BVA9501432 DOCKET NO. 93-08 436 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Albuquerque, New Mexico THE ISSUE Entitlement to service connection for bilateral pes planus. REPRESENTATION Appellant represented by: Paralyzed Veterans of America, Inc. ATTORNEY FOR THE BOARD James A. Pritchett, Associate Counsel INTRODUCTION The veteran has verified active service from November 1963 to November 1967 and from December 1973 to September 1990. Active service between November 1967 and December 1973 has been reported but not verified. By rating decision in November 1992, service connection was established for impairment of the ankles, each evaluated as 10 percent disabling, and for gout, evaluated as noncompensable. This appeal arises from a January 1991 decision by the Albuquerque, New Mexico, Department of Veterans Affairs (VA) Regional Office (RO) that denied service connection for bilateral pes planus. The Informal Hearing Presentation by the veteran's representative dated in September 1993, referred to claims for service connection for defective vision, hearing loss, allergies and back and neck disorders, including arthritis. Rating actions of record have denied service connection for the first 3 issues. It is unclear if the representative's comments were intended to constitute a notice of disagreement. With regard to the comments on the back and neck, they may be intended to constitute a claim for service connection for such disorders. As these matters are not in appellate status, they are referred to the RO for clarification. CONTENTIONS OF APPELLANT ON APPEAL It is contended that the veteran incurred bilateral pes planus as a result of active service. It is asserted in the alternative, that the veteran's bilateral pes planus was aggravated as a result of active service. 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(s). 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 service connection for bilateral pes planus is warranted. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the veteran's appeal has been obtained by the RO. 2. Bilateral pes planus existed prior to the veteran's entrance into active service. 3. An increase in severity of the preexisting bilateral pes planus beyond its natural progression is shown. CONCLUSION OF LAW Bilateral pes planus was aggravated by active service. 38 U.S.C.A. §§ 1110, 1111, 1131, 1153, 5107 (West 1991); 38 C.F.R. § 3.306 (1993). REASONS AND BASES FOR FINDINGS AND CONCLUSION The veteran's claim is "well grounded" within the meaning of 38 U.S.C.A. § 5107. That is, he has presented a claim which is plausible, and all relevant facts have been properly developed. No further assistance to the veteran is required to comply with the duty to assist the veteran mandated by 38 U.S.C.A. § 5107. The veteran's service medical records include the report of the examination for entrance dated in October 1963, which is negative for complaints or findings regarding any foot disorder. A November 1965 treatment note indicates that the veteran was to be given foam pads for his flat feet. An August 1973 podiatry consultation report indicates that the veteran had chronic longitudinal arch complaints regarding both feet and that longitudinal arch pads had provided no apparent relief. The impression was pes planus. Steel arch supports and follow-up visits were prescribed. In October 1973 the veteran was treated for blisters on the toes of the right foot and a sore ankle. Both conditions were ascribed to running on hard surfaces. Later in October 1973 the veteran complained of injuring his right foot while playing "flicker ball". The treatment note indicates that the veteran landed on his right foot and felt his arch fall. The report of an X-ray taken in August 1977 indicates gross sagging of the plantar arch bilaterally. A September 1977 entry note states that a physician explained the etiology of the problem to the veteran, noting maximum pronation from severe pes planus. The report of an October 1978 orthopedic consultation notes that the veteran had 26 degree range of motion, rear foot varus of 4 degrees bilaterally, forefoot varus of 3 degrees bilaterally, ankle dorsiflexion of 4 degrees left, 6 degrees right, 0 shortage measurement. He was instructed on foot care for runners, issued a cane and released. The veteran sought treatment for his left ankle in September 1983. The September entry notes pes planus, but the treatment plan was concerned only with the ankle joint. The report of the examination for retirement dated in June 1990 notes bilateral pes planus. The report of a VA special podiatry examination dated in December 1990 states that the veteran stated that he had somewhat flat feet and that his family history was positive for flat feet. He stated that he was fine until 1965 when he was required to walk 12 hours a day on concrete surfaces. He also stated that he was prone to foot and ankle injuries and that gout was diagnosed in his big toe joint. On examination dorsalis pedis and posterior tibial pulses were +3/4 bilaterally and severe pes plano valgus with collapse of the longitudinal and transverse arches was present. Pain was reproduced on palpation of the mid areas of the navicular of the right foot with tenderness at the insertion of the posterior tibial tendon. His gait revealed total apropulsion and flat footedness with mid-stance pronation and subtalar joint and midtarsal joint collapse. Some discomfort in the plantar fascia and on the plantar aspect of both heels was noted during the examination. The report states that radiological evaluation revealed bilateral pes plano valgus. The lateral view substantiated the severe pes plano valgus where there was absolutely no longitudinal arch calcaneal. The calcaneal inclination angle was parallel. The report of a VA special podiatry examination dated in May 1992 indicates that the veteran complained of having pain in his feet at least three to four times a week, which was aggravated by standing and walking. On examination, he wore ankle braces and had a full range of motion of both ankles with pain on passive motion. Grade III pes planus was observed. No swelling of the feet was observed. There was some minimal subcutaneous thickening of the dorsal surface of the right foot when compared carefully with the left. His posture was normal on standing and he was able to squat down and rise on toes and heels, but pain was present in the posterior part of the feet on squatting. His gait was normal. The report of an examination by Rick B. Roper, D.P.M., dated in April 1992 indicates that the veteran complained of frequent intermittent pain and swelling of his feet and ankles. On examination, a complete medial collapse of the subtalar joint and midtarsal joint complex was observed bilaterally. There was significant calcaneal eversion. Marked forefoot abduction was prominent during ambulation. Ankle joint dorsiflexion was less than ten degrees bilaterally. X-ray evaluation was consistent with severe osseous flat foot bilaterally. The diagnosis was severe pes plano valgus bilaterally with equinas of the gastroc/soleus complex and a medial instability secondary to the os tibiale externum. The report then states that the veteran's prolonged standing and walking activity during his military service may have been contributory to the degeneration of his feet resulting in the then current pain and swelling. Initially, the Board notes that in December 1990, the veteran stated that he had flat feet and that his family had a history of flat footedness, and various examiners have noted a congenital factor to be present. While pes planus was not noted at entry, these findings raise serious doubts as to the existence of the disorder prior to service. However, we need not consider this legal question. Regardless of what he had at entry, beginning a year and a half after his service entrance, the veteran sought treatment for his feet. During 1965 foam pads were prescribed. In 1973 steel arch supports were prescribed because the foam pads provided no relief. In August of 1977, X-rays revealed gross sagging of the plantar arch bilaterally. In October 1978, forefoot varus and rear foot varus were noted. Pes planus was noted during the remainder of the veteran's active service and was mentioned in the report of the examination for retirement in June 1990. The record reveals that from 1965 forward the veteran sought treatment for pes planus and that remedial measures were increased during his active service. An unfavorable mechanical relationship of the veteran's leg and foot structure was noted several years after the veteran entered active service and was noted in Dr. Roper's report. The report of the VA special examination in December 1990 essentially confirms these findings, noting that the veteran had severe pes plano valgus with collapse of the longitudinal and transverse arches and that at the time of the examination, the veteran was still wearing orthotics. The report of the May 1992 VA rating examination notes that the veteran had Grade III pes planus. Although the report of the December 1990 examination contains the examiner's opinion that the veteran's disability would have developed similiar symptoms "irrespective of his service related activity," this is not the same as saying that all his symptoms are due to natural progression. The findings reported by that examiner, and others clearly show symptomatic and anatomical progression of the disorder. Dr. Roper opined that the veteran's current degree of pes planus may have been due to his military duties which required prolonged standing and walking. Balancing the evidence and applying the benefit of the doubt under 38 U.S.C.A. § 5107(b), the veteran is entitled to service connection for bilateral pes planus. ORDER Service connection for bilateral pes planus is granted. ROBERT D. PHILIPP 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.