RESIDUALS OF FRACTURES

YVETTE R. WHITE · 2026 · Case ID: A26035571

GRANTED

Summary

The Veteran, who served in the United States Air Force from October 1993 to October 2013, appeals the denial of service connection for a left 5th metatarsal fracture and secondary service connection for left foot and ankle osteoarthritis. The Board found that the Veteran has a current, resolved left 5th metatarsal fracture, confirmed by a March 2020 VA examination and corroborated by his service treatment records. The Veteran's private podiatrist examined him in January 2020, noting pain in the left 5th metatarsal and attributing it to the in-service injury, which the Board found highly probative, especially given the private treatment records corroborating residual pain. A contradictory March 2020 VA opinion was deemed inadequate due to reliance on absence of evidence, lack of substantive analysis, and failure to consider lay statements. The Board found a nexus to service for the fracture, resolving reasonable doubt in the Veteran's favor and granting service connection. For the secondary claims, the Veteran's private records showed diagnoses of left foot and ankle osteoarthritis, satisfying the current disability element. Service connection for the metatarsal fracture was already granted. The private podiatrist attributed the osteoarthritis to the fracture, and the inadequate VA opinions did not outweigh this. Therefore, the Board granted secondary service connection for both left foot and ankle osteoarthritis, resolving reasonable doubt in the Veteran's favor.

Rationale

Favorable finding of current disability (resolved fracture); Favorable finding of in-service incurrence (corroborated by STRs); Adequate private opinion linking condition to service; Inadequate VA opinion due to deficiencies; Reasonable doubt resolved in Veteran's favor

Service Branch

AIR FORCE

Special Benefit

NO SPECIAL BENEFIT

Docket No.

210222-142124

Full Decision Text

Citation Nr: A26035571
Decision Date: 04/16/26 Archive Date: 04/16/26

DOCKET NO. 210222-142124
DATE: April 16, 2026

ORDER

Entitlement to service connection for a left 5th metatarsal fracture is granted.

Entitlement to service connection for left foot osteoarthritis, as secondary to the left 5th metatarsal fracture, is granted.

Entitlement to service connection for left ankle osteoarthritis, as secondary to the left 5th metatarsal fracture, is granted.

FINDING OF FACT

The evidence is at least in approximate balance as to whether the Veteran's current left foot pain is the result of his in-service fracture of the left 5th metatarsal.

The evidence is at least in approximate balance as to whether the Veteran's left foot osteoarthritis is the result of his service-connected left 5th metatarsal fracture.

The evidence is at least in approximate balance as to whether the Veteran's left ankle osteoarthritis is secondary to his service-connected left 5th metatarsal fracture.

CONCLUSION OF LAW

The criteria for entitlement to service connection for a left 5th metatarsal fracture have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

The criteria for entitlement to service connection for left foot osteoarthritis, as secondary to the service-connected left 5th metatarsal fracture, have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

The criteria for entitlement to service connection for left ankle osteoarthritis, as secondary to the service-connected left 5th metatarsal fracture, have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty in the United States Air Force from October 1993 to October 2013.

This case comes before the Board of Veterans' Appeals (Board) on appeal from a January 2021 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In the February 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on January 16, 2025, and a transcript of the proceedings has been associated with the claims file.

As this is an appeal of a higher-level review rating decision, the Board may only consider the evidence of record at the time of the March 2020 agency of original jurisdiction (AOJ) decision, which was subsequently subject to higher-level review, as well as any evidence submitted by the Veteran, or his 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, which was subsequently subject to higher-level review 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 claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

Service Connection

Service connection on a direct basis requires evidence of three elements: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship or nexus between the current disability and the disease or injury incurred or aggravated during active service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004).

Service connection may also be established on a secondary basis for a disability which is proximately due to, or the result of, a service-connected disability. 38 C.F.R. §
Specific instructions for filing a Supplemental Claim are included with this decision.

Service Connection

Service connection may also be established on a secondary basis for a disability which is proximately due to, or the result of, a service-connected disability. 38 C.F.R. § 3.310(a). Service connection on a secondary basis may also be established for a disorder which is aggravated by a service-connected disability; compensation may be provided for the degree of disability (but only that degree) over and above the degree of disability existing prior to the aggravation. 38 C.F.R. § 3.310(b); Allen v. Brown, 8 Vet. App. 374 (1995).

To prevail on the issue of secondary service connection, the record must show: (1) a current disability; (2) a service-connected disability; and (3) a medical nexus between the current disability and the service-connected disability. See Wallin v. West, 11 Vet. App. 509 (1998); Allen v. Brown, supra.

The determination as to whether the requirements for service connection are met is based on an analysis of all evidence of record and an evaluation of its credibility and probative value. Baldwin v. West, 13?Vet. App.?1 (1999); 38?C.F.R. §?3.303(a).

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.? ?See 38?U.S.C. §?5107;?38?C.F.R. §?3.102.

1. Entitlement to service connection for a fracture of the left 5th metatarsal is granted.

The Veteran seeks entitlement to service connection for a left 5th metatarsal fracture.

In the January 2021 VA rating decision, the AOJ made a favorable finding that the Veteran has a diagnosis of "5th metatarsal fracture, resolved." See January 2021 Rating Decision.

Pursuant to 38 C.F.R. § 20.801, any findings favorable to the claimant, as identified by the AOJ, are binding on the Board of Veterans' Appeals adjudicators unless rebutted by evidence that identifies a clear and unmistakable error in the favorable finding. Here, the Board finds no evidence of error and notes that the Veteran's diagnosis of a resolved 5th metatarsal fracture was confirmed during a March 2020 VA examination. See March 2020 Foot Conditions DBQ.

Accordingly, the Board finds that the first element of service connection, a current disability, has been satisfied.

The AOJ also made a favorable finding regarding the Veteran's in-service injury. Specifically, the AOJ noted that the Veteran's service treatment records (STRs) "dated October 31, 1997, and June 20, 2011, show a questionable fracture of the 5th metatarsal and sprained left toe." See January 2021 Rating Decision. These findings are indeed corroborated by the Veteran's STRs.

As such, the second element of service connection, an in-service incurrence, has been satisfied.

Thus, the final remaining question is whether a medical nexus exists between the Veteran's current left 5th metatarsal condition and his in-service injury.

Throughout the pendency of his appeal, the Veteran has maintained that his left pinky toe pain has persisted at the site of his initial injury. See January 2025 Board Hearing Transcript; March 2020 Foot Conditions DBQ. The Board notes that the Veteran is competent to report observable symptoms as well as the onset and progression of that symptomatology. See Layno v. Brown, 6 Vet. App. 465, 470 (1994); Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007).

In January 2020, the Veteran's private podiatrist examined the Veteran and completed a foot conditions DBQ. See January 2020 Private Foot Conditions DBQ. The podiatrist noted that the Veteran has pain in the left 5th metatarsal and indicated that it was
Conditions DBQ. The Board notes that the Veteran is competent to report observable symptoms as well as the onset and progression of that symptomatology. See Layno v. Brown, 6 Vet. App. 465, 470 (1994); Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007).

In January 2020, the Veteran's private podiatrist examined the Veteran and completed a foot conditions DBQ. See January 2020 Private Foot Conditions DBQ. The podiatrist noted that the Veteran has pain in the left 5th metatarsal and indicated that it was the result of the Veteran's in-service injury. Id. The private examiner confirmed that he had reviewed the Veteran's STRs prior to conducting the examination. Id.

Private treatment records from January 2020 also reveal that the Veteran had pain in the left 5th metatarsal upon palpation. See January 2020 American Foot & Leg Specialists Note.

The Board finds the Veteran's testimony highly probative, especially in light of the private treatment records which corroborate his complaints of residual left 5th metatarsal pain.

The Board acknowledges that a contradictory VA medical opinion was obtained regarding this matter in March 2020. See March 2020 Medical Opinion DBQ. However, the VA medical opinion is inadequate for adjudication purposes due to multiple deficiencies. First, the VA examiner improperly relied on the absence of evidence. See Fountain v. McDonald, 27 Vet. App. 258, 272-75 (2015) (indicating that a VA examiner may not generally rely on the absence of evidence as negative evidence). Second, the opinion is conclusory as it is not supported by any substantive analysis. See Stefl v. Nicholson, 21 Vet. App. 120 (2007); Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Lastly, the VA medical opinion did not consider the lay statements of the Veteran. See Miller v. Wilkie, 32 Vet. App. 249, 260 (2020). Given these shortcomings, the Board finds that the March 2020 VA medical opinion is inadequate for adjudication purposes and merits no probative value.

Upon consideration of the foregoing evidence, the Board finds that the third element of service connection, a medical nexus, has been satisfied.

As the evidence is at least in approximate balance as to whether the Veteran's current left 5th metatarsal pain is due to his in-service injury, reasonable doubt is resolved in his favor and the claim of entitlement to service connection for a left 5th metatarsal fracture is granted. See 38?U.S.C. §?5107;?38?C.F.R. §?3.102.

2. Entitlement to service connection for left foot osteoarthritis, as secondary to the left 5th metatarsal fracture, is granted.

3. Entitlement to service connection for left ankle osteoarthritis, as secondary to the left 5th metatarsal fracture, is granted.

The Veteran seeks entitlement to service connection for osteoarthritis of the left foot and ankle as secondary to his left 5th metatarsal fracture.

As noted above, to prevail on the issue of secondary service connection, the record must show: (1) a current disability; (2) a service-connected disability; and (3) a medical nexus between the current disability and the service-connected disability. See Wallin v. West, supra; Allen v. Brown, supra.

Here, private treatment records reveal a diagnosis of foot and ankle osteoarthritis. See January 2020 American Foot and Leg Specialists Note. Additionally, the privately completed Foot Conditions DBQ documents a diagnosis of osteoarthritis in the left foot and ankle. See January 2020 Private Foot Conditions DBQ.

Accordingly, the Board finds that the first element of service connection, a current disability, has been satisfied.

Further, and as discussed above, entitlement to service connection for a left 5th metatarsal fracture has been granted by the present decision. As such, the second element of service connection has been satisfied.

Thus, the final remaining question is whether a medical nexus exists between the Veteran's foot and ankle osteoarthritis and his service-connected left 5th metatarsal fracture.

Notably, the Veteran's private physician indicated that his left foot and ankle osteoarthritis is "secondary to [his] previous fracture." See January 2020 American Foot nad Leg Specialists Note. The treatment notes also specifically refer to
, the Board finds that the first element of service connection, a current disability, has been satisfied.

Thus, the final remaining question is whether a medical nexus exists between the Veteran's foot and ankle osteoarthritis and his service-connected left 5th metatarsal fracture.

Although secondary service connection opinions were obtained in March 2020, the VA examiner did not acknowledge the Veteran's private treatment records or his diagnosis of osteoarthritis. See March 2020 Medical Opinion DBQs. As such the Board finds that the March 2020 VA medical opinions are inadequate for adjudication purposes and warrant no probative value. See Reonal v. Brown, 5 Vet. App. 458, 460-61 (1993) (holding that the Board may reject a medical opinion based on an inaccurate factual basis).

As the Veteran's private foot and ankle specialist attributed his current left foot and ankle ostearthritis to the left 5th metatarsal fracture, and as there are no adequate countervailing opinions of record, the Board finds that the third element of service connection has been satisfied.

As the evidence is at least in approximate balance as to whether the Veteran's left foot and ankle osteoarthritis are secondary to his service-connected 5th metatarsal fracture, reasonable doubt is resolved in his favor and both service connection claims are granted. See 38?U.S.C. §?5107;?38?C.F.R. §?3.102.

YVETTE R. WHITE

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Zachary J. Ellis, 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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