Citation Nr: 18140831 Decision Date: 10/09/18 Archive Date: 10/09/18 DOCKET NO. 13-18 634A DATE: ORDER Service connection for right foot plantar fasciitis is granted. REMANDED Entitlement to service connection for a left foot disorder is remanded. Entitlement to service connection for a right foot disorder other than plantar fasciitis is remanded. FINDING OF FACT The Veteran has current right foot plantar fasciitis that is related to her military service. CONCLUSION OF LAW Right foot plantar fasciitis was incurred in active service. 38 U.S.C. §§ 1101, 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 1990 to October 1998. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a February 2011 rating decision. The Veteran testified at a hearing before the undersigned Veterans Law Judge in August 2016. A transcript of that proceeding is associated with the record. In March 2017, the Board remanded a claim for service connection for a bilateral food disorder for further development. That development was completed as to the claim decided herein, and the case has since been returned to the Board for appellate review. The Board notes that the Veteran changed representation prior to recertification of the appeal. Review of the claims file shows that the Veteran is currently represented by an accredited agent, Melinda J. Willi. The appropriate VA forms are associated with the claims file. The Board notes that the Veteran’s appeal originally included the issue of entitlement to service connection for a left knee disorder. However, in an April 2018 rating decision, the Regional Office granted service connection for that disorder. The Agency of Original Jurisdiction’s (AOJ) grant of service connection constitutes a full award of the benefits sought on appeal. See Grantham v. Brown, 114 F. 3d 1156, 1158 (Fed. Cir. 1997). Therefore, that matter is no longer on appeal, and no further consideration is necessary. 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 (2012). That an injury or disease occurred in service is not enough; there must be chronic disability resulting from that injury or disease. Service connection may also be granted for any injury or disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303(d) (2017). 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. 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). 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 compensable degree within one year of separation from service. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.307, 3.309. In considering the evidence of record under the laws and regulations as set forth above, the Board concludes that service connection for a right foot plantar fasciitis is warranted. The Veteran has contended that she has a current right foot disorder that had its onset during service and has continued since that time. She has asserted that her plantar fasciitis was due to running and climbing flights of stairs in service. See, e.g., June 2010 statement in support of claim. In addition, during an August 2016 hearing, the Veteran testified that she was informed by a physician that her military boots aggravated her foot disorder. The Veteran’s September 1989 enlistment and August 1998 separation examinations noted normal clinical evaluations of the feet. In addition, in accompanying reports of medical history, the Veteran denied having foot trouble. However, an August 1995 service treatment record noted that the Veteran complained of pain and edema in her right foot. In addition, a military physician diagnosed her with plantar fasciitis at that time. The post-service VA medical records show that the Veteran received treatment for complaints of bilateral heel pain in November 2006. A February 2012 private medical record also noted that the Veteran reported having a 10-year history of intermittent heel pain secondary to her plantar fasciitis. In a December 2010 VA medical opinion, the examiner opined that the Veteran’s bilateral plantar fasciitis was not caused by, a result of, or a continuation of her right foot complaints during service. However, the examiner’s opinion was not supported by a complete rationale. In particular, he did not address the Veteran’s testimony regarding her in-service symptoms of foot pain. In addition, he did not explain the medical significance of the identified time gap between the Veteran’s military service and VA treatment for right foot pain. Therefore, the probative value of the December 2010 VA medical opinion is limited. The Board acknowledges that the December 2010 VA examiner also provided a medical opinion regarding the Veteran’s other diagnosed disorders, including bilateral pes planus, hammertoes, calcaneal spurs, and hallux valgus. However, the issues of entitlement to service connection for a right foot disorder other than plantar fasciitis and entitlement to service connection for a left foot disorder are addressed in the remand portion of the decision below. In a January 2018 VA medical opinion, the examiner opined that the Veteran’s right foot plantar fasciitis was at least as likely as not incurred in or caused by the claimed in-service injury, event, or illness. In so finding, he noted that the Veteran’s service treatment records showed a diagnosis of right foot plantar fasciitis and that her separation examination was negative for the condition. However, he explained that, based on a review of medical literature, plantar fasciitis is frequently intermittent and recurrent. The Board finds that, after weighing the evidence, the January 2018 VA medical opinion is the most probative opinion of record. The examiner provided rationale for his medical opinion and considered relevant medical literature. Based on the foregoing, the Board finds that the Veteran’s right foot plantar fasciitis is related to her military service. Accordingly, service connection is warranted. REASONS FOR REMAND The Veteran was afforded a VA examination in January 2018 during which the examiner diagnosed her with bilateral plantar fasciitis and pes planus. However, the examiner’s supporting rationale for his negative nexus opinion regarding the Veteran’s left foot disorder and bilateral pes planus relied largely on the absence of in-service medical evidence and did not address the Veteran’s lay statements. In addition, he did not address the other diagnoses of foot disorders during the appeal period, to include bilateral calcaneal spurs and hallux valgus. Therefore, a remand is necessary to obtain an additional VA medical opinion. The matter is REMANDED for the following action: 1. The Agency of Original Jurisdiction (AOJ) should request that the Veteran provide the names and addresses of any and all health care providers who have provided treatment for her bilateral foot disorders. After acquiring this information and obtaining any necessary authorization, the AOJ should obtain and associate these records with the claims file. The AOJ should also obtain any outstanding VA medical records. 2. After completing the above development, the AOJ should refer the Veteran’s claims file to a suitably qualified VA examiner for a clarifying opinion as to the nature and etiology of any right foot disorders other than plantar fasciitis and any left foot disorders that may be present. A physical examination is only needed if deemed necessary by the VA examiner. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran’s service treatment records, post-service medical records, and assertions. It should be noted that the Veteran is competent to attest to factual matters of which she has first-hand knowledge. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should state this with a fully reasoned explanation. The examiner should identify all right foot disorders other than plantar fasciitis and any left foot disorders. See, e.g., December 2010 and January 2018 VA examinations. For each diagnosis identified, the examiner should provide an opinion as to whether it is at least as likely as not that the disorder manifested in or is otherwise causally or etiologically related to the Veteran’s military service. In rendering this opinion, the examiner should consider the Veteran’s contention that she began having foot problems while running during training and that her symptoms have continued since her military service. She has also indicated that she was informed that her boots in service may have contributed to her foot disorder. See e.g., August 2016 hearing testimony. (The term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of conclusion as it is to find against it.) A clear rationale for all opinions must be provided, and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. 3. The AOJ should review the medical opinion to ensure that it is in compliance with this remand. If the report is deficient in any manner, the AOJ should implement corrective procedures. J.W. ZISSIMOS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Wulff, Associate Counsel