HALLUX VALGUS (BUNION) ACQUIRED

Summary

The Veteran, an Army Veteran who served from September 1974 to September 1977, appeals the denial of service connection for right foot hallux valgus with callus pain and osteopenia of the right foot with degenerative changes. The Veteran claimed his right foot condition was secondary to his service-connected right hip arthritis. The Board found the initial VA examination inadequate because it failed to address the Veteran's service-connected hip arthritis or opine on the secondary relationship. A subsequent VA examination in June 2021 provided a favorable opinion, stating the Veteran's hallux valgus with calluses was at least as likely as not secondary to his service-connected right hip arthritis due to gait adaptation from hip pain. This opinion was deemed most probative and supported by the Veteran's treatment records and testimony. Consequently, service connection for right foot hallux valgus with callus pain was granted. However, the claim for osteopenia of the right foot with degenerative changes was remanded. The Board found the initial VA examination inadequate for this condition as well, as it did not address osteopenia or its secondary relationship to the hip arthritis. The June 2021 opinion also failed to address osteopenia. Therefore, a remand was necessary for a new VA opinion on the osteopenia claim, specifically addressing whether it was caused by or aggravated by the service-connected hip arthritis.

Rationale

Favorable June 2021 VA opinion found secondary relationship; Veteran's gait adaptations due to hip pain; Supported by treatment records and Veteran's testimony

Full Decision Text

Citation Nr: A26037477
Decision Date: 04/22/26	Archive Date: 04/22/26

DOCKET NO. 210915-185406
DATE: April 22, 2026

ORDER

Entitlement to service connection for right foot hallux valgus with callus pain, as secondary to right hip arthritis, is granted.

REMANDED

Entitlement to service connection for osteopenia of the right foot with degenerative changes is remanded.

FINDING OF FACT

The Veteran's right foot hallux valgus with callus pain was caused by, or is related to, his service-connected right hip arthritis. 

CONCLUSION OF LAW

The criteria for entitlement to service connection for right foot hallux valgus with callus pain are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303, 3.310, 4.3.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty in the United States Army from September 1974 to September 1977. 

The present appeal comes before the Board of Veterans' Appeals (Board) from a May 2021 initial rating decision that denied entitlement to service connection for right foot hallux valgus with callosities and osteopenia of the right foot with degenerative changes. The Veteran appealed that decision by filing a VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement) in September 2021. He elected the Board's hearing docket.

A Board hearing was scheduled for May 7, 2025. On April 10, 2025, the Veteran withdrew the hearing request. As a result of the Veteran's docket election, the Board may only consider the evidence of record at the time of the May 2021 initial rating decision on appeal as well as any evidence submitted by the Veteran or his representative within 90 days following receipt of the withdrawal of the hearing request (i.e., July 9, 2025). 38 C.F.R. § 20.302(b). Evidence of record specifically identified by the Veteran or his representative in his September 15, 2021 Notice of Disagreement and/or May 16, 2025 brief (submitted in lieu of a Board hearing) is likewise considered "submitted" during the evidence submission window. See Cash v. Collins, 2026 U.S. App. LEXIS 3596, 2026 LX 94368, 166 F.4th 1046, 2026 WL 302984, (Fed. Cir., Feb. 5, 2026).  The May 2025 brief made specific reference to findings made in a June 2021 VA examination, which means that the report of that examination was submitted during the applicable evidentiary window. 

However, because the Board is remanding the claim of entitlement to service connection for right foot degenerative arthritis, any evidence the Board could not consider will be considered by the AOJ in the adjudication of the claim. 38 C.F.R. § 3.103(c)(2)(ii).

?

The Board notes that the Veteran's right foot conditions include plantar fascitis. However, the rating decision on appeal deferred the issue of entitlement to service connection for right foot plantar fascitis for a medical opinion. A deferred AOJ rating decision is not a final decision that may be appealed to the Board. See Shipley v. Shinseki, 24 Vet. App. 458, 462 (2011) (holding that "because there is no "final decision" when the [AOJ] issues a deferred rating decision, there has been no "adjudicative determination" from which an NOD can be filed"). Thus, a claim for entitlement to service connection for right foot plantar fascitis is beyond of the scope of the current appeal. 

In November 10, 2021, the AOJ issued a rating decision that, in pertinent part, denied service connection for degenerative arthritis of the right foot. The Veteran filed a separate appeal in January 2022.  Docket number 220125-213431 was assigned.  That appeal is pending at the Board and will be adjudicated at a later time.  

Entitlement to service connection for right foot hallux valgus with callus pain.

The Veteran seeks service connection for right foot condition. Specifically, he contends that his right foot condition is due to, or related to, his service-connected right hip arthritis. See December 2020 VA 21-526EZ, Fully Developed Claim (Compensation). 

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service.
, denied service connection for degenerative arthritis of the right foot. The Veteran filed a separate appeal in January 2022.  Docket number 220125-213431 was assigned.  That appeal is pending at the Board and will be adjudicated at a later time.  

Entitlement to service connection for right foot hallux valgus with callus pain.

The Veteran seeks service connection for right foot condition. Specifically, he contends that his right foot condition is due to, or related to, his service-connected right hip arthritis. See December 2020 VA 21-526EZ, Fully Developed Claim (Compensation). 

Service connection may be granted for a 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. See Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Service connection may also be granted for any injury or disease diagnosed after discharge when the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38?C.F.R. §?3.303(d).

Service connection may also be granted on a secondary basis for a disability which is due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310. Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. See Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc); see also Spicer v. McDonough, 61 F.4th 1360, 1364 (Fed. Cir. 2021) (invalidating the requirement of "proximate cause" and instead held a "but for" causation or aggravation is enough to show entitlement to secondary service connection).

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 weighs in favor of the claim(s) of the Veteran, the benefit of the doubt doctrine is inapplicable, and the claim(s) will be granted on the merits. 38 U.S.C. § 5107; see also Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021); see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990).

In the May 2021 rating decision, the AOJ found that the evidence shows the Veteran was diagnosed with hallux valgus in July 2020 and that the claimed primary disability (right hip arthritis) is service connected. See Rating Decision - Narrative. The Board is bound by these favorable findings. 38 C.F.R. § 3.104(c).  The Board also takes notice that bunions are synonymous with hallux valgus. See  https://my.clevelandclinic.org/health/diseases/14386-bunions-hallux-valgus.  The first two elements for secondary service connection are met. 

The remaining question is whether the Veteran's hallux valgus with callosities is caused by, or is related to, his service-connected right hip arthritis. 

The Veteran underwent a VA examination in April 2021. The VA examiner diagnosed the Veteran with right foot plantar fascitis, hallux valgus, degenerative arthritis, and osteopenia. See April 2021 C&P Exam. Pain and callus formation were noted to have began in 2010 and were related to bunion formation on the right foot.  Generally, the VA examiner opined that the Veteran's right foot condition is less likely than not proximately due to or the result of the Veteran's service-connected right hip. In support of the opinion, the VA examiner explained that there was no nexus or plausible secondary relationship established. The VA examiner stated she was unable to confirm a
 service-connected right hip arthritis. 

The Veteran underwent a VA examination in April 2021. The VA examiner diagnosed the Veteran with right foot plantar fascitis, hallux valgus, degenerative arthritis, and osteopenia. See April 2021 C&P Exam. Pain and callus formation were noted to have began in 2010 and were related to bunion formation on the right foot.  Generally, the VA examiner opined that the Veteran's right foot condition is less likely than not proximately due to or the result of the Veteran's service-connected right hip. In support of the opinion, the VA examiner explained that there was no nexus or plausible secondary relationship established. The VA examiner stated she was unable to confirm a current chronic diagnosis based on the onset of the Veteran's right foot condition in 2020. 

The VA examiner's opinion is inadequate. The opinion does not address the Veteran's service-connected right hip arthritis much less discuss or opine as to whether the Veteran's right foot conditions are due to, or related to, his service-connected right hip arthritis. Such is particularly troubling given that the Veteran does not argue that his right foot condition has been chronic since service and clearly asserts that his right foot condition is etiologically related to his right hip arthritis. See Dalton v. Nicholson, 21 Vet. App. 23, 39 (2007) (finding that an examiner impermissibly ignored the appellant's lay assertions). Additionally, the VA examiner's failure to address or discuss the Veteran's right hip arthritis ignores the specific instructions for the opinion as provided by VA. 

A second VA opinion was provided in June 2021. The VA examiner opined that the Veteran's right foot condition is at least as likely as not proximately due to or the result of the Veteran's service-connected right hip arthritis. The VA examiner concluded that the Veteran's right foot condition, callus on the lateral 5th digit, is the result of adapting to movement required by his right hip pain. She explained that callus formation with bunion type pressure forms over years of ongoing change in the normal placement of the foot with walking or lifting due to radiating pain from the hips, knees, or back. She noted that the Veteran adapted his foot placement due to pain, and the callus/bunion area was consistent with a history of turning the foot outward, causing pressure and callus formation. Based on the foregoing, she opined that the Veteran's calluses with bunion type pressure are at least as likely as not secondary to his service-connected right hip arthritis. 

The Board assigns the most probative weight to the June 2021 VA opinion. The June 2021 VA opinion provides a clear conclusion as to the etiology of the Veteran's hallux valgus with calluses due to ongoing compensation for the radiating pain in the Veteran's hip with supporting medical literature and rationale connecting the two. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008) (finding that a medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two). 

The VA examiner's opinion is also supported by the Veteran's treatment records. The Veteran was seen frequently for foot and callus care at Beckley VAMC. He reported having a callus on his right foot under his little toe since the 1990s. See October 2021 CAPRI. In October 2021, he admitted that he altered his gait as he walks, adding pressure to the lateral aspects of his right foot. See November 2021 CAPRI. In February 2025, the Veteran was treated for his painful callus on his right foot. See July 2025 Medical Treatment Record - Government Facility. He reported instability, difficulty with balance, and frequently falling due to radiating pain in his lower extremities. 

Based on the foregoing, the Board finds the evidence is neither evenly balanced nor approximately so with regard to whether entitlement to service connection for right foot hallux valgus with callus pain, as secondary to right hip arthritis, is warranted. Rather, the evidence persuasively weighs in favor of entitlement to service connection for right foot hallux valgus with callus pain, as secondary to right hip arthritis, and the claim is granted. 38 U.S.C. §?3.303; see also Shedden, at 1166-67.

REASONS FOR REMAND

Entitlement to service connection for osteopenia of the right foot with degenerative changes.

One of the effects of the AMA is to narrow the set of circumstances in which the Board must remand appeals to the AOJ for further development instead of immediately deciding them directly. Nevertheless, even under the AMA, the Board has the duty to remand issues when necessary to correct a
 is warranted. Rather, the evidence persuasively weighs in favor of entitlement to service connection for right foot hallux valgus with callus pain, as secondary to right hip arthritis, and the claim is granted. 38 U.S.C. §?3.303; see also Shedden, at 1166-67.

REASONS FOR REMAND

Entitlement to service connection for osteopenia of the right foot with degenerative changes.

One of the effects of the AMA is to narrow the set of circumstances in which the Board must remand appeals to the AOJ for further development instead of immediately deciding them directly. Nevertheless, even under the AMA, the Board has the duty to remand issues when necessary to correct a pre-decisional duty to assist error where the issues cannot be granted in full. 38 U.S.C. § 5103A(f); 38 C.F.R. § 20.802(a). 

The May 2021 rating decision on appeal also denied entitlement to service connection for right foot osteopenia with degenerative changes. The AOJ denied the claim as the Veteran's service treatment records do not show complaints, treatment, or a diagnosis of osteopenia or degenerative changes to the right foot, and the VA examiner was unable to find a link between osteopenia and/or degenerative changes and the Veteran's military service or service-connected right hip arthritis. 

As stated above, the April 2021 VA examiner noted the Veteran's diagnosis of osteopenia with degenerative changes on the VA examination. However, the April 2021 opinion does not clearly address his right foot osteopenia with degenerative changes nor does the opinion substantively discuss the Veteran's service-connected right hip arthritis or secondary service connection, as discussed above. Thus, the April 2021 opinion is inadequate as it fails to provide an adequate opinion addressing the nature and etiology of the Veteran's right foot osteopenia with degenerative changes or the Veteran's contentions as to secondary service connection. [It is again noted that a separate appeal for service connection for degenerative arthritis of the right foot is pending at the Board.]  

Furthermore, while the June 2021 VA opinion provides an adequate opinion as to the Veteran's hallux valgus with painful calluses, the VA examiner did not address or discuss the diagnosis of osteopenia with degenerative changes.  

Thus, the Board finds a remand is necessary to cure the pre-decisional duty to assist error by not obtaining an adequate medical opinion addressing the Veteran's right foot degenerative arthritis as service connection for right foot degenerative arthritis cannot be granted in full based on the evidence of record. 38 U.S.C. § 5103A(f); 38 C.F.R. § 20.802(a).

The matter is REMANDED for the following action:

Provide the claims file to a qualified VA examiner for an opinion regarding the Veteran's osteopenia of the right foot with degenerative changes. The entire claims file, including a copy of this Remand, must be made available to, and be reviewed by the examiner. All necessary tests and studies should be accomplished, and the examiner should provide a complete rationale for the conclusions reached. The need for a full, in-person examination shall be left up to the discretion of the examiner.?

Following a review of the record and, if applicable, an in-person examination or telephone interview, the VA examiner shall opine as to the following: 

(a.) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's osteopenia of the right foot with degenerative changes was caused by or is the result of his service-connected right hip arthritis? 

The examiner is advised that proximate cause is not required for secondary service connection. Rather, the question is whether the Veteran's service-connected right hip arthritis is a but for cause of his osteopenia of the right foot with degenerative changes, including whether his osteopenia of the right foot with degenerative changes would have been less severe but for his service-connected right hip arthritis.

(b.) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's osteopenia of the right foot with degenerative changes is aggravated by his service-connected right hip arthritis? 

The term "incremental increase in disability" means additional impairment of earning capacity. Objective measurement, or numerical quantification, is not required to ascertain an increase in disability. Moreover, any "incremental increase in disability" need not be permanent.

If the examiner cannot provide the requested opinions without resorting to speculation, he or she should expressly indicate this and provide a supporting rationale as to why an opinion cannot be made without resorting to speculation. 

 

MICHAEL A. HERMAN

Veterans Law Judge