Citation Nr: 18152162 Decision Date: 11/21/18 Archive Date: 11/21/18 DOCKET NO. 16-43 669 DATE: November 21, 2018 ORDER Entitlement to service connection for a heart disability is denied. REMANDED Entitlement to service connection for a left knee disability is remanded. Entitlement to service connection for a left foot disability is remanded. Entitlement to service connection for a right foot disability is remanded. FINDINGS OF FACT The Veteran does not have a currently diagnosed heart disability. CONCLUSIONS OF LAW The criteria for service connection for a heart disability are not met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from May 1999 to January 2005. The medical evidence of record includes diagnoses of both bilateral plantar fasciitis and bilateral pes planus. Therefore, the Board has recharacterized the Veteran's claims for service connection for left and right foot pain, also claimed as heel strain, as claims for a left foot and a right foot disability. See Clemons v. Shinseki, 23 Vet. App. 1 (2009). Service Connection 1. Heart Disability The Veteran asserts that he is entitled to service connection for a heart disability. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that the Veteran does not have a current diagnosis of any heart disability and has not had one at any time during the pendency of the claim or recent to the filing of the claim. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); 38 C.F.R. § 3.303(a), (d). The February 2014 VA examiner evaluated the Veteran and determined that the Veteran did not have any subjective symptoms and there was no objective evidence to support the diagnosis of a heart disorder. While the Veteran may believe he has a heart disability, he has not been shown to be competent to render a medical diagnosis. Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence. Since a heart condition has not been shown, service connection for a heart condition is denied. REASONS FOR REMAND 1. Left Knee Disability First, the Veteran has not been given a specific diagnosis of a left knee disability. However, pain may constitute a disability when it results in functional impairment or functional limitations. See Saunders v. Wilkie, 886 F.3d 1356, 1367-68 (Fed. Cir. 2018). The Veteran has made subjective reports of pain and reported that pain resulted in difficulty going up stairs, limping after walking too long, and difficulty kneeling and squatting, which the January 2017 VA examiner opined resulted in a functional impact. Further, the February 2014 VA examiner reported a slight reduction in flexion after repetitive use testing. However, while the January 2017 VA examiner opined that the Veteran's left knee was not related to or, aggravated by, his service-connected right knee disability, the opinion was based on the examiner’s finding that the Veteran did not have a specifically diagnosed disability, and the examiner did not provide an opinion regarding the Veteran's functional loss due to pain. Since that examination, in August 2018, a VA physician opined that the Veteran's left knee pain could be secondary to overcompensating from right knee pain; however, such an opinion is speculative. As such, an addendum opinion is necessary. 2. Left and Right Foot Disabilities The Veteran has been afforded three VA examinations, however, each has been inadequate. A February 2014 VA examiner reported a diagnosis of bilateral foot strain and opined that the diagnosis was not related to an in-service ankle injury, but did not address the diagnosis of bilateral pes planus noted on the Veteran's March 1999 service entrance examination. Next, a December 2017 VA examiner reported diagnoses of bilateral pes planus and plantar fasciitis. The examiner opined that the Veteran's plantar fasciitis was not secondary to his service-connected right knee disability, but did not provide an opinion as to direct service connection and did not provide an opinion regarding the Veteran's bilateral pes planus at all. Finally, a January 2018 VA examiner opined that the Veteran's bilateral plantar fasciitis was not secondary to his service-connected right knee disability, but provided no opinion as to direct service connection. The examiner further reported that there “appears to be clear evidence” that the Veteran's bilateral pes planus pre-existed his service and opined that the disability was therefore less likely than not incurred in or caused by service. However, where a preexisting disease or injury is noted on an entrance examination, the preexisting injury or disease will be considered to have been aggravated by active service where there is an increase in disability during service, unless there is a specific finding that the increase in disability is clearly and unmistakably due to the natural progress of the disease. See 38 U.S.C. § 1153; 38 C.F.R. § 3.306 (a). As the examiner’s opinion was based on the incorrect standard, an addendum opinion is necessary. As such, the Veteran's claim must be remanded for an addendum opinion. The matters are REMANDED for the following action: 1. Contact the Veteran, and, with his assistance, identify any outstanding records of pertinent medical treatment from private or VA health care providers and associate them with the claims file. 2. Obtain an addendum opinion from an appropriate clinician to determine the nature and etiology of any left knee disability or functional loss associated with left knee pain. The examiner must opine whether it is at least as likely not (50 percent or greater probability) that any diagnosed left knee disability or functional loss associated with left knee pain is related to an in-service injury, event, or disease; is proximately due to service-connected right knee disability; or was aggravated beyond its natural progression by the service-connected right knee disability. If, and only if, determined necessary by the examiner, the Veteran should be scheduled for another VA examination. A detailed rationale for the opinion must be provided. 3. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s current bilateral plantar fasciitis is at least as likely as not (50 percent or greater probability) related to and injury, event, or disease during active duty. The reviewing clinician should also determine if there was an increase in the Veteran’s pes planus disability during service. If the reviewing clinician determines that there was an increase in the Veteran’s pes planus disability during service, the reviewing clinician should determine whether there is clear and unmistakable evidence (i.e., is it undebatable) that the increase was due to the natural progression of the disease. A detailed rationale for the opinion must be provided. (Continued on the next page)   4. Then readjudicate the claim. If any benefit sought is not granted, the Veteran and his representative should be furnished an SSOC and given the requisite opportunity to respond before the case is returned to the Board. DONNIE R. HACHEY Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD E. Mine, Associate Counsel