Citation Nr: 20004477 Decision Date: 01/21/20 Archive Date: 01/21/20 DOCKET NO. 10-11 022 DATE: January 21, 2020 ORDER Entitlement to a rating in excess of 30 percent for bilateral plantar fasciitis is denied. FINDING OF FACT The Veteran’s bilateral plantar fasciitis is characterized by accentuated pain on manipulation and use and swelling on use. CONCLUSION OF LAW The criteria for entitlement to a rating in excess of 30 percent for bilateral plantar fasciitis have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.3, 4.7, 4.10, 4.14, 4.20, 4.27, 4.71a, Diagnostic Code 5299-5276 (2019). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from October 1983 to February 1987, March 1996 to September 1996, and from October 1992 to February 1993. He received the Army Achievement Medal; Army Good Conduct Medal; National Defense Service Medal; Overseas Service Ribbon; Air Force Training Ribbon; Sharpshooter Marksmanship Qualification Badge with rifle bar; and Marksmanship Qualification Badge with grenade bar. In December 2018, the Veteran testified at a Travel Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the claims file. The Veteran’s claim was previously characterized as a staged increased rating claim (before October 3, 2008 and after October 3, 2008). However, a review of the claims file shows that the Veteran was granted service connection for plantar fasciitis in a December 1996 rating decision that was not appealed. See December 1996 Rating Decision, p. 1. The Veteran did not file a claim for an increased rating before October 3, 2008; therefore, the period on appeal begins on October 3, 2008. Increased Rating for Bilateral Plantar Fasciitis The Veteran’s bilateral plantar fasciitis has been rated under the provisions of 38 C.F.R. § 4.71a, Diagnostic Code (DC) 5299-5276. Hyphenated DCs are used when a rating under one DC (5299) requires the use of an additional DC to identify the basis for the rating assigned (DC 5276). The provisions of 38 C.F.R. § 4.27 provide that when an unlisted disability requires rating by analogy, the code will be “built-up” as follows: the first two digits will be selected from that part of the schedule most closely identifying the body part or system involved, and the last two digits will be “99.” Here, the hyphenated DC indicates that an unlisted condition involving the feet (DC 5299) is rated under the criteria for acquired flatfeet (DC 5276). See 38 C.F.R. § 4.20. Under DC 5276, a 30 percent rating is assigned for a severe foot disability with objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, and characteristic callosities. A 50 percent rating is assigned for a pronounced foot disability with marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo achillis on manipulation, and not improved by orthopedic shoes or appliances. Turning to the evidence, the Veteran underwent a VA examination in January 2009. At the time, he reported pain partially relieved by medication, fatigability, weakness and lack of endurance. See January 2009 VA Examination, pp. 2-3. The Veteran noted that he experienced flare-ups of pain occurring weekly or more often and lasting less than one day. During flare-ups, the Veteran reported having to sit down and put his feet up. There was evidence of tenderness and abnormal weight-bearing, including callosities on both feet. There were no other foot deformities noted. In March 2011, the Veteran was afforded another VA examination. At this time, the Veteran’s disability was characterized by pain, swelling, heat, redness, stiffness, fatigability, weakness and lack of endurance. See March 2011 VA Examination, pp. 2-3. The examiner recorded evidence of abnormal weight-bearing, including skin breakdown and unusual shoe wear pattern. However, there was no pronation in either foot. The Veteran reported wearing non-prescription high-arched tennis shoes. The Veteran underwent an examination in February 2013. The examiner indicated that the Veteran had moderate bilateral plantar fasciitis with no obvious edema or pain with manipulation of the forefoot. See February 2013 VA Examination, p. 42. The Veteran reported the regular use of orthotics and difficulty with prolonged standing and walking. At his March 2014 examination, the Veteran noted that he constantly used orthotics and experienced difficulty with prolonged standing, walking, lifting and carrying. See March 2014 CAPRI, pp. 22-25. The examiner noted that there was no obvious edema or deformity and no pain manipulation of the forefoot. However, there was tenderness to palpation over the arches, balls of the feet and anterior pedal surfaces. The Veteran indicated that the orthotics were somewhat helpful. Most recently, the Veteran underwent an examination in July 2019. The Veteran reported a noticeable difference in symptoms when he wears arch supports but indicated that he experiences pain with rest and weight-bearing. See July 2019 VA Examination, p. 2. In addition to pain on weight-bearing, contributing factors of his disability include disturbance of locomotion, interference with standing and lack of endurance. The Veteran reported flare-ups of pain in the first four hours of the morning or if he makes a wrong step. The examiner estimated that there was mild functional loss with repeated use and with flare-ups. Diagnostic testing revealed an essentially unremarkable examination of the feet. Treatment records demonstrate that the Veteran experienced heel pain, pain at the balls of his feet, tenderness, and altered gait. See November 2011 CAPRI, pp. 1, 13; March 2013 CAPRI, pp. 70, 89, 103, 114, 132; September 2013 CAPRI, p. 24; September 2013 CAPRI, pp. 4, 12; March 2014 CAPRI, p. 6; August 2014 CAPRI, p. 1; April 2017 CAPRI, pp. 46, 63, 87, 142, 174; June 2019 CAPRI, p. 22. At his December 2018 hearing, the Veteran indicated that he has pain with standing, experiences spasms, and has pain that radiates down into his feet. See December 2018 Hearing Transcript, pp. 12-13. He further testified that he uses shoe inserts to manage his foot pain but that he no longer experiences total relief from the inserts. Id. at pp. 3, 6, 13-14. The Board finds that the evidence preponderates against a finding of entitlement to a rating in excess of 30 percent for bilateral plantar fasciitis. To warrant a higher evaluation, the evidence must show a pronounced foot disability with marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo achillis on manipulation, and not improved by orthopedic shoes or appliances. The evidence does not show this degree of symptomatology. Instead, the evidence shows that the Veteran’s disability is characterized by accentuated pain on use, swelling on use, characteristic callosities, and some relief with the use of orthotics. To the extent that the Veteran experiences radicular pain that affects his feet, these symptoms are contemplated by his separate ratings for bilateral lower extremity radiculopathy. The Veteran’s bilateral plantar fasciitis symptoms are adequately contemplated by the current 30 percent rating; accordingly, a rating in excess of 30 percent for bilateral plantar fasciitis is not warranted. The Board is grateful for the Veteran’s honorable service, and this decision is not meant to detract from that service. However, given the record before it, the Board finds that evidence in this case does not reach the level of equipoise for the claim. See 38 U.S.C. § 5107(a) (“[A] claimant has the responsibility to present and support a claim for benefits”); Skoczen v. Shinseki, 564 F.3d 1319, 1323-29 (Fed. Cir. 2009) (recognizing that “[w]hether submitted by the claimant or VA... the evidence must rise to the requisite level set forth in section 5107(b),” requiring an approximate balance of positive and negative evidence regarding any issue material to the determination). Accordingly, the Board is unable to award an increased rating at this time. A. S. CARACCIOLO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board W.V. Walker, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.