Citation Nr: 18145562 Decision Date: 10/29/18 Archive Date: 10/29/18 DOCKET NO. 16-18 055 DATE: October 29, 2018 ORDER Entitlement to an initial increased rating exceeding 30 percent for service connected plantar fasciitis, bilateral feet (“plantar fasciitis”) is denied. FINDING OF FACT Throughout the rating period on appeal, the Veteran’s plantar fasciitis has not manifested to pronounced marked pronation, extreme tenderness of the plantar surfaces, or marked inward displacement and severe spasm of the tendo achillis on manipulation, with no improvement from orthopedic shoes and appliances. CONCLUSION OF LAW The criteria for an increased rating exceeding 30 percent for service connected plantar fasciitis have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.21, 4.71a, Diagnostic Code (DC) 5276. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 1977 to May 1983. This case comes before the Board of Veterans’ Appeals (Board) on appeal from a May 2015 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Wichita, Kansas. Entitlement to an initial increased rating exceeding 30 percent for service connected plantar fasciitis, bilateral feet. The Veteran contends that he is entitled to an increased disability rating for his service connected plantar fasciitis. Disability ratings are determined by applying the criteria set forth in the schedule of ratings. The percentage ratings are based on the average impairment of earning capacity, and individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. When a question arises as to which of two ratings apply under a single diagnostic code, the higher evaluation is assigned if the disability more closely approximates the criteria for the higher rating. 38 C.F.R. § 4.7. As such, the Board must consider all potentially applicable diagnostic codes when rating a Veteran’s disability. However, evaluation of the same manifestation of the same disability under various diagnoses, otherwise known as “pyramiding” is to be avoided. 38 C.F.R. § 4.14; Esteban v. Brown, 6 Vet. App. 259, 261 (1994). Where the Veteran challenges the initial rating of a disability for which he has been granted service connection, the Board considers all evidence of severity since the effective date for the award of service connection. See generally Fenderson v. West, 12 Vet. App. 119 (1999). However, whether the issue is an initial increase or not, consideration of the appropriateness of a “staged rating” is required. See Fenderson v. West, 12 Vet. App. 119, 126 (1999). Additionally, if the positive evidence supporting a claim and the negative evidence indicating a denial of the claim is relatively equal, the Veteran is entitled to the benefit of the doubt. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102, 4.3. Accordingly, any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. Id. Upon review of the record, the Board notes the Veteran has an additional disability involving his feet, pes planus (nonservice-connected), beyond his service connected plantar fasciitis. In this regard, the Board recognizes case law holding that when it is not possible to separate the effects of the service-connected disability from a nonservice-connected condition, such signs and symptoms must be attributed to the service-connected disability. 38 C.F.R. § 3.102; Mittlieder v. West, 11 Vet. App. 181, 182 (1998). In this case, the record shows medical evidence specifically related to the Veteran’s service-connected plantar fasciitis, which include an August 2014 VA examination and VA treatment records dated for February 2016, October 2016, and April 2017. Additionally, the record includes medical findings specifically related to the Veteran’s nonservice-connected pes planus, which include an October 2011 VA Examination, a March 2014 Disability Benefits Questionnaire (DBQ), and an August 2014 VA Examination. Accordingly, the Board finds that the medical evidence of record does separate the symptoms of the service-connected plantar fasciitis from the symptoms of his additional, nonservice-connected pes planus. Therefore, the Board will only consider the symptoms related to the Veteran’s service-connected plantar fasciitis. The Veteran’s plantar fasciitis has been appropriately rated under DC 5276, to which he is currently rated as 30 percent disabled. 38 C.F.R. § 4.71a, DC 5276. Pursuant to DC 5276, a 30 percent disability rating is assigned for severe bilateral plantar fasciitis with symptoms of objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, characteristic callosities. A rating of 50 percent rating is assigned for pronounced bilateral plantar fasciitis with symptoms of marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo achillis on manipulation, not improved by orthopedic shoes or appliances. Id. After considering the evidence, the Board finds that an increased rating exceeding 30 percent is not warranted for the Veteran’s plantar fasciitis. The Veteran appeared for a VA examination in August 2014 for his plantar fasciitis. The examiner noted the Veteran experienced pain on use on both feet while being evaluated, however, showed no reports of flare-ups or having any functional loss or impairment. There was pain accentuated on manipulation; but no indication of swelling, characteristic calluses, marked deformity (pronation, abduction, etc.), or extreme tenderness of plantar surfaces. However, the Veteran did have inward bowing of the achilles tendon and decreased longitudinal arch height on weight-bearing in both feet. In a March 2014 DBQ, evidence shows the Veteran had pain, accentuated, on both feet, pain on manipulation on both feet, and swelling, with no relief from arch supports. Also, the Veteran experienced extreme tenderness of the plantar surfaces on both feet, and his tenderness did not improve by orthopedic shoes. There was objective evidence of marked deformity on both feet, marked pronation of both feet, inward bowing of the achilles tendon of both feet, and marked displacement and severe spasm of achilles tendon on manipulation, with no improvement by orthopedic shoes. These findings would be commensurate to an increased rating of 50 percent; however, this examination associates all foot symptoms with the Veteran’s nonservice-connected pes planus and valgus deformity due to pes planus. It does not associate these symptoms with the Veteran’s plantar fasciitis, and thus, this evidence cannot be considered. During the appeal period, the record does not reflect the Veteran’s symptoms increasing in pain and/or severity to warrant an increased rating for his plantar fasciitis. VA treatment records in February 2016, October 2016, and April 2017 show the Veteran has a history of bilateral plantar fasciitis; with repeated reports of experiencing pain while walking and pain with pressure to the plantar of each foot. The examiner noted in the records that the Veteran also has severe pes planus deformity with completely collapsed medial longitudinal arch bilaterally during weightbearing. However, the October 2016 VA examination shows the Veteran’s plantar fasciitis had resolved with custom orthotics and shoe gear. Based on the information above, and given the Veteran has not provided any additional statements or clinical records (private or VA) that would entitle him to an increased rating exceeding 30 percent for his bilateral plantar fasciitis, the Board finds the Veteran’s current rating of 30 percent is appropriate. VA treatment records during the pendency of the appeal, show that the Veteran’s plantar fasciitis has consistently manifested in treatment for symptoms of no more than marked deformity and pain, as required for a 30 percent rating. Accordingly, the Boards finds the preponderance of the evidence is against an assignment of a rating exceeding 30 percent for plantar fasciitis, and the claim is denied. The Board has considered the doctrine of giving the benefit of the Appellant, under 30 U.S.C. § 5107 and 38 C.F.R. § 3.102, but does not find that the evidence is of such approximate balance as to warrant its application. Gilbert v. Derwinski, 1 Vet. App. 49, 54056 (1990). M. H. HAWLEY Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD B. Hodges, Associate Counsel