FLATFOOT BILATERAL ACQUIRED

JOHN Z. JONES · 2026 · Case ID: A26039909

MIXED

Summary

The veteran, an Army veteran who served from January 2003 to March 2004 and May 2007 to July 2008, appeals the denial of service connection for several conditions and the remand of others. The Board granted service connection for bilateral pes planus, bone spurs, and arthritis, noting the veteran's credible testimony of continuous foot pain since service and favorable nexus opinions from a treating podiatrist and a military physician. Service connection for concussion with residuals was also granted, based on the veteran's credible testimony of two in-service head injuries in Iraq and continuing symptoms, despite the lack of specific in-service diagnoses. The Board also granted service connection for degenerative disc disease, left and right knee patellofemoral pain syndrome, and right shoulder impingement syndrome, relying on credible lay testimony of in-service injuries and favorable nexus opinions from a military physician. The Board found the evidence persuasively favored service connection for these conditions. However, the Board remanded claims for right thumb condition, right hip condition, and lower extremity nerve conditions (peripheral neuropathy and radiculopathy). The remand was necessary due to duty-to-assist errors, specifically the failure to obtain adequate VA examinations and medical opinions for these conditions, including addressing potential secondary relationships and TERA exposure. The Board noted that while the veteran's service treatment records were silent for some conditions, his credible lay testimony and favorable private medical opinions were sufficient to establish service connection for the granted conditions.

Rationale

Credible lay testimony of continuous foot pain since service; Favorable nexus opinions from treating podiatrist and military physician; Service treatment records silent for diagnosis, but noted foot numbness/tingling

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

210813-179360

Full Decision Text

Citation Nr: A26039909
Decision Date: 04/29/26 Archive Date: 04/29/26

DOCKET NO. 210813-179360
DATE: April 29, 2026

ORDER

Entitlement to service connection for bilateral pes planus, bone spurs and arthritis, claimed as bilateral feet pain and problems, is granted.

Entitlement to service connection for concussion with residuals, claimed as head injury/traumatic brain injury (TBI), is granted.

Entitlement to service connection for degenerative disc disease, claimed as lower back (lumbar), is granted.

Entitlement to service connection for left knee patellofemoral pain syndrome, claimed as left knee injury, is granted.

Entitlement to service connection for right knee patellofemoral pain syndrome, claimed as right knee injury, is granted.

Entitlement to service connection for right shoulder impingement syndrome and rotator cuff tendinitis is granted.

REMANDED

Entitlement to service connection for right hip is remanded.

Entitlement to service connection for dislocated right thumb is remanded.

Entitlement to service connection for lower extremity nerve conditions, to include peripheral neuropathy of the feet and radiculopathy, is remanded.

FINDINGS OF FACT

1. The probative evidence of record shows that the bilateral pes planus, bone spurs and arthritis is related to service.

2. The probative evidence of record shows that the concussion with residuals is related to service.

3. The probative evidence of record shows that the degenerative disc disease is related to service.

4. The probative evidence of record shows that the left knee patellofemoral pain syndrome is related to service.

5. The probative evidence of record shows that the right knee patellofemoral pain syndrome is related to service.

6. The probative evidence of record shows that the right shoulder impingement syndrome is related to service. The evidence is in approximate balance whether the right shoulder rotator cuff tendinitis is related to service.

CONCLUSIONS OF LAW

1. The criteria for service connection for bilateral pes planus, bone spurs and arthritis have been met. 38 U.S.C. §§ 1101, 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.309(a).

2. The criteria for service connection for concussion with residuals have been met. 38 U.S.C. §§ 1101, 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.309(a).

3. The criteria for service connection for degenerative disc disease have been met. 38 U.S.C. §§ 1101, 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304.

4. The criteria for service connection for left knee patellofemoral pain syndrome have been met. 38 U.S.C. §§ 1101, 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304.

5. The criteria for service connection for right knee patellofemoral pain syndrome have been met. 38 U.S.C. §§ 1101, 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304.

6. The criteria for service connection for right shoulder impingement syndrome and rotator cuff tendinitis have been met. 38 U.S.C. §§ 1101, 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Army from January 2003 to March 2004 and from May 2007 to July 2008 with additional inactive periods in the United States Army Reserves.

In the August 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on June 23, 2025.

Therefore,
1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Army from January 2003 to March 2004 and from May 2007 to July 2008 with additional inactive periods in the United States Army Reserves.

In the August 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on June 23, 2025.

Therefore, the Board may only consider the evidence of record at the time of the August 2020 agency of original jurisdiction (AOJ) decision on appeal, 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 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.

However, because the Board is remanding the claims of entitlement to service connection for right thumb condition, right hip condition and lower extremity nerve conditions, any evidence the Board could not consider will be considered by the AOJ in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii).

Service Connection

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). To establish a right to compensation for a present disability, a Veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service-the so-called "nexus" requirement. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting 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 that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

If a disability for which service connection is sought is a chronic condition as recognized by the Secretary under 38 C.F.R. § 3.309(a), the in-service incurrence of a disease or injury and relationship between the current disability and that in-service disease or injury may be established by competent and persuasive evidence of a continuity of symptomatology. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). A continuity of symptomatology may be established if the claimant can demonstrate that a condition was "noted" in service, post-service continuity of the same symptomatology, and a nexus between the present disability and that post-service symptomatology. Savage v. Gober, 10 Vet. App. 488, 496 (1997).

VA is required to give due consideration to all pertinent medical and lay evidence in evaluating a claim for disability benefits. 38 U.S.C. § 1154(a). Lay testimony is competent to prove that a claimant exhibited certain lay-observable symptoms and the time that those symptoms appeared. Layno v. Brown, 6 Vet. App. 465, 470 (1994). Lay evidence cannot be determined to lack credibility merely because it is unaccompanied by contemporaneous medical evidence. Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006).

The Board is responsible for determining whether the evidence persuasively supports
488, 496 (1997).

The Board is responsible for determining whether the evidence persuasively supports the claim or is in approximate balance, with the Veteran prevailing in either event, or whether the evidence is persuasively against the claim, in which case the claim is denied. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded to the claimant. 38 U.S.C. § 5107(b); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

Feet

The Veteran contends that his bilateral foot pain is due to in-service events, including several in-service injuries and wearing boots that were too small while deployed to Iraq. See June 2025 Hearing testimony.

In September 2025, the Veteran provided a February 2025 nexus letter from his treating podiatrist, Dr. A.O. The podiatrist indicated that the Veteran had a diagnosis of bilateral pes planus and that it was more likely than not related to past military duties.

The Veteran provided a September 2025 nexus letter from Dr. M.G., a military physician, who diagnosed peripheral neuropathy of the feet, bilateral bone spurs, and arthritis confirmed by imaging. The physician opined that physical stress in service more likely than not contributed to the development of the bone spurs and arthritis.

As to the first element of service connection, the Board finds that the Veteran has a current diagnosis of bilateral pes planus, bone spurs and arthritis based on the two nexus letters received in September 2025.

As for the second element of service connection, an in-service event, the service treatment records are silent for any diagnosis of the feet while in service. Service treatment records note a complaint of feet being numb or tingling in the February 2004 post deployment assessment. However, the Veteran also submitted additional evidence in the form of lay statements.

At the Board hearing the Veteran testified that he was given the wrong size boots, a size eight, when he normally wears size nine and a half, while he was deployed to Iraq. He reported wearing the wrong size boots for about four and a half months from January until May 2003. The Veteran reported constant foot pain starting during this period and continuing to present, reporting "There has never been a moment where my feet have not hurt."

The Veteran submitted two September 2025 lay statements from his brother G.C. in which the Veteran's brother indicated that the Veteran was not provided with the correct size of boots, and that he was called by the unit family readiness group asking him to go to a local clothing and sales store to search for boots since the unit did not have enough proper equipment to issue. The Veteran's brother indicated going to every store in the Fort Bragg area looking for the right boots and being unsuccessful.

The Veteran is competent to report on what he personally experienced or observed. The Board finds the Veteran credible. Therefore, the Board finds an in-service event, foot pain and numbness/tingling during service; the second element for service connection has been met.

As to the third element of service connection, a causal relationship between the foot conditions and military service, the Veteran's credible lay statements indicate that he has experienced pain since service.

Because arthritis is one of the chronic conditions indicated in 38 C.F.R. § 3.309(a), where the evidence demonstrates the existence of a current disability of arthritis, a continuity of symptomatology may establish the relationship between that current disability and service. Savage v. Gober, 10 Vet. App. 488, 496 (1997). See also Barr v. Nicholson, 21 Vet. App. 303, 308 (2007).

The Board considers the Veteran's credible testimony of continuous foot pain since service is sufficient to establish service connection for arthritis. As for the other two conditions of bilateral pes planus and bilateral bone spurs, the private medical opinions in combination with the Veteran's credible lay statements is sufficient to show that it was more likely than not that the foot conditions are related to service.

However, the Board notes that in the September 2025 nexus letter from Dr. M.G. it is not clear whether the peripheral neuropathy
current disability and service. Savage v. Gober, 10 Vet. App. 488, 496 (1997). See also Barr v. Nicholson, 21 Vet. App. 303, 308 (2007).

However, the Board notes that in the September 2025 nexus letter from Dr. M.G. it is not clear whether the peripheral neuropathy of the feet is due to in-service injuries or as secondary to the other foot conditions, and as the examiner also diagnosed lumbar radiculopathy in another nexus opinion, there is potential overlap of symptoms, see remand, below.

Based on the above, the Board finds the evidence persuasively favors that the Veteran's current bilateral pes planus, bone spurs and arthritis is related to service. Entitlement to service connection for bilateral pes planus, bone spurs and arthritis is warranted. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 3.303.

Head injury

The Veteran contends that he experienced at least two head injuries in-service. See June 2025 Hearing testimony.

As to the first element of service connection, the Board finds that the Veteran has a current diagnosis of concussion. December 2014 private medical records show a diagnosis of post concussive syndrome. The Veteran reported at the Board hearing that an in-service doctor told him he had a concussion. Unfortunately, the criteria for a diagnosis of TBI have not been met, as a TBI has not been diagnosed by a qualified professional, and it is not clear from the record which claimed residuals are the direct result of the head injury and which are the result of other causes. But the Board considers the condition of a concussion and its residuals to be within the scope of claim for a TBI.

As for the second element of service connection, an in-service event, the service treatment records are silent for any diagnosis of a concussion or TBI while in service. Service treatment records do note a complaint of two separate head injuries in the February 2004 post deployment assessment.

At the Board hearing the Veteran testified that he experienced two head injuries while he was deployed to Iraq, the first on the third day, and the second during the motor vehicle accident with the Humvee. He reported,

"I was in a troop carrying Humvee and my body was essentially hurled from the troop carrying section into the driver's compartment and I had a communications box that had followed with me and had essentially like opened up my legs a little bit more than what I could do. My foot was caught on a section of the vehicle. I was kind of folded like a piece of paper with regards to I guess my head was still pointed towards the back of the vehicle. My rear end was against the driver's windshield and let's see, I think that's the --that one hurt the most I would say."

The Veteran reported constant symptoms since the head injuries of memory loss, headaches, vertigo, and other symptoms.

The Veteran submitted two September 2025 lay statements from his brother G.C. in which the Veteran's brother indicated,

"During the deployment, [the Veteran] would remark about lingering headaches, vomiting, sensitivity to light, and dizziness that persisted for a few months after the event occurred. Post-deployment, there was a decrease in [the Veteran]'s memory, spatial awareness, judgement, irritability, and social interactions. Prior to deployment it was rare for [the Veteran] to become irritable at much of anything. However, post-deployment, I firmly believe that [the Veteran] became short-fused and now easily becomes irritated in social settings. I believe that his decrease in short-term memory and lack of judgment in social settings have negatively impacted his life."

The Veteran submitted a September 2025 lay statement from M.F. which described the motor vehicle accident in the Humvee in Iraq, as well as the Veteran's continuing symptoms.

The Veteran is competent to report on what he personally experienced or observed. The Board finds the Veteran credible. Therefore, the Board finds an in-service event, two head injuries during service; the second element for service connection has been met.

As to the third element of service connection, a causal relationship between the concussion and military service, the Veteran's credible lay statements and the lay statements of his brother and M.F. indicate that he has experienced symptoms since service.

Because brain injuries are one of the chronic conditions indicated in 38 C.F.R. § 3.309(a), where the evidence demonstrates the existence
statement from M.F. which described the motor vehicle accident in the Humvee in Iraq, as well as the Veteran's continuing symptoms.

Because brain injuries are one of the chronic conditions indicated in 38 C.F.R. § 3.309(a), where the evidence demonstrates the existence of a current disability of a brain injury, a continuity of symptomatology may establish the relationship between that current disability and service. Savage v. Gober, 10 Vet. App. 488, 496 (1997). See also Barr v. Nicholson, 21 Vet. App. 303, 308 (2007).

The Board considers the Veteran's credible testimony of continuous symptoms since service sufficient to establish service connection for a concussion and its residuals.

Based on the above, the Board finds the evidence persuasively favors that the Veteran's current concussion with residuals is related to service. Entitlement to service connection for concussion with residuals is warranted. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 3.303.

Back

The Veteran contends that he experienced at least two back injuries in-service. See June 2025 Hearing testimony.

The Veteran provided a September 2025 nexus letter from Dr. M.G., a military physician, who diagnosed degenerative disc disease, spondylosis and lumbar radiculopathy. M.G. opined that the lumbar degenerative disc disease is causally connected to military service. (Regarding radiculopathy, see remand, below.)

The Veteran submitted a September 2025 lay statement from M.F. which described the motor vehicle accident in the Humvee in Iraq, as well as the Veteran's continuing symptoms.

As to the first element of service connection, the Board finds that the Veteran has a current diagnosis of degenerative disc disease based on the nexus letter received in September 2025.

As for the second element of service connection, an in-service event, the service treatment records are silent for any diagnosis of the back while in service. Service treatment records note back pain at the May 2008 separation examination, and the March 2004 post deployment examination. Service treatment records note a complaint of back pain in the February 2004 post deployment assessment. At the Board hearing, the Veteran described in detail two in-service motor vehicle injuries, the first when he was hit by a vehicle, and the second being thrown inside a Humvee (see discussion for head injury, above).

The Veteran is competent to report on what he personally experienced or observed. The Board finds the Veteran credible. Therefore, the Board finds an in-service event, the second element for service connection has been met.

As to the third element of service connection, a causal relationship between the concussion and military service, the September 2025 nexus statement provides a connection, and as there is no contradictory medical evidence, the probative weight of evidence supports a connection between the in-service injuries and the current degenerative disc disease.

Based on the above, the Board finds the evidence persuasively favors that the Veteran's current degenerative disc disease is related to service. Entitlement to service connection for degenerative disc disease is warranted. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 3.303.

Bilateral knees

The Veteran contends that he experienced a number of knee injuries in-service, starting in training and continuing during his service in Iraq. See June 2025 Hearing testimony.

The Veteran provided a September 2025 nexus letter from Dr. M.G., a military physician, who diagnosed bilateral knee pain and patellofemoral pain syndrome. The physician opined that the bilateral knee pain is "highly likely due to, or the result of, the physical demands and activities performed during military service."

The Veteran submitted a September 2025 lay statement from M.F. which described the motor vehicle accident in the Humvee in Iraq, as well as the Veteran's continuing symptoms.

As to the first element of service connection, the Board finds that the Veteran has a current diagnosis of bilateral patellofemoral pain syndrome based on the nexus letter received in September 2025.

The Veteran submitted a September 2025 lay statement from M.F. which described the motor vehicle accident in the Humvee in Iraq, as well as the Veteran's continuing symptoms.

As to the first element of service connection, the Board finds that the Veteran has a current diagnosis of bilateral patellofemoral pain syndrome based on the nexus letter received in September 2025.

As for the second element of service connection, an in-service event, the service treatment records are silent for any diagnosis of the knees while in service. The Veteran reported right knee pain at the May 2008 separation examination. Service treatment records note a complaint of bilateral knee pain in the February 2004 post deployment assessment. At the Board hearing, the Veteran described in detail two in-service motor vehicle injuries, the first when he was hit by a vehicle, and the second being thrown inside a Humvee (see discussion for head injury, above).

As to the third element of service connection, a causal relationship between the patellofemoral pain syndrome and military service, the September 2025 nexus statement provides a connection, and as there is no contradictory medical evidence, the probative weight of evidence supports a connection between the in-service injuries and the current patellofemoral pain syndrome.

Based on the above, the Board finds the evidence persuasively favors that the Veteran's current bilateral patellofemoral pain syndrome is related to service. Entitlement to service connection for bilateral patellofemoral pain syndrome is warranted. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 3.303.

Right Shoulder

The Veteran contends that he experienced right shoulder injuries in service in Iraq. See June 2025 Hearing testimony.

The Veteran provided a September 2025 nexus letter from Dr. M.G., a military physician, who diagnosed right shoulder impingement syndrome and rotator cuff tendinitis. The physician opined that the right shoulder impingement syndrome is "highly likely related to his military service."

The Veteran submitted a September 2025 lay statement from M.F. which described the motor vehicle accident in the Humvee in Iraq, as well as the Veteran's continuing symptoms.

As to the first element of service connection, the Board finds that the Veteran has a current diagnosis of right shoulder impingement syndrome and rotator cuff tendinitis based on the nexus letter received in September 2025.

As for the second element of service connection, an in-service event, the service treatment records are silent for any diagnosis of the right shoulder while in service. The Veteran reported right shoulder pain at the May 2008 separation examination. Service treatment records note a complaint of right shoulder pain in the February 2004 post deployment assessment. At the Board hearing, the Veteran described in detail two motor vehicle injuries, including being hit by a car in Baghdad,

"A vehicle that I was standing on front of whether out of intention or accident the I guess the clutch slipped and they did run into me and I was hit behind both knees but I did go up onto the hood and slam into it with my right hip as well as my right shoulder."

The second motor vehicle accident was being thrown inside a Humvee (see discussion for head injury, above).

As to the third element of service connection, a causal relationship between the right shoulder impingement syndrome and military service, the September 2025 nexus statement provides a connection, and as there is no contradictory medical evidence, the probative weight of evidence supports a connection between the in-service injuries and the current right shoulder impingement syndrome.

Although the nexus letter does not opine whether the right shoulder rotator cuff tendinitis is related to military service, it does comment in the rationale that the dislocation of the Veteran's right shoulder during combat operations placed considerable stress on the rotator cuff complex, and in the absence of contradictory evidence, this is sufficient to place the evidence in relative balance whether the rotator cuff tendinitis was also related to military service. Granting the benefit of the doubt, right shoulder rotator cuff tendinitis is also related to military service.

Based on the above, the Board finds the evidence persuasively favors that the Veteran's current right shoulder impingement syndrome is related to service. The evidence is in relative balance whether the right shoulder rotator cuff tendonitis is
not opine whether the right shoulder rotator cuff tendinitis is related to military service, it does comment in the rationale that the dislocation of the Veteran's right shoulder during combat operations placed considerable stress on the rotator cuff complex, and in the absence of contradictory evidence, this is sufficient to place the evidence in relative balance whether the rotator cuff tendinitis was also related to military service. Granting the benefit of the doubt, right shoulder rotator cuff tendinitis is also related to military service.

REASONS FOR REMAND

Under the Appeals Modernization Act (AMA), remands are limited to pre-decisional duty to assist errors and "correction of any other error by the agency of original jurisdiction in satisfying a regulatory or statutory duty, if correction of the error would have a reasonable possibility of aiding in substantiating the appellant's claim." 38 C.F.R. § 20.802(a).

When a medical examination is necessary to make a decision on a claim, it must be provided. 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4). VA must provide an examination when there is (1) competent evidence of a current disability or symptoms of a disability; (2) evidence establishing an event, injury, or disease occurred in service or a presumptive disease during the pertinent presumptive period; and (3) an indication the disability or symptoms of a disability may be associated with the in-service event, injury, or disease, or with another service-connected disability, but there is (4) insufficient competent medical evidence on file for VA to make a decision on the claim. 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 79, 83-86 (2006).

The Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics (PACT) Act, was enacted on August 10, 2022. Pub. L. No. 117-168, 136 Stat. 1759. The PACT Act also provides that, when a veteran submits a claim for compensation with evidence of a disability and evidence of 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 under 38 U.S.C. § 5103A(d) and obtain a medical opinion as to whether it is at least as likely as not that there is a nexus between the disability and the TERA. The PACT Act further provides that, when providing a medical opinion under this provision, the health care provider shall consider the total potential exposure through all applicable military deployments of the veteran and the synergistic, combined effect of all TERAs of the veteran.

Right thumb, right hip

Here, for the reasons discussed below, the Board must remand these issues to correct pre-decisional duty-to-assist errors, specifically, failure to order examinations and medical opinions.

In the present appeal, no VA examiner has opined whether it is at least as likely as not that the Veteran's current symptoms for the claimed disabilities are the result of military service.

The Veteran testified as to his right thumb and right hip symptoms at the Board hearing. His credible lay statements that he experiences current symptoms and that they are due to military service, combined with a military record showing two deployments to Iraq and a combat action badge meets the low threshold required under McLendon, such that VA medical opinions are required. McLendon v. Nicholson, 20 Vet. App. 79, 84-85 (2006). There is insufficient competent medical evidence for VA to decide on the claim. The Veteran has not been afforded a VA examination to determine the nature and etiology of his claimed disabilities, and the Board is not competent to substitute its own medical rationale for that of a medical opinion. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007); Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991).

Peripheral neuropathy of the feet and lower extremity radiculopathy

Here, for the reasons discussed below, the Board must remand this issue to correct pre-decisional duty-to-assist errors, specifically, failure to order
85 (2006). There is insufficient competent medical evidence for VA to decide on the claim. The Veteran has not been afforded a VA examination to determine the nature and etiology of his claimed disabilities, and the Board is not competent to substitute its own medical rationale for that of a medical opinion. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007); Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991).

Peripheral neuropathy of the feet and lower extremity radiculopathy

Here, for the reasons discussed below, the Board must remand this issue to correct pre-decisional duty-to-assist errors, specifically, failure to order an examination and medical opinion. Because the Veteran specifically reported nerve damage in his feet on the March 2020 VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits (526), the AOJ was on notice that it was part of the claimed foot conditions.

No VA examiner has opined whether it is at least as likely as not that the Veteran's current lower extremity neurological symptoms, to include diagnosed peripheral neuropathy of the feet and lower extremity radiculopathy, are the result of military service, to include the reported wearing of boots that were too small during deployment.

In addition, the evidence reasonably raises the question whether the lower extremity neurological symptoms are secondary to the degenerative disc disease (back condition), or to the other conditions of the feet. The Board is required to address all issues reasonably raised by either the claimant or the evidence of record. See Robinson v. Peake, 21 Vet. App. 545, 554 (2008). As such, secondary medical opinions are required.

Also, although not a pre-decisional duty-to-assist error, recent change in law, that is the PACT act, requires a medical opinion as to whether lower extremity neurological symptoms including peripheral neuropathy of the feet is due to TERA exposure, since the Veteran has conceded TERA exposure from his service in Iraq.

The matters are REMANDED for the following action:

1. Make reasonable efforts to obtain an examination and medical opinion from an appropriate clinician to determine the nature and etiology of the Veteran's right thumb condition. The examiner shall be provided with and review the electronic claims file and provide a medical opinion on the following:

Whether it is at least as likely as not that the right thumb condition is related to service.

2. Make reasonable efforts to obtain an examination and medical opinion from an appropriate clinician to determine the nature and etiology of the Veteran's right hip condition. The examiner shall be provided with and review the electronic claims file and provide a medical opinion on the following:

Whether it is at least as likely as not that the right hip condition is related to service.

3. Make reasonable efforts to obtain an examination and medical opinion from an appropriate clinician to determine the nature and etiology of the Veteran's lower extremity neurological symptoms, to include diagnosed lower extremity radiculopathy and peripheral neuropathy of the feet. The examiner shall be provided with and review the electronic claims file and provide a medical opinion on the following:

(a) Whether it is at least as likely as not that the lower extremity neurological symptoms are related to service, to include the Veteran's report of wearing boots that were too small while deployed to Iraq.

(b) Whether, but for the Veteran's degenerative disc disease of the spine, he would not have had lower extremity neurological symptoms.

(c) Whether the Veteran's lower extremity neurological symptoms would have been less severe and resulted in less functional impairment but for the degenerative disc disease of the spine.

(d) Whether, but for the Veteran's bilateral pes planus, bone spurs and arthritis, he would not have had lower extremity neurological symptoms.

(e) Whether the Veteran's lower extremity neurological symptoms would have been less severe and resulted in less functional impairment but for the Veteran's bilateral pes planus, bone spurs and arthritis.

(f) Whether it is at least as likely as not that the lower extremity neurological symptoms were caused by the Toxic Exposure Risk Activities (TERA) after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic combined effect of all TERA of the Veteran, to include exposure to burn pits and fine particulate matter from service in Iraq.

(Continued on the next page)

The Veteran is competent to attest to factual matters of which he has first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the clinician should provide a fully reasoned explanation.

The clinician must provide a complete rationale for all opinions provided.

JOHN Z. JONES

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Schneider

Analyze in VA Law Explorer