BVA9507736 DOCKET NO. 92 09 900 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Seattle, Washington THE ISSUE Entitlement to service connection for osteoarthritis of the right foot. REPRESENTATION Appellant represented by: The American Legion WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD C. R. Olson, Counsel INTRODUCTION The veteran reports active military service from September 1978 to May 1991. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an October 1991 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida. That rating decision, in part, denied service connection for osteoarthritis of the right foot. The case was previously before the Board for appellate consideration. However, at the request of the veteran, it was returned to the field for an RO hearing. The hearing was held. The hearing examiner requested another examination of the veteran. This was done. Subsequent adjudication continued to deny service connection for osteoarthritis of the right foot and the case was returned to the Board for appellate review. CONTENTIONS OF APPELLANT ON APPEAL The appellant contends that the RO committed error in denying service connection for osteoarthritis of the right foot. He reports that military doctors told him that he had osteoarthritis in his right foot. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), has reviewed and considered all of the evidence and material of record in the veteran's claims file. Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that the preponderance of the evidence is against service connection for osteoarthritis of the right foot. FINDINGS OF FACT 1. The RO has obtained all relevant evidence necessary for an equitable disposition of the veteran's appeal. 2. Foot symptoms during service were due to a Morton's neuroma, for which service connection has been granted, or the veteran's congenital toe anomaly. 3. Osteoarthritis of the right foot was not present in service or manifested in the first post service year. 4. The veteran does not have osteoarthritis of the right foot as a result of disease or injury during his active military service. CONCLUSION OF LAW Osteoarthritis of the right foot was not incurred in or aggravated by active military service and may not be presumed to have been incurred in service. 38 U.S.C.A. §§ 101(16), 1101, 1112, 1131, 1137 (West 1991); 38 C.F.R. §§ 3.303, 3.307, 3.309 (1994). REASONS AND BASES FOR FINDINGS AND CONCLUSION The veteran's claim is "well grounded" within the meaning of 38 U.S.C.A. § 5107(a) (West 1991). That is, he has presented a claim which is plausible. All relevant facts have been properly developed and no further assistance to the veteran is required to comply with the duty to assist mandated by 38 U.S.C.A. § 5107(a). Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C.A. §§ 101(16), 1131 (West 1991). This requires that the veteran now have the disability he is claiming. Osteoarthritis may be presumed to have been incurred during active military service if it is manifest to a degree of 10 percent or more within the first year following active service. 38 U.S.C.A. §§ 1101, 1112, 1137 (West 1991); 38 C.F.R. §§ 3.307, 3.309 (1994). Congenital or developmental anomalies are not diseases or injuries with in the meaning of the law providing compensation benefits. 38 C.F.R. § 3.303(c) (1994). There is no question that the veteran has a service-connected right foot disorder. The question presented in this case deals with the nature of that disorder. Service connection has been granted for Morton's neuroma of the right foot. The veteran contends that he has osteoarthritis of the right foot, either instead of or in addition to the Morton's neuroma. The Board understands the veteran's consternation with the varying diagnoses for his right foot disorder. There are indeed diagnoses of osteoarthritis of the right foot in the service medical records. However, they are not supported by examination findings or x-ray studies. The diagnosis of osteoarthritis seems to have emanated from a November 1989 podiatry clinic note which contains the earliest recorded reference to osteoarthritis. Examination at that time disclosed a slight forefoot valgus. The assessment was that the foot pain was "possibly osteoarthritic in nature." The note does not indicate that any x-ray studies were reviewed or requested. The report of a May 1990 examination for separation from service and a medical board lists chronic right foot pain secondary to osteoarthritis. No specific foot findings or x-ray studies were reported. A medical record report for a medical board is dated in December 1990. It shows that the veteran was examined and his extremities had no cyanosis, clubbing or edema. The were no specific foot findings. There were no foot x-rays. The diagnoses included right foot osteoarthritis with chronic right foot pain. The medical board report repeated the diagnosis. The veteran was examined at a VA medical center in July 1991. The report shows that squeezing of his right foot revealed pain in the anterior portion. There was also tenderness between the 4th and 5th digits of the right foot. The examiner commented that finding was characteristic of Morton's neuroma. The diagnosis was Morton's neuroma of the right foot. The diagnoses also included "osteoarthritis of right foot from records". This shows that the examiner had reviewed the records and considered that diagnosis in them; however, he could not make such a diagnosis on his findings. The report of a temporary disability retirement evaluation by the service department is dated in December 1992. Physical examination of the extremities showed no evidence of cyanosis or edema. There were no specific findings as to the veteran's feet. The diagnoses included right foot osteoarthritis with chronic right foot pain. These diagnoses of osteoarthritis appear to be mere repetitions as they are not supported by reported examination findings or x-ray studies. The preponderance of the evidence shows that when the veteran's feet were carefully examined, the physicians found diagnoses other than osteoarthritis. Most agreed on the Morton's neuroma. Further, the x-ray studies during and after service have been completely consistent in showing no arthritic changes in the right foot. The service medical records show complaints of foot pain in November 1986. The veteran was subsequently seen at military clinics on numerous occasions. There were several evaluations of the foot disorder, which included x-ray studies. A bone scan of the right foot, in January 1987, had normal images. This was referred to in a February 1987 clinical note. The assessment at that time was plantar fasciitis. A clinical note dated in October 1988 shows the veteran complained of pain on running. Examination disclosed pain on compression and other findings. An x-ray study revealed a congenital fusion of the middle and distal phalanges of the third, fourth, and fifth toes, bilaterally. The radiologist specified that there was no evidence of acquired pathology. The clinical note concluded with the assessment of a probable Morton's neuroma. A note dated later in October 1988 shows similar findings with an assessment of metatarsalgia versus digital neuroma. In November 1988, it was noted that treatment had not provided relief. Examination still demonstrated right foot tenderness. The assessment was metatarsalgia versus Morton's neuroma. The veteran was referred to the orthopedic clinic. The report of a December 1988 consultation shows that he had a cavus type foot with mild discomfort on palpation. It was noted that the x-ray studies were within normal limits. The impression was a cavus type foot with lateral stress, especially on running, etc. Insoles were recommended and provided. The clinical records show additional foot complaints in April 1989. On examination, there was tenderness over the metatarsal heads. The assessment was probable plantar fasciitis secondary to pes cavus. X-ray studies demonstrated slightly high arches bilaterally. Mild hallux valgus was evident in both feet. The study was otherwise unremarkable. Foot pain was also noted in May and June 1989. The veteran was examined at a VA medical center in July 1991. The report shows that squeezing of his right foot revealed pain in the anterior portion. There was also tenderness between the 4th and 5th digits of the right foot. The examiner commented that finding was characteristic of Morton's neuroma. The diagnosis was Morton's neuroma of the right foot. X-ray studies specifically considered the reported history of osteoarthritis in examining the right foot. Several views showed the bone structures to be normal. The joint spaces were well preserved throughout and soft tissue shadows were normal. It was the impression of the medical doctor who reviewed the studies that they showed a normal right foot. Another VA examination was performed in April 1994. The veteran told of right foot pain, particularly on running, walking or standing. Symptoms were totally in the forefoot with some rare heel discomfort. Foot motion was 10 degrees dorsiflexion, 45 degrees plantar flexion, 30 degrees inversion, and 20 degrees eversion. The heel and ankle were nontender bilaterally. Arch development was average and equal. All 10 toes had satisfactory alignment. The right forefoot was not tender over the metatarsophalangeal joints. The right foot was tender at the space between the second and third metatarsals. The diagnoses were synovitis at the right third and fourth metatarsophalangeal joints and Morton's neuroma at the three-four interspace. A determination as to the degenerative status was referred to the VA radiology department. X-ray studies were made and were interpreted as showing no significant bone or joint abnormality. The clear preponderance of medical examination and x-ray findings in this case establishes that the veteran has a Morton's neuroma and that he does not have osteoarthritis in his right foot. Since the veteran does not have the disability, service connection can not be granted. ORDER Service connection for osteoarthritis of the right foot is denied. JAN DONSBACH Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___ (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991), a decision of the Board of Veterans' Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a Notice of Disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402 (1988). The date which appears on the face of this decision constitutes the date of mailing and the copy of this decision which you have received is your notice of the action taken on your appeal by the Board of Veterans' Appeals.