HALLUX VALGUS

DANETTE MINCEY · 2026 · Case ID: A26020200

GRANTED

Summary

The Veteran, an Army Veteran who served from January 1992 to January 1998, appeals the denial of service connection for a left foot condition and seeks an increased rating for PTSD. The Board granted service connection for the left foot condition, finding the evidence in approximate balance and resolving doubt in the Veteran's favor. The Veteran claimed the left foot condition was secondary to a right foot condition, but since service connection for the right foot was not established, the Board considered direct service connection. The Board found the Veteran's left foot condition, hallux valgus, to be related to service based on a November 2024 opinion from a nurse practitioner, which cited military training, footwear, and a study on recruit foot complaints. This opinion was given significant probative weight as it addressed pertinent medical evidence and was not contradicted by other evidence. For PTSD, the Veteran was service-connected with a 50% rating and sought an increased rating. The Board reviewed the Veteran's VA examination and a subsequent PTSD DBQ, noting symptoms such as depressed mood, anxiety, panic attacks, sleep impairment, memory issues, and suicidal ideations. The Board found these symptoms caused occupational and social impairment in most areas, warranting a 70% rating, but not a 100% rating due to continued employment and lack of total incapacitation. The Board granted the increased rating for PTSD to 70%.

Rationale

Evidence in approximate balance; Benefit of the doubt resolved in Veteran's favor; November 2024 nurse practitioner opinion found probative

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

200807-102030

Full Decision Text

Citation Nr: A26020200
Decision Date: 03/05/26 Archive Date: 03/05/26

DOCKET NO. 200807-102030
DATE: March 5, 2026

ORDER

Entitlement to service connection for left foot condition is granted.

Entitlement to an increased rating of 70 percent, but no higher, for posttraumatic stress disorder (PTSD) claimed as depression, is granted.

FINDINGS OF FACTS

1. The evidence is at least in approximate balance as to whether the Veteran's left foot condition is related to her military service.

2. The Veteran's PTSD manifested by occupational and social impairment with deficiencies in most areas such judgment, thinking, or mood, due to such items as suicidal ideation, difficulty in adapting to stressful circumstances, and inability to establish and maintain effective relationships.

CONCLUSIONS OF LAW

1. The criteria for service connection for left foot condition are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 20.80.

2. The criteria for a 70 percent rating, but no higher, for PTSD are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1-4.14, 4.130, Diagnostic Code 9411.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Army from January 1992 to January 1998.

The Appeals Modernization Act (AMA) automatically applies to all claims for which VA issues notice of an initial decision on or after February 19, 2019. See 38 C.F.R. § 3.2400(a)(1). The rating decision on appeal was issued in April 2020 and constitutes an initial decision; therefore, the modernized review system, also known as the AMA, applies.

In the August 7, 2020 VA Form 10182, Decision Review Request: Board Appeal Notice of Disagreement (NOD), the Veteran elected the Hearing docket. A Board hearing was held on August 29, 2024. A transcript of the hearing is of record.

Therefore, the Board may only consider the evidence of record at the time of the April 2020 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or representative at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 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 claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

In November 2020, the Board notified the Veteran that the appeal has been placed on the Hearing docket. Thus, the appeal is properly before the Board, and this decision follows.

Service Connection

Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active service, even if the disability was initially diagnosed after service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Establishing service connection generally requires competent evidence of three things: (1) current disability; (2) in-service incurrence of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018).

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App
service connection generally requires competent evidence of three things: (1) current disability; (2) in-service incurrence of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018).

Service connection for left foot condition is granted.

The Veteran contends that she is entitled to service connection for her left foot condition, secondary to her right foot condition. In general, service connection may be granted for a disability or injury incurred in or aggravated by active military service. See 38 U.S.C. § 1110; 38 C.F.R. § 3.303. To prevail on a direct service connection claim, there must be competent evidence of (1) a current disability, (2) an in-service incurrence or aggravation of a disease or injury, and (3) a nexus between the in-service disease or injury and the current disability. See Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Service connection may be established by credible lay evidence and medical evidence provided by the Veteran or otherwise. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303.

Service connection is also warranted for disability proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Such secondary service connection is warranted for any increase in severity of a nonservice-connected disability that is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(b); see Allen v. Brown, 7 Vet. App. 439, 448 (1995).

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Under the AMA, any favorable finding made by AOJ is binding on the Board unless it can be rebutted. 38 C.F.R. § 3.104(c).

The Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination about the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994).

When considering whether lay evidence is competent, the Board must determine, on a case-by-case basis, whether a veteran's disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). A veteran is competent to report symptoms because this requires only personal knowledge, not medical expertise, as it comes to him through his senses. See Layno, 6 Vet. App. 465, 469. Lay testimony is competent to establish the presence of observable symptomatology, where the determination is not medical in nature and is capable of lay observation. Barr v. Nicholson, 21 Vet. App. 303 (2007). Lay evidence may
. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). A veteran is competent to report symptoms because this requires only personal knowledge, not medical expertise, as it comes to him through his senses. See Layno, 6 Vet. App. 465, 469. Lay testimony is competent to establish the presence of observable symptomatology, where the determination is not medical in nature and is capable of lay observation. Barr v. Nicholson, 21 Vet. App. 303 (2007). Lay evidence may establish a diagnosis of a simple medical condition, a contemporaneous medical diagnosis, or symptoms that later support a diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007).

The AOJ found that the Veteran has a complaint of bunion on the left foot. See April 2020 Rating Decision. The Veteran had been diagnosed with hallux valgus and hallux rigidus. See July 6, 2005 Medical Treatment Record; September 26, 2011 VA Medical Treatment Record. The first element of service connection is satisfied.

The Veteran is not service connected for right foot condition. As such, service connection for left foot condition secondary to right foot condition is not possible. 38 C.F.R. § 3.310. Thus, the Board will consider whether the Veteran is entitled to direct service connection for left foot condition.

On October 27, 2006, the Veteran was afforded a VA examination filed on September 14, 2011 for her feet pain. The Veteran had complained that her left foot had an average daily pain of 8 out of 10. See September 14, 2011 VA Examination. She started experiencing symptoms in 1996 or 1997 to the first metatarsophalangeal joint. Id. Wearing bunion pads provided approximately 10 percent relief. Id. The initial symptoms were dull throbbing type of pain that occurred with shoe gear. Id. Without shoe gear, the Veteran would experience the same symptoms on the bottom of her foot at the sesamoid apparatus. Id. The examiner provided a positive nexus opinion for the Veteran's right foot condition but did not provide an opinion for the left foot condition.

On November 22, 2024, the Veteran filed a medical opinion dated November 20, 2024. A nurse practitioner opined that the Veteran's left foot hallux valgus was at least as likely as not incurred in or due to her military service. See November 22, 2024 Medical Treatment Report. As rationale, the evaluator noted the Veteran had been diagnosed with hallux valgus of the right foot and underwent a bunionectomy in 2000. Id. The evaluator recounted facts recorded during the September 14, 2011 VA examination. Id. The Veteran stated that whenever she would wear closed-toed shoe gear, the metatarsophalangeal joint would swell and become red. Id. The symptoms increased with standing. Id. The Veteran underwent military training and was on her feet all day with military footwear. Id. The evaluator cited a study that stated "the feet of the military man are a principal and enduring concern.... In peacetime, there is also a high frequency of foot disorders in the military population, particularly among recruits experiencing for the first time, prolonged periods of marching, the use of military footwear and the general rigors of training.... Over a period of 1.5 years, approximately 26% of all recruits reported to the podiatry clinic with foot-related complaints. Approximately 65% of these complaints were attributed to a structural or mechanical abnormality of the foot such as pes planus, hallux valgus, hammer or mallet toes, and pes cavus. These were experienced by 25, 12, 12, and 2% of the recruits seen, respectively." As the evaluator addressed pertinent medical evidence of record and provided some analysis, the Board assigns it probative weight. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007).

Accordingly, the Board finds that the evidence of record supports that the Veteran's left foot condition is related to her military service. Upon review, there is no competent medical evidence that contradicts the November
us, hammer or mallet toes, and pes cavus. These were experienced by 25, 12, 12, and 2% of the recruits seen, respectively." As the evaluator addressed pertinent medical evidence of record and provided some analysis, the Board assigns it probative weight. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007).

Accordingly, the Board finds that the evidence of record supports that the Veteran's left foot condition is related to her military service. Upon review, there is no competent medical evidence that contradicts the November 22, 2024 medical treatment report. As such, the Board assigns significant probative weight to the report. Accordingly, as the report is the most probative opinion evidence of record, resolving any doubt in the Veteran's favor, weighing the probative value of the report and opinion, the Board finds the evidence of record is at least in relative equipoise as to whether the Veteran's left foot condition was related to her military service. Therefore, the Board resolves reasonable doubt in the Veteran's favor, and as all the elements necessary for establishing service connection are met, finds entitlement to service connection for left foot condition is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. The appeal is granted.

Increased Rating

Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R., Part 4. The rating schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1.

In determining the severity of a disability, the Board is required to consider the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the Veteran, as well as the entire history of the Veteran's disability. 38 C.F.R. §§ 4.1, 4.2; Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991).

If the disability more closely approximates the criteria for the higher of two ratings, the higher rating will be assigned; otherwise, the lower rating is assigned. 38 C.F.R. § 4.7. It is not expected that all cases will show all the findings specified; however, findings sufficiently characteristic to identify the disease and the disability therefrom and coordination of rating with impairment of function will be expected in all instances. 38 C.F.R. § 4.21.

The Veteran's entire history is to be considered when making disability evaluations. See generally 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589. With the initial rating assigned with the award of service connection for a disability, "staged" ratings to reflect distinct periods when different levels of impairment were shown are for consideration. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Where entitlement to compensation has already been established and increase in disability is at issue, the present level of disability is of primary concern. See Francisco v. Brown, 7 Vet. App. 55 (1994).

Entitlement to an increased rating of 70 percent, but no higher, for posttraumatic stress disorder (PTSD) claimed as depression, is granted.

The Veteran contends that her service-connected PTSD entitled to an increased rating. The Veteran was service connected for PTSD and has a current evaluation of 50 percent under 38 C.F.R. § 4.130 Diagnostic Code (DC) 9411.

PTSD is evaluated under DC 9411, which provides that such disability is evaluated pursuant to the General Rating Formula for Mental Disorders (General Rating Formula). 38 C.F.R. § 4.130. The General Rating Formula provides a 50 percent rating is assigned when there is occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of
PTSD and has a current evaluation of 50 percent under 38 C.F.R. § 4.130 Diagnostic Code (DC) 9411.

PTSD is evaluated under DC 9411, which provides that such disability is evaluated pursuant to the General Rating Formula for Mental Disorders (General Rating Formula). 38 C.F.R. § 4.130. The General Rating Formula provides a 50 percent rating is assigned when there is occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships.

A 70 percent rating is warranted for occupational and social impairment with deficiencies in most areas such as work, family relations, judgment, thinking, or mood, due to such items as: suicidal ideation; obsessional rituals which interfere with routine activity; speech intermittently illogical, obscure or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances and inability to establish and maintain effective relationships.

A 100 percent disability evaluation requires total occupational and social impairment, due to symptoms such as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation or name.

The use of the term "such as" in the general rating formula for mental disorders in 38 C.F.R. § 4.130 demonstrates that the symptoms after that phrase are not intended to constitute an exhaustive list, but rather are to serve as examples of the type and degree of symptoms, or their effects, that would justify a particular rating. See Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). It is not required to find the presence of all, most, or even some, of the enumerated symptoms recited for particular ratings. Id. The use of the phrase "such symptoms as," followed by a list of examples, provides guidance as to the severity of symptoms contemplated for each rating, in addition to permitting consideration of other symptoms, particular to each veteran and disorder, and the effect of those symptoms on the claimant's social and work situation. Id.

In Vazquez-Claudio v. Shinseki, 713 F.3d 112 (Fed. Cir. 2013), the Federal Circuit stated that "a veteran may only qualify for a given disability rating under § 4.130 by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration." It was further noted that "§ 4.130 requires not only the presence of certain symptoms but also that those symptoms have caused occupational and social impairment in most of the referenced areas." Vazquez-Claudio, 713 F.3d 112.

When evaluating an acquired psychiatric disorder, the rating agency shall consider the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the capacity for adjustment during periods of remission. The rating agency shall assign an evaluation based on all the evidence of record that bears on occupational and social impairment, rather than solely on the examiner's assessment of the level of disability at the moment of the examination. When evaluating the level of disability from a mental disorder, the rating agency will consider the extent of social impairment but shall not assign an evaluation solely on the basis of social impairment. The focus of the rating process is on industrial impairment from the service-connected psychiatric disorder, and social impairment is significant only insofar as it affects earning capacity. 38 C.F.R. §§ 4.126, 4.130.

The specified factors for each incremental psychiatric rating are not requirements for a particular rating but are examples providing guidance as to the type and degree of severity, or their effects on social and work situations. Analysis should not be limited to whether the symptoms listed in the rating scheme are exhibited; rather, consideration must be given to factors outside the rating criteria in determining the level of occupational and social impairment. Mauerhan, 16 Vet. App. 436.

Under the General Rating Formula, the Board must conduct a "holistic analysis" that considers all associated symptoms, regardless of whether they are listed as criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017); 38 C.F.R. § 4.130. The Board must determine whether unlisted symptoms are similar in severity, frequency, and duration to the listed symptoms associated with specific disability percentages. Then, the Board must determine whether the associated symptoms, both listed and unlisted, caused the level of impairment required for a higher disability rating. Vazquez-Claudio, 713 F.3d 112.

On February 19, 2020, the Veteran was afforded a VA examination for evaluation of her PTSD. The examiner noted the Veteran was married for 16 years and had two children, ages 20 and 29. See February 19, 2020 VA Examination. The Veteran denied having any hobbies or recreational interests. Id. She attended church service but no other church activities. Id. She had a best friend in Georgia but socially distanced herself from others. Id. The Veteran had symptoms of depressed mood, anxiety, suspiciousness, panic attacks that occur weekly or less often, chronic sleep impairment, disturbances of motivation and mood, and difficulty in establishing and maintaining effective work and social relationships. Id. The Veteran denied suicidal ideations but acknowledged thoughts of death. Id.

On October 2, 2024, the Veteran submitted a PTSD Disability Benefits Questionnaire (DBQ) dated October 1, 2024. The psychologist noted the Veteran had occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgement, thinking, and/or mood. See October 2, 2024 DBQ. The Veteran had been employed as a biologist for the FDA for 11 years. Id. The Veteran stated that her marriage was not going well and that she had angry outbursts and would occasionally throw things. Id. Her relationship with her adult son who lives 30 minutes from here was not good. Id. The Veteran acknowledged that she had a hard time being a friend and spent a lot of time by herself. Id. The Veteran had symptoms of depressed mood; anxiety; suspiciousness; panic attacks that occur weekly or less often; near continuous panic or depression affecting the ability to function independently, appropriately, and effectively; chronic sleep impairment; mild memory loss, such as forgetting names, directions, or recent events; disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships; and suicidal ideations. Id.

Based on the medical evidence of record, the Board finds that an increased rating of 70 percent, but no higher, is warranted. The Veteran had suffered symptoms of depressed mood; anxiety; suspiciousness; panic attacks that occur weekly or less often; near continuous panic or depression affecting the ability to function independently, appropriately, and effectively; chronic sleep impairment; mild memory loss, such as forgetting names, directions, or recent events; disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships; and suicidal ideations. Her symptoms affected her relationships with her family. Although she had a close friend in another state, she often spent time alone and acknowledged that she had difficulty being a friend. She had angry outbursts and would throw things. The Veteran did not have any hobbies or recreational interests. For these reasons, the Board finds the Veteran had occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgement, thinking, and/or mood. Therefore, an increased rating of 70 percent, but no higher, is warranted.

The Board finds that the Veteran's PTSD does not nearly approximate the criteria for a 100 percent rating at any time during the appeal period. In this regard, the Veteran did not have an inability to perform activities of daily living. The Veteran has been able to recount her occupational and social history. Although the Veteran has had some difficulty with her memory, the record is devoid of instances where she exhibited memory loss of names of close relatives or her own name
. For these reasons, the Board finds the Veteran had occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgement, thinking, and/or mood. Therefore, an increased rating of 70 percent, but no higher, is warranted.

The Board finds that the Veteran's PTSD does not nearly approximate the criteria for a 100 percent rating at any time during the appeal period. In this regard, the Veteran did not have an inability to perform activities of daily living. The Veteran has been able to recount her occupational and social history. Although the Veteran has had some difficulty with her memory, the record is devoid of instances where she exhibited memory loss of names of close relatives or her own name. Additionally, the Board finds that the Veteran has not had virtual isolation in the community and is not totally incapacitated by her symptoms. The Veteran continued to work as a biologist. See February 19, 2020 VA Examination; October 2, 2024 DBQ. Consequently, the Board finds that the Veteran's symptomatology does not result in total occupational and social impairment to warrant a 100 percent rating for her PTSD at any time.

In sum, resolving all reasonable doubts in the Veteran's favor, the Board finds that an increased rating of 70 percent, but no higher, for the Veteran's service-connected PTSD is warranted. The appeal is granted.

Danette Mincey

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board T. Hahn

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

Analyze in VA Law Explorer