HALLUX VALGUS (BUNION) ACQUIRED

T. RAYMOND · 2025 · Case ID: A25105380

GRANTED

Summary

The veteran, who served in the United States Army across multiple periods including April 1991 to April 1995, December 2004 to May 2006, and May 2009 to July 2023, appeals the denial of service connection for several conditions. The veteran sought direct service connection for right and left hallux valgus, right and left femoral acetabular impingement syndrome, right knee degenerative arthritis, left knee strain, cervical strain, right shoulder strain, and dyspnea, attributing them to physical training during service. Alternatively, the veteran claimed secondary service connection for the hip, knee, and cervical spine disabilities to service-connected degenerative arthritis of the spine, the right shoulder strain to cervical strain, and dyspnea to service-connected sleep apnea. The Board reviewed the evidence, including service treatment records (which were absent specific foot complaints), a December 2024 private medical opinion from Dr. N.P.D., and a March 2024 VA examination report. Dr. N.P.D. opined that the hallux valgus conditions were at least as likely as not due to service, citing prolonged wear of military boots and participation in physical fitness tests, and found a nexus supported by medical literature. The VA examiner opined less likely than not for the foot conditions, noting the lack of in-service diagnosis but failing to address chronicity or medical literature. The Board found Dr. N.P.D.'s opinion more probative for the foot conditions, establishing a positive nexus and granting service connection. For the hip, knee, cervical spine, right shoulder, and respiratory conditions, the Board relied on Dr. N.P.D.'s December 2024 opinion. Dr. N.P.D. concluded these conditions were caused by service-connected degenerative arthritis of the spine (for hips, knees, cervical spine), cervical strain (for right shoulder), and sleep apnea (for dyspnea), supported by chronicity of symptoms and medical literature. The Board found these opinions highly probative and noted no contrary opinions. Applying the benefit of the doubt, service connection was granted for all these secondary conditions. Consequently, service connection was granted for right and left hallux valgus on a direct basis, and for right and left femoral acetabular impingement syndrome, right knee degenerative arthritis, left knee strain, cervical strain, right shoulder strain, and dyspnea on a secondary basis.

Rationale

Positive nexus established by private medical opinion; Private opinion considered more probative than VA opinion; Chronicity of symptoms since service noted

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

241122-498299

Full Decision Text

Citation Nr: A25105380
Decision Date: 12/08/25 Archive Date: 12/08/25

DOCKET NO. 241122-498299
DATE: December 8, 2025

ORDER

Entitlement to service connection for right hallux valgus is granted.

Entitlement to service connection for left hallux valgus is granted.

Entitlement to service connection for right femoral acetabular impingement syndrome is granted.

Entitlement to service connection for left femoral acetabular impingement syndrome is granted.

Entitlement to service connection for right knee degenerative arthritis is granted.

Entitlement to service connection for left knee strain is granted.

Entitlement to service connection for cervical strain is granted.

Entitlement to service connection for right shoulder strain is granted.

Entitlement to service connection for dyspnea is granted.

FINDINGS OF FACT

1. The Veteran's right foot disability diagnosed as hallux valgus is related to service.

2. The Veteran's left foot disability diagnosed as hallux valgus is related to service.

3. The Veteran's right hip disability diagnosed as femoral acetabular impingement syndrome is caused by his service-connected degenerative arthritis of the spine.

4. The Veteran's left hip disability diagnosed as femoral acetabular impingement syndrome is caused by his service-connected degenerative arthritis of the spine.

5. The Veteran's right knee disability diagnosed as degenerative arthritis is caused by his service-connected degenerative arthritis of the spine.

6. The Veteran's left knee disability diagnosed as left knee strain is caused by his service-connected degenerative arthritis of the spine.

7. The Veteran's neck disability diagnosed as cervical strain is caused by his service-connected degenerative arthritis of the spine.

8. The Veteran's right shoulder disability diagnosed as right shoulder strain is caused by his service-connected cervical strain.

9. The Veteran's respiratory disability diagnosed as dyspnea is caused by his service-connected sleep apnea.

CONCLUSIONS OF LAW

1. The criteria for service connection for right hallux valgus are met. 38?U.S.C. §?1110; 38?C.F.R. §?3.303.

2. The criteria for service connection for left hallux valgus are met. 38?U.S.C. §?1110; 38?C.F.R. §?3.303.

3. The criteria for service connection for right femoral acetabular impingement syndrome as secondary to service-connected degenerative arthritis of the spine are met. 38?C.F.R. §?3.310.

4. The criteria for service connection for left femoral acetabular impingement syndrome as secondary to service-connected degenerative arthritis of the spine are met. 38?C.F.R. §?3.310.

5. The criteria for service connection for right knee degenerative arthritis as secondary to service-connected degenerative arthritis of the spine are met. 38?C.F.R. §?3.310.

6. The criteria for service connection for left knee strain as secondary to service-connected degenerative arthritis of the spine are met. 38?C.F.R. §?3.310.

7. The criteria for service connection for cervical strain as secondary to service-connected degenerative arthritis of the spine are met. 38?C.F.R. §?3.310.

8. The criteria for service connection for right shoulder strain as secondary to service-connected cervical strain are met. 38?C.F.R. §?3.310.

9. The criteria for service connection for dyspnea as secondary to service-connected sleep apnea are met. 38?C.F.R. §?3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Army from April 1991 to April 1995, December 2004 to May 2006, and May 2009 to July 2023.???????

These matters come to the?Board of Veterans' Appeals?(Board) from an April 2024 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO).?????????

In the November 2024 VA Form 10182, Decision Review Request: Board Appeal, the Veteran elected the Evidence Submission docket.? Therefore, the Board may only consider the evidence of record at the time of the April 2024 rating decision, as well as any evidence submitted by the Veteran within 90 days of the filing of the November 2024 VA Form 10182.? In this regard, the Board may only consider the evidence of record before the AOJ at the time of its decision on the issues on appeal, as well as any evidence submitted
the?Board of Veterans' Appeals?(Board) from an April 2024 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO).?????????

In the November 2024 VA Form 10182, Decision Review Request: Board Appeal, the Veteran elected the Evidence Submission docket.? Therefore, the Board may only consider the evidence of record at the time of the April 2024 rating decision, as well as any evidence submitted by the Veteran within 90 days of the filing of the November 2024 VA Form 10182.? In this regard, the Board may only consider the evidence of record before the AOJ at the time of its decision on the issues on appeal, as well as any evidence submitted by the appellant or his or her representative with the NOD (VA Form 10182) or within 90 days following receipt of the NOD.? 38?C.F.R. §§?20.300(a), 303.? If additional evidence was submitted between the dates of the AOJ decision and VA's receipt of the NOD, the Board will not consider it unless it is resubmitted during the 90 days following VA's receipt of the NOD.????

Service connection for right and left foot, hip, and knee disabilities and cervical spine disability, right shoulder disability, and respiratory disability

Veterans are entitled to compensation from VA if they develop a disability "resulting from personal injury suffered or disease contracted in line of duty, or for aggravation of a preexisting injury suffered or disease contracted in line of duty."? 38?U.S.C. §?1110 (wartime service), 1131 (peacetime service).? To establish a right to compensation for a present disability, a veteran must show: "(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service"-the so-called "nexus" requirement.? Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

Secondary service connection may be warranted for a current disability that is either caused by or aggravated by a service-connected disability. ?38 C.F.R. § 3.310(a), (b); Allen v. Brown, 7 Vet. App.?439 (1995). ?A "permanent worsening" of a non-service-connected disability is not required to establish secondary service connection based on aggravation (i.e., aggravation may include temporary worsening of a disability). ?Ward v. Wilkie, 31 Vet. App. 233 (2019). ?Secondary service connection may also be warranted where a nonservice-connected disability would have been less severe but-for a service-connected disability, either because there is an etiological link (to include worsening of functionality) between the two, or because the service-connected disability resulted in the inability to treat the nonservice-connected disability. ?Spicer?v. McDonough,?61 F.4th 1360?(Fed. Cir. 2023).

The Veteran seeks entitlement to service connection for right and left foot, hip, and knee disabilities as well as a cervical spine disability, right shoulder disability, and respiratory disability. In particular, he contends that these disabilities are related to physical training during service. He alternatively contends that the hip, knee, and cervical spine disabilities are secondary to his service-connected degenerative arthritis of the spine, the right shoulder disability is secondary to the cervical spine disability, and the respiratory disability is secondary to his service-connected sleep apnea.

As will be discussed below, the Board is awarding the Veteran service connection for the right and left foot disabilities on a direct basis and is awarding service connection for the right and left hip and knee disabilities as well as the cervical spine, right shoulder, and respiratory disabilities on a secondary basis.

Right and left foot disabilities

The Board notes that the Veteran's service treatment records are absent complaints of or treatment specifically for foot disabilities. However, the Veteran is competent to report injury to his feet from physical training and the Board finds that such reports are consistent with the record. Moreover, the current medical evidence documents findings of right and left hallux valgus. See, e.g., March 2024 VA examination report.

The Board finds that the competent and probative evidence demonstrates that the Veteran's currently diagnosed right and left hallux valgus is related to his service.

Specifically, the Veteran submitted a private medical opinion dated December 2024 from Dr. N.P.D. who noted after review of the Veteran's medical history the Veteran's right and left hallux valgus is at least as likely as not due to service to include as due to prolonged use of military boots. Dr. N.P.D.'s rationale was based on review of the Veteran's medical history to include wearing military boots for at least 12 hours per day in service and that he participated in physical fitness tests such as a 2-mile run. He further noted the Veteran's chronicity of symptoms since service resulting in the current hallux valgus and foot pain that was sharp in quality and exacerbated with activity and relieved by rest. Finally, Dr. N.P.D. indicated review of medical literature which supported a nexus.

The December 2024 opinion of Dr. N.P.D. was based upon thorough analysis of the Veteran's medical condition. See Bloom v. West, 12?Vet. App.?185, 187 (1999) [the probative value of a physician's statement is dependent, in part, upon the extent to which it reflects "clinical data or other rationale to support his opinion"].

The Board acknowledges that a VA examiner opined in a March 2024 report that it is less likely than not that the Veteran has a right or left foot disability that was incurred in or caused by service. However, the examiner did not address the Veteran's report of a chronicity of foot symptoms since service but rather only noted the Veteran was not diagnosed with a foot disability until five months after separation from service. Moreover, the examiner did not attribute any cause to the Veteran's current hallux valgus and did not address medical literature that supports a nexus. Therefore, the Board finds that the opinion of Dr. N.P.D. is of greater probative value than the VA opinion as to whether the Veteran's current right and left hallux valgus had its onset in service.

In short, based on the total record, the Board finds that there is sufficient competent medical evidence to indicate a positive nexus between the Veteran's current right and left hallux valgus and his service. Therefore, the Veteran has met all requirements needed to establish service connection for these disabilities. The benefits sought on appeal are therefore granted.

Right and left hip and knee disabilities, cervical spine disability, right shoulder disability, and respiratory disability

The current medical evidence documents findings of right and left femoral acetabular impingement syndrome, right knee degenerative arthritis, left knee strain, cervical strain, right shoulder strain, and dyspnea.

Probative medical opinions are of record concerning the issue of nexus for the Veteran's right and left hip and knee disabilities, cervical spine disability, right shoulder disability, and respiratory disability in the form of a December 2024 private opinion by Dr. N.P.D. Specifically, after review of the Veteran's medical history, Dr. N.P.D. concluded that the Veteran's right and left femoral acetabular impingement syndrome, right knee degenerative arthritis, left knee strain, and cervical strain are caused by the Veteran's service-connected degenerative arthritis of the lumbar spine. He also concluded that the Veteran's right shoulder strain is at least as likely as not caused by the Veteran's cervical strain and it is at least as likely as not that the Veteran's dyspnea is caused by the Veteran's service-connected sleep apnea. Dr. N.P.D.'s rationales for these conclusions were based on the Veteran's severity and chronicity of symptoms as well as his review of medical literature which supported these findings of a nexus.

In this case, the Board finds that the most probative evidence supports findings that the Veteran currently has right and left femoral acetabular impingement syndrome, right knee degenerative arthritis, left knee strain, and cervical strain that are caused by the Veteran's service-connected degenerative arthritis of the lumbar spine, the Veteran's right shoulder strain is caused by the Veteran's service-connected cervical strain, and the Veteran's dyspnea is caused by the Veteran's service-connected sleep apnea. In this regard, the Board finds the medical opinions of Dr. N.P.D. highly probative as such opinions were based on thorough review of the Veteran's medical history. The Board adds that there are no medical opinions contrary
nexus.

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Accordingly, there is a competent and credible basis to conclude that the Veteran's current right and left femoral acetabular impingement syndrome, right knee degenerative arthritis, left knee strain, and cervical strain are caused by the Veteran's service-connected degenerative arthritis of the lumbar spine, the Veteran's right shoulder strain is caused by the Veteran's service-connected cervical strain, and the Veteran's dyspnea is caused by the Veteran's service-connected sleep apnea, particularly when reasonable doubt is resolved in his favor. See 38?U.S.C. §?5107(b) (2012); 38?C.F.R. §?3.102 (2023). Therefore, service connection for right and left femoral acetabular impingement syndrome, right knee degenerative arthritis, left knee strain, cervical strain, right shoulder strain, and dyspnea is warranted. See 38?U.S.C. §?1110; 38?C.F.R. §?3.303, 3.310.

T. Raymond

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Arif Syed, Counsel

The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.

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