Townsend v. Derwinski — Presumption of aggravation must be addressed when in-service worsening is shown

The veteran sought service connection for pes planus after the Board found no new factual basis to reopen and denied service connection. The opinion recounted that his induction examination was normal, but in service he was diagnosed with flat feet, placed on restricted duty, and later separated with severe pes planus noted at discharge. The Court concluded that the evidence showed an increase in severity during service, which triggered the presumption of aggravation under 38 U.S.C. § 353 and 38 C.F.R. § 3.306(b). The Board erred by failing to discuss that presumption, by relying on the regional office’s unsupported statement that pes planus is generally held to preexist service and not be aggravated, and by failing to provide adequate reasons or bases. The Court also noted the Board did not consider the benefit-of-the-doubt doctrine. The decision was reversed and remanded.

If a preexisting disability increases in severity during service, VA must presume aggravation unless it shows by clear and unmistakable evidence that the increase was due to natural progress.

Townsend is a strong aggravation precedent: once in-service worsening is shown, VA must confront the presumption directly and support any rebuttal with evidence, not conclusory medical assertions.

This case is important for service-connection appeals involving preexisting conditions because it requires VA to analyze worsening under the aggravation presumption rather than defaulting to preexistence. It also reinforces that the Board must provide reasons or bases grounded in evidence and address benefit of the doubt when the aggravation question is close.

Ignoring the presumption of aggravation and relying on unsupported conclusions that a condition preexisted service and was not aggravated.

A veteran enters service with no foot abnormality on induction, develops worsening foot pathology during active duty, and the Board denies the claim by stating the condition is usually congenital or preexisting without addressing aggravation or natural progression.

Cite Townsend when the record shows in-service worsening of a preexisting condition and VA fails to apply 38 C.F.R. § 3.306(b), relies on conclusory medical language, or omits a clear natural-progress analysis.

Akles v. Derwinski, Murphy v. Derwinski, Colvin v. Derwinski, Webster v. Derwinski, Gilbert v. Derwinski