service is not, in fact, chronic, or where a diagnosis of chronicity may be legitimately questioned. Id. The presumptive service connection provisions based on "chronic" in-service symptoms and "continuity of symptomatology" after service under 38 C.F.R. § 3.303(b) have been interpreted as an alternative to service connection only for the specific chronic diseases listed in 38 C.F.R. § 3.309 (a). See Walker v. Shinseki, 718 F.3d 1331 (Fed. Cir. 2013) (holding that the "chronic" in service and "continuous" post-service symptom presumptive provisions of 38 C.F.R. § 3.303 (b) only apply to "chronic" diseases at 3.309(a)).

Lay assertions may serve to support a claim for service connection by establishing the occurrence of observable events or the presence of disability or symptoms of disability that are subject to lay observation. 38 U.S.C. § 1153 (a); 38 C.F.R. § 3.303 (a); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); see also Buchanan v. Nicholson, 451 F. 3d 1331, 1336 (Fed. Cir. 2006) (addressing lay evidence as potentially competent to support presence of disability even where not corroborated by contemporaneous medical evidence).

Depending on the evidence and the contentions of record in a particular case, lay evidence can be competent and sufficient to establish a diagnosis and medical etiology of a condition. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Specifically, lay evidence may be competent and sufficient to establish a diagnosis where (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau, 492 F.3d at 1377. Additionally, where symptoms are capable of lay observation, a lay witness is competent to testify to a lack of symptoms prior to service, continuity of symptoms after in-service injury or disease, and receipt of medical treatment for such symptoms. Charles v. Principi, 16 Vet. App. 370, 374 (2002). Lay testimony is not competent to determine the extent or etiology of matters which require medical testing and expertise to determine. See Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007); Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011).

The claimant has the responsibility to present and support a claim for benefits. 38 U.S.C. § 5107(a). The VA shall consider all information, including lay and medical evidence of record. VA is responsible for determining whether the evidence persuasively favors one side or another. 38 C.F.R. § 4.3. When there is an approximate or nearly equal balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the Veteran and the claim will be granted on the merits. 38 U.S.C. § 5107(b). When the evidence persuasively favors against the claims of the Veteran, the benefit of the doubt doctrine is inapplicable, and the claim will be denied on its merits. 38 U.S.C. § 5107; Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021).

The first element of service connection is a current disability. Based on a July 2022 radiograph report noting the Veteran had mild spondylosis of the lumbar spine, the July 2022 VA thoracolumbar examiner diagnosed spondylosis. Accordingly, the first element of service connection, a current disability, has been satisfied.

The second element of service
persuasively favors against the claims of the Veteran, the benefit of the doubt doctrine is inapplicable, and the claim will be denied on its merits. 38 U.S.C. § 5107; Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021).

The second element of service connection is an inservice injury or illness. The Veteran was a fire fighter while he was on active duty. As a firefighter, he was required to complete numerous questionnaires and forms inquiring about his assessment of his health. In October 1998, the Veteran completed an occupational health examination questionnaire and noted he had no work-related injury or experience affecting his health and no difficulty with protective clothing or equipment. On a September 1999 respirator user questionnaire, the Veteran noted that his job required one hour of heavy lifting each day. The Veteran also noted on the questionnaire that he did not have any back pain or injury and no musculoskeletal issues that interfered with the use of a respirator. On a September 1999 occupational work history questionnaire, the Veteran noted that he did not have any work injury, no difficulty wearing protective clothing or equipment and had no work-related experience that he believed affected his health. In November 2000, the Veteran again noted on an occupational work history questionnaire that he did not have any work injury or difficulty wearing protective clothing or equipment and had no work-related experience that he believed affected his health.

On the July 1996 and February 2001 reports of medical history, the Veteran noted that he did not have recurrent back pain. Also in February 2001, the Veteran completed another medical form which noted he did not have back pain or any other musculoskeletal problem. In June 2002, the Veteran completed a special purpose medical history form and noted he did not have any medical problems which he thought were related to his job. In March 2003, the month he separated from active duty, the Veteran completed a medical assessment form stating he had not had an injury for which he did not seek medical care and did not have any conditions which limited his ability to perform his occupational specialty.

During a July 2018 VA thoracolumbar spine examination, the Veteran advised the examiner that he has had intermittent low back since service which continued to this day. He also acknowledged that he had never sought any treatment for a back condition and that it did not interfere with his work as a firefighter. The Board notes that there were no service treatment records reflecting the Veteran ever complained of or sought treatment for low back pain while on active duty. Additionally, as noted above, the Veteran consistently completed numerous medical and occupational questionnaires indicating he did not have a back issue or other issue interfering with protective clothing or equipment. During the July 2018 examination, the examiner noted that the Veteran currently worked as a firefighter without difficulty although he may have some difficulty with strenuous or repetitive lifting.

In a January 2019 Veteran statement, the Veteran stated that after active duty he had back pain on a daily basis. The Board notes that the Veteran did not specify how long after active duty the low back pain began. The Board notes that the Veteran submitted private physician records from January 2012, March 2012 and December 2013, which noted that the Veteran did not have back or muscle pain.

The Veteran also noted in his statement that on active duty he was required to do strenuous physical activities "numerous times." He further described the equipment firefighters are required to wear on their back, and the requirement to drag heavy equipment and mannequins during training. He stated that after doing this for five years on active duty, it took a toll on his lower back which he still deals with today. The Veteran did not explain why he attributes his low back pain to his active-duty firefighting and not the subsequent post service years of firefighting. A January 2020 supplemental claim which included low back pain, stated the low back pain was due to the equipment worn during training and a career as a firefighter.

In April 2023, the Veteran submitted a private chiropractor's (Dr. M.T.) opinion relating to his lumbar spine condition. The opinion stated that the Veteran suffered from low back pain during active duty due to heavy lifting and training. The opinion further stated that the Veteran followed up with his primary doctor. The opinion did not state when this follow-up occurred, nor has the Veteran referenced receiving treatment from a private physician. The chiropractor
not explain why he attributes his low back pain to his active-duty firefighting and not the subsequent post service years of firefighting. A January 2020 supplemental claim which included low back pain, stated the low back pain was due to the equipment worn during training and a career as a firefighter.

In April 2023, the Veteran submitted a private chiropractor's (Dr. M.T.) opinion relating to his lumbar spine condition. The opinion stated that the Veteran suffered from low back pain during active duty due to heavy lifting and training. The opinion further stated that the Veteran followed up with his primary doctor. The opinion did not state when this follow-up occurred, nor has the Veteran referenced receiving treatment from a private physician. The chiropractor diagnosed pain of the lumbar spine and further noted that the condition "should qualify" for service connection. There was no reasoning provided for this conclusion. The Board has no reason to doubt the competence or credibility of this chiropractor. The opinion, however, has no probative value or evidentiary weight as there was no explanation for the conclusion that the low back pain was due to service nor any indication that the conclusion was based on an examination of the Veteran.

The Board finds that the second element of service connection, an in-service injury, has not been satisfied. The Veteran did not have any service treatment records reflecting back pain and he repeatedly stated on numerous medical forms that he did not have back pain, musculoskeletal issues, or any injury which affected his ability to wear the required protective clothing or equipment. The Board has no reason to doubt the current credibility of the Veteran; however, during service, the Veteran specifically noted on multiple occasions that he did not have any back issues or recurrent back pain.

The Veteran worked as a career firefighter in service and post service. Additionally, post service, the Veteran has been inconsistent as to the onset of his back pain, indicating in one instance that it began intermittently in service and in other cases after service with no indication of how long after service it began. Dr. M.T. stated that the Veteran sought treatment for his back, but he has not provided any evidence to reflect that he ever sought treatment for this condition. Private records for 2012 and 2013 reflected the Veteran did not have back pain or musculoskeletal issues. His first claim for a back condition was in 2018, approximately 15 years after he separated from service.

The inservice documents represent contemporaneous treatment records which contain both the Veteran's contemporaneous statements to the military and his own assessment of his physical condition. Those contemporaneous records are more reliable and probative than the Veteran's recollections over 15 years later, particularly given that the March 2022 VA mental disorder and May 2023 VA PTSD examiners both noted that the Veteran had short term and long-term memory impairment. The Board is not implying that the Veteran purposely provided inaccurate information. His recollection, however, did not appear accurate in light of information in the evidentiary record, likely due to the passage of time and possible memory impairment, and is outweighed by the contemporaneously documented evidence in the record.

Accordingly, the Board finds that the persuasive weight of the evidence weighs against a finding that the Veteran incurred an inservice back injury or illness. Thus, the second element of service connection has not been satisfied. As the elements of service connection on a direct basis have not been met, the persuasive weight of the evidence weighs against a finding that the Veteran's back condition is directly related to his service.

The Board will next consider whether the Veteran's back condition is service connected on a secondary basis. In the Veteran's February 2022 supplemental claim, the Veteran asserted that his low back pain resulted from a gait impairment which was caused by bilateral pes planus. The Board notes that the Veteran's July 2018 VA thoracolumbar spine examiner diagnosed lumbar strain and noted there were not any lower extremity functions such as balance and propulsion that were affected. No gait impairment was noted. The Veteran's March 2022 VA pes planus examiner noted there was not any marked pronation and that pain was the only symptom resulting from pes planus. No gait impairment was noted. The examiner noted that the Veteran had a decreased longitudinal arch height and there was no objective evidence of marked deformity.

The June 2022 VA pes planus nexus examiner noted that the Veteran's military entrance physical noted the Veteran had asymptomatic left foot pes planus.

The July 2022 VA thoracolumbar examiner noted spondylosis was diagnosed in July 2022 and that the Veteran stated he began having gait issues in service. The July 2022 examiner noted that the Veteran did not have muscle spasms, localized tenderness, or guarding and there was not an abnormal gait.

The July 2022 VA nexus opinion stated
symptom resulting from pes planus. No gait impairment was noted. The examiner noted that the Veteran had a decreased longitudinal arch height and there was no objective evidence of marked deformity.

The June 2022 VA pes planus nexus examiner noted that the Veteran's military entrance physical noted the Veteran had asymptomatic left foot pes planus.

The July 2022 VA nexus opinion stated that the feet do not commonly affect the back as the feet do not cause more pressure, weight bearing, or strain on the back. There is no causal medical pathophysiological relationship between the two conditions. Therefore, the examiner opined that it was less likely than not that that the Veteran's back condition was proximately due to or caused by the Veteran's pes planus.

In October 2022, the Veteran submitted another private chiropractor opinion from Dr. D.B. This chiropractor stated that the Veteran's duties as a firefighter led to his pes planus and that since his pes planus diagnosis, he developed severe lower back pain. This statement concerning onset of the low back pain is unclear. As noted above, the Veteran had asymptomatic left foot pes planus prior to service and his right foot pes planus was diagnosed after service in 2022. There were no service treatment records reflecting the Veteran ever complained of feet or back issues. Additionally, the Veteran has served as a firefighter in service and post service. Attributing pes planus to the Veteran's firefighting is unclear given the more than two-decade period of time, covering pre and post service, during which the Veteran served as a firefighter.

Dr. D.B. further opined that the Veteran's pes planus aggravated his lumbar condition. The doctor explained that the Veteran's gait pattern was affected by his pes planus which in turn aggravated his back condition. Dr. D.B.'s opinion stated it was based on a review of the Veteran's medical records. Accordingly, the opinion did not state that Dr. D.B. personally observed a gait impairment. Additionally, there was not any medical evidence in the record reflecting the Veteran has an impaired gait.

Dr. D.B. also stated that he "believed" the flattening of the Veteran's feet resulted in overpronation of his ankles and internal rotation from the tibia which the doctor "believed" affected the Veteran's static and dynamic gait pattern to compensate for his deformed feet. The opinion did not state the doctor observed the Veteran's gait and did not state the type of deformity Dr. D.B. was referencing. The March 2022 VA examiner conducted an in-person examination of the Veteran and noted there was not any objective evidence of deformity, there was no marked pronation, and no gait impairment was noted. The only pes planus symptom noted in the VA pes planus examination was pain.

The Board has no reason to doubt the credibility or competency of Dr. D.B. or the VA examiner. However, the VA examiner conducted an in-person examination of the Veteran and therefore the observations and report by the March 2022 VA examiner are more reliable. Dr. D.B. relied on evidence inconsistent with the medical evidence in the record relating to an impaired gait. As such the VA examination reports have significantly higher probative value and evidentiary weight than the private opinion from Dr. D.B. which relied on inaccuracies relating to the Veteran's gait and pronation.

The private opinion from Dr. D.B. also included summaries of several articles relating to foot conditions and the impact on lower back pain. The first summary noted that pronated foot function may contribute to low back symptoms in women. No additional information was included and as noted above, based on a VA physical examination, the Veteran did not have marked pronation.

The second summary stated that flat feet, ankle instability, sagittal plane blockage and excessive pronation are linked to low back pain. Specifically, excessive pronation has been shown to create a leg length discrepancy leading to pelvic tilt and low back pain. As noted above, the Veteran does not have marked pronation and there is no medical evidence in the record to indicate the Veteran has a leg length discrepancy.

Dr. D.B. also included a VA decision where the Board found that pes planus aggravated a veteran's low back condition. Board cases are not precedential and the facts and circumstances surrounding each claim are unique to the specific medical history of a veteran. Accordingly, inclusion of this decision has no probative value or evidentiary

For the reasons explained above, the Board finds the persuasive weight of the evidence weighs against a finding that the Veteran's back condition was aggravated or caused by his service-connected pes planus.

The Veteran acknowledged during his July 2018 VA examination that he had never sought treatment for his back condition. As noted above, the Veteran consistently noted while on active duty that he did not have back pain or a back injury. Additionally, the Veteran's initial diagnosis in July 2018 was back strain, and it was not until July 2022 that mild spondylosis was diagnosed. Accordingly, there is no evidence that the Veteran had spondylosis began in service or shortly thereafter. Thus, there is no evidence of chronicity of symptomatology since service.

When the evidence persuasively favors against the claims of the Veteran, the benefit of the doubt doctrine is inapplicable, and the claim will be denied on its merits. 38 U.S.C. § 5107; Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021). In this case, the evidence is persuasively against the Veteran's back condition claim, to include secondary to pes planus. Therefore, it must be denied.

B. D. WATSON

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board W. Polk

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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