HALLUX VALGUS (BUNION) ACQUIRED

S.C. KREMBS · 2025 · Case ID: A25107386

MIXED

Summary

The veteran served in the U.S. Army from November 1982 to November 1985, with additional service in the Army National Guard. This case comes before the Board of Veterans' Appeals (Board) following denials of readjudication for claims related to left foot hallux valgus and a skin condition, specifically tinea versicolor. The Board previously denied these claims in April 2020 due to a lack of current diagnosis. The veteran subsequently submitted new and relevant evidence, including private treatment records, showing current diagnoses for both left foot hallux valgus and tinea versicolor. The Board found this new evidence sufficient to warrant readjudication for these conditions. However, claims for tinea corporis, tinea cruris, carbuncle, cyst, and scarring secondary to tinea versicolor were denied readjudication as no new and relevant evidence was presented. The Board remanded the claims for left foot hallux valgus, tinea versicolor, and Meibomian Gland Dysfunction (MGD) for further development. The remands are primarily due to inadequate VA medical opinions and potential duty-to-assist errors, particularly concerning the nexus between the conditions and service, including TERA exposure for tinea versicolor and MGD. The Board noted the veteran's in-service diagnoses and TERA participation as relevant factors for the remanded conditions.

Rationale

New and relevant evidence presented showing current diagnosis of left foot hallux valgus.; In-service diagnosis of hallux valgus and complaints of left foot pain.; Remanded for adequate etiology opinion regarding nexus to service.

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250801-573582

Full Decision Text

Citation Nr: A25107386
Decision Date: 12/11/25 Archive Date: 12/11/25

DOCKET NO. 250801-573582
DATE: December 11, 2025

ORDER

The petition to readjudicate the claim for entitlement to service connection for left foot hallux valgus is granted.

The petition to readjudicate the claim for entitlement to service connection for tinea versicolor, also claimed as skin lesions all over the body and/or pityriasis rosea, is granted.

The petition to readjudicate the claim for entitlement to service connection for tinea corporis, tinea cruris, carbuncle, and cyst, is denied.

The petition to readjudicate the claim for entitlement to service connection for scarring secondary to tinea versicolor is denied.

REMANDED

Entitlement to service connection for left foot hallux valgus is remanded.

Entitlement to service connection for tinea versicolor is remanded.

Entitlement to service connection for Meibomian Gland Dysfunction (MGD), also claimed as conjunctivitis and trachoma, is remanded.

FINDINGS OF FACT

1. In April 2020, the Board denied entitlement to service connection for left foot hallux valgus and skin lesions all over the body because there was no evidence that the Veteran had a current diagnosis of left foot hallux valgus and of a skin disability.

2. In February 2023, the Board denied the Veteran's motion for reconsideration of the April 2020 Board decision.

3. Since the April 2020 Board denial, new and relevant evidence showing that the Veteran has a current diagnosis of left foot hallux valgus and tinea versicolor, has been presented.

4. Since the April 2020 Board denial, no new and/or relevant evidence were presented or secured showing a current diagnosis of tinea corporis, tinea cruris, carbuncle, and/or cyst.

5. In August 2022, the AOJ denied service connection for scarring secondary to tinea versicolor because there was no evidence of a current disability.

6. Since the August 2022 rating decision, the Veteran did not present or secure new and relevant evidence demonstrating that he has a current scarring disability secondary to his tinea versicolor.

CONCLUSIONS OF LAW

1. The criteria to readjudicate the claim for entitlement to service connection for left foot hallux valgus are met. 38 U.S.C. §§ 1110, 5108; 38 C.F.R. § 3.156(d).

2. The criteria to readjudicate the claim for entitlement to service connection for tinea versicolor, also claimed as skin lesions all over the body and/or pityriasis rosea, are met. 38 U.S.C. §§ 1110, 5108; 38 C.F.R. § 3.156(d).

3. The criteria to readjudicate the claim for entitlement to service connection for tinea corporis, tinea cruris, carbuncle, and cyst, are not met. 38 U.S.C. §§ 1110, 5108; 38 C.F.R. § 3.156(d).

4. The criteria to readjudicate the claim for entitlement to service connection for scarring secondary to tinea versicolor are not met. 38 U.S.C. §§ 1110, 5108; 38 C.F.R. § 3.156(d).

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran honorably served on active duty in the United States Army from November 1982 to November 1985, with additional service in the Army National Guard. See DD Form 214.

This appeal comes to the Board of Veterans' Appeals (Board) from a September 2024 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) denying readjudication of the claim for entitlement to service connection for left foot hallux valgus, pityriasis rosea, tinea versicolor, tinea corporis, tinea cruris, carbuncle, cyst, and lesions all over the body, as well as scarring secondary to tinea versicolor, while implicitly finding that new and relevant evidence had been presented for the issue of service connection for Meibomian Gland Dysfunction (MGD) by denying the claim on the merits. 38 C.F.R. § 20.801(a). In August 2025, the Veteran appealed the denials, and he selected the direct review docket on his Notice of Disagreement (NOD). See August 2025 VA Form 10182 NOD.

Not
foot hallux valgus, pityriasis rosea, tinea versicolor, tinea corporis, tinea cruris, carbuncle, cyst, and lesions all over the body, as well as scarring secondary to tinea versicolor, while implicitly finding that new and relevant evidence had been presented for the issue of service connection for Meibomian Gland Dysfunction (MGD) by denying the claim on the merits. 38 C.F.R. § 20.801(a). In August 2025, the Veteran appealed the denials, and he selected the direct review docket on his Notice of Disagreement (NOD). See August 2025 VA Form 10182 NOD.

Notably, as the Veteran has not presented or secured evidence to obtain readjudication of the issue of entitlement to service connection for tinea corporis, tinea cruris, carbuncle, and cyst, the Board has bifurcate this issue from that of entitlement to service connection for tinea versicolor, previously claimed as skin lesions all over the body, and/or pityriasis rosea. See Locklear v. Shinseki, 24 Vet. App. 311 (2011) (bifurcation of a claim generally is within VA's discretion); see also Tyrues v. Shinseki, 23 Vet. App. 166, 178-79 (2009), aff'd, 631 F.3d 380 (Fed. Cir. 2011). Therefore, the Board has characterized the issue accordingly.

APPLICABLE EVIDENTIARY WINDOW

As the appellant has selected the Direct Review Docket, the Board may only consider the evidence of record before the AOJ at the time of its decision on the issue(s) on appeal. See 38 C.F.R. §§ 20.300(a), 301. The Board will not consider evidence received after the AOJ decision unless the claimant files a timely request for a Board hearing or an opportunity to submit additional evidence on the NOD (VA Form 10182). 38 C.F.R. § 20.301. The appellant has not filed such a request. If additional evidence was submitted after the AOJ decision, the Board will not consider it. The appellant is welcome to file a supplemental claim to have this evidence considered. See Cook v. McDonough, 36 Vet. App. 175 (2023).

New and Relevant Evidence

VA will readjudicate a previously denied claim if new and relevant evidence is presented or secured. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(d). New evidence is evidence not previously part of the actual record before agency adjudicators. "Relevant evidence" is evidence that tends to prove or disprove a matter in issue. 38 C.F.R. § 3.2500(a)(1). In determining whether new and relevant evidence is presented or secured, VA will consider any VA treatment records reasonably identified by the claimant and any evidence received by VA after VA issued notice of a decision on the claim and while the evidentiary record was closed. 38 C.F.R. § 3.2501.

Service connection will be granted if the evidence demonstrates a current disability resulted from an injury or disease incurred in or aggravated by active military service, even if the disability was initially diagnosed after service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Establishing service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) evidence of a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may be granted for any disease initially diagnosed after service when all the evidence, including pertinent to service, establishes the disease was incurred in service. 38 C.F.R. § 3.303(d).

1. The petition to readjudicate the claim for entitlement to service connection for left foot hallux valgus.

2. The petition to readjudicate the claim for entitlement to service connection for tinea versicolor, also claimed as skin lesions all over the body and/or as pityriasis rosea.

3. The petition to readjudicate the claim for entitlement to service connection for tinea corporis, tinea cruris, carbuncle, and cyst.

4. The petition to readjudicate the claim for entitlement to service connection for scarring secondary to tinea versicolor.

The Veteran seeks readjudication of
disease was incurred in service. 38 C.F.R. § 3.303(d).

1. The petition to readjudicate the claim for entitlement to service connection for left foot hallux valgus.

2. The petition to readjudicate the claim for entitlement to service connection for tinea versicolor, also claimed as skin lesions all over the body and/or as pityriasis rosea.

3. The petition to readjudicate the claim for entitlement to service connection for tinea corporis, tinea cruris, carbuncle, and cyst.

4. The petition to readjudicate the claim for entitlement to service connection for scarring secondary to tinea versicolor.

The Veteran seeks readjudication of a claim of entitlement to service connection for left foot hallux valgus, for a skin disability claimed as skin lesions all over the body, tinea versicolor, pityriasis rosea, tinea corporis, tinea cruris, carbuncle, and cyst, and for scarring secondary to tinea versicolor.

As a background, in April 2020, the Board denied entitlement to service connection for left foot hallux valgus and for skin lesions all over the body because there was no evidence that the Veteran had a current diagnosis for either disabilities. See April 2020 BVA Decision. In February 2023, the Board also denied the Veteran's motion for reconsideration of the April 2020 Board decision. See February 2023 BVA Decision.

In April 2022, the Veteran filed a new claim for service connection for scarring secondary to tinea versicolor, as well as a request for readjudication of the issue of entitlement to service connection for left foot hallux valgus and for a skin disability, to include tinea versicolor. See April 2022 VA Form 21-526EZ, Fully Developed Claim.

In August 2022, the AOJ ordered a Skin Conditions and Scars VA examination in connection with the Veteran's new claim for scarring, at which time the examiner found a diagnosis of tinea versicolor on the head, chest, back, and knees, but without any evidence of scarring. See August 2022 VA Examination Reports.

In August 2022, the AOJ denied service connection for scarring as secondary to tinea versicolor based on lack of evidence of a current disability. See August 2022 Rating Decision. The AOJ did not decide whether to readjudicate the Veteran's claims for service connection for left foot hallux valgus and for a skin disability, because the request for readjudication had been filed on the wrong form. See May 2022 Request for Application.

In July 2023, the Veteran filed a new request for readjudication of the issue of entitlement to service connection for left foot hallux valgus and for a skin disability, to include tinea versicolor, submitting private treatment records showing a current diagnosis of left foot hallux valgus with pain, as well as a diagnosis of tinea versicolor and dermatitis with flaky rashes. See July 2023 VA Form 21-526EZ, Fully Developed Claim, and Private Treatment Record. The RO formally rejected the request for readjudication because it was submitted on the wrong form. See October 2023 Request for Application AMA Review Letter.

In May 2024, the Veteran submitted a supplemental claim requesting readjudication of the previously denied claims for service connection for left foot hallux valgus and for a skin disability, to include tinea versicolor, along with evidence in support of the request. See May 2024 Medical Treatment Record - Government, and Private Treatment Record.

In September 2024, the AOJ denied readjudication of the previously denied claims for service connection for left foot hallux valgus and for a skin disability, to include tinea versicolor, because no new and relevant evidence was presented.

With respect to the claims for service connection for left foot hallux valgus and for a skin disability, to include tinea versicolor, the Board finds that evidence presented by the Veteran, or otherwise secured, since the April 2020 Board denial is both new and relevant because they show that the Veteran has a current diagnosis of left foot hallux valgus and tinea versicolor, which was the reasons for the April 2020 Board denial. See 38 C.F.R. § 3.2501 (a)(1). Accordingly, the claims should be readjudicated based on all of the evidence of record.

With respect to the claim for service connection for a skin disability other than tinea versicolor, to include tinea corporis, tinea cruris, carbuncle, and cyst, the Board finds that the Veteran has not presented, or
the Board finds that evidence presented by the Veteran, or otherwise secured, since the April 2020 Board denial is both new and relevant because they show that the Veteran has a current diagnosis of left foot hallux valgus and tinea versicolor, which was the reasons for the April 2020 Board denial. See 38 C.F.R. § 3.2501 (a)(1). Accordingly, the claims should be readjudicated based on all of the evidence of record.

With respect to the claim for service connection for a skin disability other than tinea versicolor, to include tinea corporis, tinea cruris, carbuncle, and cyst, the Board finds that the Veteran has not presented, or otherwise secured, any new or relevant evidence showing that he has a current diagnosis of pityriasis rosea, tinea corporis, tinea cruris, carbuncle, or cyst. In sum, there is no new and relevant evidence that tends to prove or disprove the matters at issue for this claim, and as such, readjudication of the issue of entitlement to service connection for pityriasis rosea, tinea corporis, tinea cruris, carbuncle, or cyst is not warranted. 38 C.F.R. § 3.2500(a)(1).

Similarly, with respect to the claim for service connection for scarring secondary to tinea versicolor, the Board finds that since the most recent denial in August 2022, the Veteran has not presented, or otherwise secured, new and relevant evidence showing a diagnosis of scarring secondary to tinea versicolor. In sum, there is no new and relevant evidence that tends to prove or disprove the matters at issue for this claim, and as such, readjudication of the issue of entitlement to service connection for scarring secondary to tinea versicolor is not warranted. 38 C.F.R. § 3.2500(a)(1).

REASONS FOR REMAND

1. Entitlement to service connection for left foot hallux valgus.

The Veteran contends that his current diagnosis of left foot hallux valgus is related to his in-service diagnosis of hallux valgus.

Notably, in May 1983, during service, the Veteran was seen for complaints of left foot pain, and he was excused from running or completing physical training. See December 2015 STR. Later in August 1987, the Veteran reported a history of pain on the inside of the left foot, and based on a physical examination, he was diagnosed with left foot bunion, and excused from wearing boots. Id.

The Board also finds that VA's duty to obtain an etiology opinion has been triggered by the medical evidence indicating the Veteran has a current diagnosis of left foot hallux valgus.

Although further delay is regrettable, the Board finds that failure to obtain an etiology opinion was a pre-decisional duty-to-assist error that needs to be cured in order to adjudicate the claim on appeal. 38 U.S.C. § 5103A; 38 C.F.R. § 20.802.

In light of the above, entitlement to service connection for left foot hallux valgus is remanded.

The Board, by this remand, makes no determination, expressed or implied, concerning the credibility of any statements on file.

2. Entitlement to service connection for tinea versicolor.

The Veteran contends that his current diagnosis of tinea versicolor is related to his in-service diagnosis of tinea versicolor.

Notably, in March 1985, during service, the Veteran was diagnosed with tinea versicolor. See December 2015 and January 2024 STRs. Moreover, the Veteran's Military Occupational Specialty (MOS) was that of laundry and bath specialist, smoke operation specialist, and fuel handler. See DD Form 214 and Military Personnel Record; see also November 2023 TERA Memo.

In August 2022, the AOJ ordered a Skin Conditions and Scars VA examination, at which time the examiner found a diagnosis of tinea versicolor on the head, chest, back, and knees, treated in the preceding 12 months with Triamcinolone Ointment. See August 2022 VA Examination Reports. The VA examiner ultimately opined that the Veteran's tinea versicolor was not related to his service because of lack of evidence of chronicity, stating that the Veteran's in-service tinea versicolor was acute only. See August 2022 VA Opinion.

Here, the Board finds the August 2022 VA opinion to be inadequate to decide the claim.

Notably, service connection does not have to be granted based on continuity of symptomatology or chronicity. Service connection may be granted where there is credible evidence of an
diagnosis of tinea versicolor on the head, chest, back, and knees, treated in the preceding 12 months with Triamcinolone Ointment. See August 2022 VA Examination Reports. The VA examiner ultimately opined that the Veteran's tinea versicolor was not related to his service because of lack of evidence of chronicity, stating that the Veteran's in-service tinea versicolor was acute only. See August 2022 VA Opinion.

Here, the Board finds the August 2022 VA opinion to be inadequate to decide the claim.

Notably, service connection does not have to be granted based on continuity of symptomatology or chronicity. Service connection may be granted where there is credible evidence of an event or injury in service, post-service medical findings of a current disability, and a medically sound basis upon which to attribute the post-service findings to the injury in service. 38 C.F.R. § 3.303(d); see Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994); Delrio v. Wilkie, 32 Vet. App. 232, 240-41 (2019) (explaining that "the absence of evidence on a particular question cannot be construed as negative evidence against a claimant unless there is a foundation in the record that demonstrates that such silence has a tendency to prove or disprove a relevant fact"); see also Fountain v. McDonald, 27 Vet. App. 258, 272 (2015).

In this case, the Veteran is currently diagnosed with the same disability he was diagnosed with during service, and the August 2022 VA examiner did not adequately explain why the lack of evidence of treatment for tinea versicolor after service has the tendency to prove or disprove whether the disability is related to his service.

Moreover, the Board finds the August 2022 VA opinion does not provide a thorough medical analysis to support the negative conclusion. The Board must be able to conclude that a medical expert has applied valid medical analysis to the significant facts of the case to reach the conclusion submitted in the medical opinion. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295,304 (2008); see also Stefl v. Nicholson, 21 Vet. App. 120 (2007) (holding "a mere conclusion by a medical doctor is insufficient to allow the Board to make an informed decision as to what weight to assign to a doctor's opinion").

Additionally, Pursuant to Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022 (PACT Act), VA must provide a VA examination and/or medical opinion when there exists evidence of a disability and evidence of participation in a toxic exposure risk activity (TERA) when such evidence is not sufficient to establish service connection for the disability. 38 U.S.C. § 1168(a).

The examination requirement does not apply if the VA Secretary has determined that there is no indication of an association between the disability claimed by the veteran and the toxic exposure risk activity for which the veteran has submitted evidence. 38 U.S.C. § 1168(b). The Pact Act sub-regulatory guidance clarified that claims based on physical trauma, claims for a mental disorder disability, and claims that manifested during service or with an etiology not associated with toxic exposure, are exempted from the TERA examination and medical opinion requirement. See VBA Letter 20-22-10, Processing Claims Involving the PACT Act, (Dec. 22, 2022), p.12.

Here, the Veteran's service record shows that he participated in a TERA. Moreover, a skin disability does not meet the criteria of disabilities exempt from a TERA examination and opinion requirement pursuant to the PACT Act. Based on the above, the Board finds that a remand is necessary to afford the Veteran with a VA opinion on whether his skin disability is related to his TERA exposure.

In light of the above, the Board concludes that denying the claim for service connection for tinea versicolor based on inadequate opinion constituted a pre-decisional duty-to-assist error that needs to be cured in order to adjudicate the claim on appeal. 38 U.S.C. § 5103A; 38 C.F.R. § 20.802.

Based on the above, entitlement to service connection for tinea versicolor must be remanded.

The Board, by this remand, makes no determination, expressed or implied, concerning the credibility of any statements on file.

3. Entitlement to service connection for Meibomian Gland Dysfunction (MGD), also claimed as conjunctivitis and trachoma.

The Veteran asserts that his current diagnosis of conjunctivitis and MGD is related to his
based on inadequate opinion constituted a pre-decisional duty-to-assist error that needs to be cured in order to adjudicate the claim on appeal. 38 U.S.C. § 5103A; 38 C.F.R. § 20.802.

Based on the above, entitlement to service connection for tinea versicolor must be remanded.

The Board, by this remand, makes no determination, expressed or implied, concerning the credibility of any statements on file.

3. Entitlement to service connection for Meibomian Gland Dysfunction (MGD), also claimed as conjunctivitis and trachoma.

The Veteran asserts that his current diagnosis of conjunctivitis and MGD is related to his service, to include his in-service diagnosis of trachoma.

Notably, in August 1985, during service, the Veteran was diagnosed with trachoma. See October 2021 STR.

In October 2023, the Veteran submitted private treatment record showing a diagnosis of bilateral chronic conjunctivitis, with a history of trachoma. See October 2023 Private Treatment Record.

In December 2023, a VA examiner could not find a diagnosis for the Veteran's claimed eye disability. See December 2023 VA Examination Report and Opinion.

In September 2024, the Veteran was seen for a new examination, at which time he reported gradual onset of bilateral foreign body sensation, eye burning, intermittent eyelid discharge, and photophobia beginning in 1983. See September 2024 VA Examination Report. The VA examiner ultimately diagnosed the Veteran with MGD, indicating that MGD is a more accurate diagnosis than the claimed trachoma based on his symptoms of bilateral eye irritation, burning, foreign body sensation and photophobia. Id. Ultimately, the VA examiner found no causal connection between the Veteran's current diagnosis and his service based on lack of evidence of eye complaints during service. See September 2024 VA Opinion.

The Board finds the October 2023 and September 2024 opinions inadequate to decide the claim.

First, the October 2023 VA examiner did not find an eye disability despite private treatment record showing a diagnosis of bilateral chronic conjunctivitis, with a history of trachoma. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (holding that an opinion based upon an inaccurate factual premise has no probative value). Similarly, the September 2024 VA examiner provided a negative opinion based on absence of evidence of an eye disability during service. However, the evidence shows the Veteran was diagnosed with trachoma in August 1985, during service. Id.

Additionally, as noted above, pursuant to Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022 (PACT Act), VA must provide a VA examination and/or medical opinion when there exists evidence of a disability and evidence of participation in a toxic exposure risk activity (TERA) when such evidence is not sufficient to establish service connection for the disability. 38 U.S.C. § 1168(a).

Here, the Veteran's service record shows that he participated in a TERA. Moreover, eye disabilities do not meet the criteria of disabilities exempt from a TERA examination and opinion requirement pursuant to the PACT Act. Based on the above, the Board finds that a remand is necessary to afford the Veteran with a VA opinion on whether his MGD is related to his TERA exposure.

In light of the above, the Board concludes that denying the claim for service connection for MGD based on inadequate opinions constituted a pre-decisional duty-to-assist error that needs to be cured in order to adjudicate the claim on appeal. 38 U.S.C. § 5103A; 38 C.F.R. § 20.802.

Based on the above, entitlement to service connection for MGD must be remanded.

The Board, by this remand, makes no determination, expressed or implied, concerning the credibility of any statements on file.

The matters are REMANDED for the following actions:

1. Obtain an opinion from an appropriate examiner on whether the Veteran's left foot hallux valgus is related to his service, to include his complaints of left foot pain. The examiner is advised that the Veteran is competent to report his symptoms and history, and such reports must be considered. If the examiner rejects the Veteran's reports, the examiner must provide a reason for doing so.

A rationale for all opinions expressed should be provided. A discussion of the facts and the medical principles involved will be of considerable assistance, including citation to any supporting medical treatises.

2. Obtain an opinion from an appropriate examiner on whether the Veteran's tinea versicolor is related to service, to include his in-service diagnosis of tinea versicolor,
:

2. Obtain an opinion from an appropriate examiner on whether the Veteran's tinea versicolor is related to service, to include his in-service diagnosis of tinea versicolor, and his in-service TERA exposure. In rendering this opinion, the examiner must consider the total potential exposure through the Veteran's military deployment and the synergistic, combined effect of all toxic exposure risk activities of the Veteran.

The examiner is advised that the Veteran is competent to report his symptoms and history, and such reports must be considered. If the examiner rejects the Veteran's reports, the examiner must provide a reason for doing so.

3. Obtain an opinion from an appropriate examiner on whether the Veteran's MGD is related to service, to include his in-service diagnosis of trachoma, and his in-service TERA exposure. In rendering this opinion, the examiner must consider the total potential exposure through the Veteran's military deployment and the synergistic, combined effect of all toxic exposure risk activities of the Veteran.

S.C. KREMBS

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board E. Fiorito, Associate 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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