PERIPHERAL ARTERIAL OCCLUSIVE DISEASE (BUERGER'S DISEASE)

J. NICHOLS · 2026 · Case ID: A26037947

MIXED

Summary

The veteran served from September 1975 to March 1981. This case involves an appeal from a February 2025 Higher Level Review rating decision, with the Board considering evidence of record at the time of a November 2023 AOJ decision. The appeal expanded to include claims for peripheral vascular disease of the lower extremities and bilateral foot disabilities. The veteran claimed peripheral vascular disease was related to service, specifically a foot operation at Fort Campbell. However, the Board found no evidence of chronic peripheral vascular disease in service, no manifestation to a compensable degree within the presumptive period, and no continuity of symptomatology. VA treatment records showed a diagnosis over 20 years post-service, and a December 2008 VA examination opined the complaints were unrelated to service, noting only an ankle sprain in service records. The Board found the VA opinion more probative and denied service connection for peripheral vascular disease. For bilateral foot disabilities, the veteran claimed they were related to service foot surgery. While service treatment records from 1975-1978 were unavailable, a December 2008 VA examination noted peripheral vascular disease and status post right fifth toe corn removal. A January 2011 VA examination diagnosed congenital pes planus. The Board found clear and unmistakable evidence of pre-existing congenital pes planus but also found that it was not clear and unmistakable that this condition was not aggravated during service, citing the documented right fifth toe surgery and the veteran's lay statements of in-service foot pain. Therefore, service connection was granted for residuals of corn removal, bilateral foot pain, and bilateral pes planus.

Rationale

Not chronic in service; No manifestation within presumptive period; No continuity of symptomatology; VA opinion found no nexus to service

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250915-586034

Full Decision Text

Citation Nr: A26037947
Decision Date: 04/22/26 Archive Date: 04/22/26

DOCKET NO. 250915-586034
DATE: April 22, 2026

ORDER

Readjudication of service connection for peripheral vascular disease, right lower extremity (claimed as bilateral foot condition) is granted.

Readjudication of service connection for peripheral vascular disease, left lower extremity (claimed as bilateral foot condition) is granted.

Entitlement to service connection for peripheral vascular disease of the right lower extremity is denied.

Entitlement to service connection for peripheral vascular disease of the left lower extremity is denied.

Entitlement to service connection for bilateral pes planus is granted.

Entitlement to service connection for bilateral foot pain and residuals of right fifth toe corn removal is granted.

FINDINGS OF FACT

1. New and relevant evidence has been received to readjudicate the claim for service connection for peripheral vascular disease of the right lower extremity. 38 U.S.C. §§ 5104C, 5108; 38 C.F.R. §§ 3.160 (d), 3.2500, 3.2501.

2. New and relevant evidence has been received to readjudicate the claim for service connection for peripheral vascular disease of the left lower extremity. 38 U.S.C. §§ 5104C, 5108; 38 C.F.R. §§ 3.160 (d), 3.2500, 3.2501.

3. The Veteran's right lower extremity peripheral vascular disease was not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disability is not otherwise etiologically related to an in-service injury or disease.

4. The Veteran's left lower extremity peripheral vascular disease was not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disability is not otherwise etiologically related to an in-service injury or disease.

5. The evidence is at least evenly balanced as to whether pre-existing pes planus was aggravated during service.

6. Bilateral foot pain and right fifth toe corn removal is related to service.

CONCLUSIONS OF LAW

3. The criteria for service connection for peripheral vascular disease of the right lower extremity are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307.

4. The criteria for service connection for peripheral vascular disease of the left lower extremity are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307.

5. The criteria for service connection for bilateral pes planus are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

6. The criteria for service connection for bilateral foot pain and residuals of right fifth toe corn removal are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from September 1975 to March 1978 and from March 1978 to March 1981.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a February 2025 Higher Level Review rating decision of a Department of Veterans Affairs (VA) Regional Office (RO).

In the September 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket.

Therefore, the Board may only consider the evidence of record at the time of the November 2023 agency of original jurisdiction (AOJ) decision
3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from September 1975 to March 1978 and from March 1978 to March 1981.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a February 2025 Higher Level Review rating decision of a Department of Veterans Affairs (VA) Regional Office (RO).

In the September 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket.

Therefore, the Board may only consider the evidence of record at the time of the November 2023 agency of original jurisdiction (AOJ) decision, which was subsequently subject to higher-level review. 38 C.F.R. § 20.301. If evidence was submitted during the period after the AOJ issued the decision, which was subsequently subject to higher-level review the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.301, 20.801.

Based on the evidence developed in processing the Veteran's claim, the scope of issues on appeal has been expanded to include a claim for peripheral vascular disease of the lower extremities and bilateral foot disabilities. Clemons v. Shinseki, 23 Vet. App. 1, 4-5 (2009) (a claim should not be limited to the disorder as characterized by the Veteran but must be characterized and addressed based on the reasonable expectations of the non-expert claimant and the evidence in processing the claim).

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[s], 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 may be established for disability resulting from personal injury suffered or disease contracted in line of duty in the active military, naval, or air service. 38 U.S.C. §§ 1110, 1131. That an injury or disease occurred in service is not enough; there must be chronic disability resulting from that injury or disease. If there is no showing of a resulting chronic condition during service, then a showing of continuity of symptomatology after service is required to support a finding of chronicity. 38 C.F.R. § 3.303(b). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

Generally, to prove service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009).

In some cases, service connection may be established by showing evidence of a chronic disease in service, which requires a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. 38 C.F.R. § 3.303(b). For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. For specified chronic diseases, if chronicity in service is not established, a showing of continuity of symptoms after discharge may support the claim. 38 C.F.R. §§ 3.303(b), 3.309; Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013); see also Fountain v. McDonald, 27 Vet. App. 258 (2015).

In addition, for veterans who have served 90 days or more of active service during a war period or after December 31, 1946, certain chronic disabilities are presumed to have been incurred in service if they manifested to a degree of 10 percent or more within one year from the date of separation from service. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309.

A veteran will be considered to have been in sound condition when examined, accepted, and enrolled
. Cir. 2013); see also Fountain v. McDonald, 27 Vet. App. 258 (2015).

A veteran will be considered to have been in sound condition when examined, accepted, and enrolled for service, except as to defects, infirmities, or disorders noted at entrance into service, or where clear and unmistakable evidence demonstrates that an injury or disease existed prior thereto and was not aggravated by service. 38 U.S.C. § 1111. Only such conditions as are recorded in examination reports are to be considered as noted. 38 C.F.R. § 3.304 (b). Under VA regulations, every person employed in the active military, naval, or air service shall be taken to have been in sound condition when examined, accepted and enrolled for service, except as to defects, infirmities, or disorders noted at the time of the examination, acceptance and enrollment, or where clear and unmistakable evidence demonstrates that the injury or where evidence of medical judgment is such as to warrant a finding that the disease or injury existed before acceptance and enrollment. 38 U.S.C. § 1132. Only such conditions as are recorded in examination reports are considered as noted at enlistment. 38 C.F.R. § 3.304 (b).

Where such defects, infirmities or disorders are not noted when examined, accepted, and enrolled for service, pursuant to 38 U.S.C. § 1111 and 38 C.F.R. § 3.304, in order to rebut the presumption of soundness on entry into service, VA must show by clear and unmistakable evidence both that the disease or injury existed prior to service and that the disease or injury was not aggravated by service. See Wagner v. Principi, 370 F.3d 1089 (Fed. Cir. 2004); VAOPGCPREC 3-03. "Clear and unmistakable evidence" means that the evidence "'cannot be misinterpreted and misunderstood, i.e., it is undebatable.'" Quirin v. Shinseki, 22 Vet. App. 390, 396 (2009).

Service connection may also be granted on a secondary basis for disability that is proximately due to or the result of service-connected disease or injury. 38 C.F.R. § 3.310(a). Secondary service connection under 38 C.F.R. § 3.310 (a) is warranted where a non service-connected disability would have been less severe but for a service-connected disability, either because there is a direct, etiological link (to include worsening of functionality) between the two, or because the service-connected disability resulted in the inability to treat the non-service-connected disability. Spicer v. McDonough, 61 F.4th 1360, 1366 (Fed. Cir. 2023) (holding that 38 C.F.R. § 3.310 (b), which provides for the award of service connection for a non service-connected disability that is aggravated by a service-connected disability, is inconsistent with 38 U.S.C. § 1110 and unlawful to the extent that it excludes the natural progress of a disease from compensation).

The Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022 (PACT Act), Pub. L. No. 117-168, 136 Stat. 1759 (2022) changed how VA processes claims for toxic exposed veterans, in relevant part, it created a new basis for presumptive service connection based on exposure to burn pits and other toxins, expanded locations associated with service in the Southwest Asia theater of operations, and the requirements for medical examinations. See 38 U.S.C. §§ 1117, 1119, 1120, 1168.

The PACT Act provides that where a veteran submits a service connection claim with evidence of a disability and evidence of participation in a toxic exposure risk activity (TERA) during active military service and such evidence is not sufficient to establish service connection for the disability, VA shall provide the veteran with a medical examination and secure a nexus opinion unless VA determines that there is no assertion that the claimed disorder is related to the TERA. Pub. L. No. 117-168,
exposure to burn pits and other toxins, expanded locations associated with service in the Southwest Asia theater of operations, and the requirements for medical examinations. See 38 U.S.C. §§ 1117, 1119, 1120, 1168.

Except as provided by law, a claimant has the responsibility to present and support a claim for benefits. VA shall consider all information and lay and medical evidence of record in a case and when there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (benefit-of-the-doubt rule not for application when evidence persuasively favors one side or the other).

New and relevant evidence

A January 2009 rating decision denied service connection for peripheral vascular disease claimed as a bilateral foot condition. The rating decision found that there was negative nexus evidence for bilateral feet complaints and peripheral vascular disease. The Veteran submitted a timely notice of disagreement. A Statement of the Case was issued in August 2012. A substantive appeal was not received within 60 days of the issuance of the SOC. A December 2015 letter informed the Veteran that his substantive appeal was not timely and could not be accepted. As a timely appeal was not received, the January 2009 rating decision is final.

The evidence of record at the time of the prior decision included a December 2008 VA examination. The examination reflects a diagnosis of status post right fifth toe corn removal with possible percutaneous alignment procedure to the fifth digit on the right; and moderate peripheral vascular disease with cramping and functional loss as primary complaint. The VA examiner opined that the Veteran's current bilateral feet complaints are not related to documented injury or treatment while enlisted in active service. The examiner noted that the only documented complaint was in reference to ankle sprain. The examiner stated that this was unrelated to any current complaints.

A Supplemental Claim was received in August 2023.

The evidence received since the last rating decision includes the Veteran's lay statements. The Veteran contends that he has arthritis of his feet and foot pain due to corn removal in service. See December 2021 Application for Compensation. The Veteran's statement contentions about his lower extremity symptoms are new and relevant. Accordingly, readjudication of the claims is warranted.

Entitlement to service connection for peripheral vascular disease of the left and right lower extremities

The Veteran contends that peripheral vascular disease of the lower extremities is related to service. Specifically, he contends it is related to a foot operation he had during service at Fort Campbell.

The Veteran has a current diagnosis of peripheral vascular disease of the lower extremities.

As noted above, certain chronic diseases will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013).

The Veteran has a current diagnosis of peripheral vascular disease of the lower extremities as evidenced by VA treatment records dated in March 2023. Cardiovascular renal disease is an enumerated condition under 38 C.F.R. § 3.309(a); Walker, 708 F.3d 1331.

However, the disability was not shown as chronic in service, did not manifest to a compensable degree within a presumptive period, and was not noted in service with attributable continuity of symptomatology.

VA treatment records show the Veteran was not diagnosed with peripheral vascular disease until February 2008, more than 20 years after separating
F.3d 1331, 1338 (Fed. Cir. 2013).

VA treatment records show the Veteran was not diagnosed with peripheral vascular disease until February 2008, more than 20 years after separating from service and outside of the applicable presumptive period.

A December 2008 VA examination reflects diagnoses of status post right fifth toe corn removal with possible percutaneous alignment procedure to the fifth digit on the right; and moderate peripheral vascular disease with cramping and functional loss as primary complaint. The VA examination noted the Veteran's report of poor circulation in his feet and legs since 2000. The VA examiner opined that the Veteran's current bilateral feet complaints are not related to documented injury or treatment while enlisted in active service. The examiner explained that based on the history, claims file review and radiographic findings, the current bilateral feet complaints are not related to documented injury or treatment while enlisted in active service. The examiner noted that the only documentation in the Veteran's claims file was in reference to an ankle sprain. The examiner stated this was essentially unrelated to any current complaints.

While the Veteran is competent to report foot pain during service and since service, the Veteran is not competent to provide a diagnosis in this case or determine that these symptoms were manifestations of peripheral vascular disease as the Veteran has not demonstrated the necessary medical expertise. The issue is medically complex, as it requires complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007).

The Board gives more probative weight to competent medical evidence, which found no relationship between peripheral vascular disease and service. The opinion is probative, as it was based on a review of the claims file and considered the treatment history for peripheral vascular disease and his foot surgery in service. See Nieves-Rodriguez v. Peake, 22 Vet. App. at 302 (2008).

In conclusion, the Board finds that the evidence weighs persuasively against service connection for peripheral vascular disease of the left and right lower extremities. Peripheral vascular disease of the left and right lower extremities was not chronic in service and did not manifest to a compensable degree within one year of separation from service. The competent medical evidence persuasively weighs against a nexus to service for peripheral vascular disease of the lower extremities. As the evidence weighs persuasively against the claims, the claims must be denied. 38 C.F.R. § 3.102; 38 U.S.C. § 5107.

Entitlement to service connection for left and right foot disabilities (other than peripheral vascular disease)

The Veteran claims that bilateral foot disabilities are related to foot surgery in service. He contends it is related to a foot operation he had during service at Fort Campbell.

Service treatment records note a history of foot surgery at Fort Campbell in 1978.

The Board notes that service treatment records dated from 1975 to 1978 could not be located and were determined to be unavailable. See December 2021 correspondence. There is no indication that pes planus was noted on enlistment. A history of foot surgery is documented in the Veteran's separation examination.

As there is no record indicating a foot condition was noted on enlistment, the Veteran is presumed to have been sound with respect to his feet. Clear and unmistakable evidence is required to establish both that pes planus pre-existed service and was not aggravated in service.

The Veteran has a current diagnosis of a bilateral foot condition. An October 2007 VA treatment record noted chronic pain in both feet. The record noted that the Veteran had surgery on his feet in 1977 with removal of lateral bones of mid feet. A December 2008 VA examination reflects a diagnosis of status post right fifth toe corn removal. A January 2011 VA examination reflects a diagnosis of congenital pes planus. He was diagnosed with chronic foot pain.

The Board finds there is clear and unmistakable evidence of pre-existing pes planus, based on the diagnosis of congenital pes planus.

The Board finds that it is not clear and unmistakable that pre-existing pes planus was not aggravated during service. The evidence reflects that the Veteran underwent surgery on the right fifth toe during service
VA treatment record noted chronic pain in both feet. The record noted that the Veteran had surgery on his feet in 1977 with removal of lateral bones of mid feet. A December 2008 VA examination reflects a diagnosis of status post right fifth toe corn removal. A January 2011 VA examination reflects a diagnosis of congenital pes planus. He was diagnosed with chronic foot pain.

The Board finds there is clear and unmistakable evidence of pre-existing pes planus, based on the diagnosis of congenital pes planus.

The evidence, including STRs, competent and credible lay statements of bilateral foot symptoms in-service, and the continuation of symptoms since service, are sufficient to establish that he incurred a right fifth toe injury condition in service and that his pes planus symptoms were aggravated during service. Buchanan v. Nicholson, 451 F.3d 1331, 1335 (Fed. Cir. 2006). The evidence documents right foot surgery with removal of corns and alignment procedure of the right fifth digit in service. His current diagnoses include chronic foot pain. Considering his foot pain symptoms, the Board finds that the evidence of record does not clearly and unmistakably establish that his pes planus was not aggravated in service. Accordingly, service connection is warranted for residuals of corn removal, bilateral foot pain, and bilateral pes planus. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

J. NICHOLS

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Catherine Cykowski

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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