Citation Nr: 20021905 Decision Date: 03/27/20 Archive Date: 03/27/20 DOCKET NO. 15-15 000 DATE: March 27, 2020 ORDER Entitlement to service connection for a bilateral foot disability, to include plantar fasciitis is denied. FINDINGS OF FACT 1. Pes planus was noted at service entrance, and the Veteran did not undergo aggravation during service beyond the natural progression of the disease. 2. The Veteran’s bilateral foot disability is not secondary to his service-connected lumbar spine disability, and is not otherwise related to an in-service injury or disease. CONCLUSION OF LAW The criteria for service connection for a bilateral foot disability are not met. 38 U.S.C. §§ 1110, 1153; 38 C.F.R. §§ 3.303, 3.304, 3.306. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from November 1985 to January 1990. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an October 2013 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Nashville, Tennessee. Jurisdiction of the Veteran’s claim was subsequently transferred to the RO in Winston-Salem, North Carolina. In December 2017, the Veteran appeared with her attorney for a video conference hearing before the undersigned. A transcript of that proceeding has been associated with the record. The Board notes that in October 2018 the Veteran’s claim for service connection for a bilateral foot disability was remanded by the Board for further development. At that time the Board found that a remand was warranted for a new VA examination in order to determine the etiology of the Veteran’s foot disability and whether it was proximately due to or aggravated by active service or by the Veteran’s service connected lumbar disability. As the Board’s May 2018 directives have been completed, the case may move forward without prejudice to the Veteran. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Entitlement to service connection for a bilateral foot disability. Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. The Veteran asserts that she has plantar fasciitis due to the many years of military activities which placed undo stress and strain on her heels and attached tissues. The Veteran also asserts that she has bilateral pronounced marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement, and severe spasm of the tendo achillis on manipulation that has not improved by orthopedic shoes or appliances during and after her military career. Additionally, she asserts that the issues she experiences with her feet stem from her service-connected lumbar spine disability. Every veteran is presumed to have been in sound condition at entry into service except as to defects, infirmities, or disorders noted at the time of such entry, or where clear and unmistakable evidence demonstrates that the injury or disease existed before entry and was not aggravated by such service. 38 U.S.C. § 1111. If a condition is noted on an entrance examination report, the presumption of soundness never attaches - the only benefits that can be awarded are for aggravation of such condition by application of 38 U.S.C. § 1153 and 38 C.F.R. § 3.306. Wagner v. Principi, 370 F.3d 1089, 1096 (Fed. Cir. 2004). The burden falls on the veteran to establish aggravation. Jensen v. Brown, 19 F.3d 1413, 1417 (Fed. Cir. 1994). For service connection claims involving a preexisting injury or disease, 38 U.S.C. § 1153 provides that a preexisting injury or disease will be considered to have been aggravated by service where there is an increase in disability during such service, unless there is a specific finding that the increase in disability is due to the natural progress of the disease. Aggravation may not be conceded where the disability underwent no increase in severity during service on the basis of all the evidence of record pertaining to the manifestations of the disability prior to, during and subsequent to service. 38 C.F.R. § 3.306(b). In this case, because pes planus was noted at entry, the presumption of soundness did not attach to this disorder. The issue in this regard is whether the pes planus was aggravated beyond the natural progression of the disease by the Veteran’s active service. The Veteran’s service treatment records (STRs) show that on the enlistment examination in October 1985 moderate pes planus of the feet was documented. A STR dated March 1990 and another undated STR state that the Veteran had trouble walking and experienced pain when walking, respectively. Another STR dated April 1986 states that the Veteran experiences abdominal pain when walking. The STRs are otherwise negative for any complaints of and/or treatment for a foot disability in service. Post service medical treatment records dated in May 2012 reflect, in pertinent part, a diagnosis of plantar fasciitis, with possible underlying systemic arthritis. Medical records dated in April 2015 reflect complaints of frequent aching, numbing, tingling, and shooting and throbbing pain in the bottom of her bilateral feet. At that time, the Veteran was diagnosed with sciatica. In a May 2017 post service treatment record it was noted that the Veteran presented with ongoing foot pain which “has been present for the past 30 plus years.” The Board notes that the Veteran’s post service treatment records include several complaints of foot pain, however, the earliest documented record related to the Veteran’s feet was during an orthopedic consultation in April 2008 which noted bilateral plantar flexion. The Board notes that a private examination dated October 2017 reflects, in pertinent part, a diagnosis of neuralgia “stemming from history of lumbar [disability].” The Veteran described the pain as burning pain of the feet and ankle limiting ability to ambulate. The Board notes the Veteran is service-connected for lumbar disability. In May 2019 the Veteran was afforded a VA examination to assess her bilateral foot disability. The examiner indicated that the Veteran’s VBMS e folder was reviewed. The examiner diagnosed the Veteran with bilateral plantar fasciitis and opined that the foot disability was less likely than not (less than 50 percent probability) incurred in or caused by an in-service injury, event or illness. As rationale, the examiner listed and described each of the Veteran’s pertinent medical records related to her bilateral foot disability from April 2008 to January 2019. Next, the examiner stated that there were no records found from 1985 to 1990 of a diagnosis or treatment of a foot condition during the time the Veteran was in service. The examiner also opined that the Veteran’s bilateral foot disability is less likely than not proximately due to or the result of the Veteran’s service-connected lumbar disability condition. The examiner also opined that regardless of an established baseline, the Veteran’s foot disability was not at least as likely as not aggravated beyond its natural progression by the lumbar spine disability. As rationale, the examiner stated that the symptoms of a lumbar spine related foot condition would cause radiculopathy, not plantar fasciitis. The examiner also stated that it involves inflammation of a thick band of tissue that runs across the bottom of one’s foot and connects ones heel bone toes. Additionally, the examiner stated that this is a local foot condition and not a lumbar spine radiating condition and therefore it is less likely than not that the Veteran’s current foot condition was proximately due to her lumbar spine condition. Analysis Based on a review of the record, the Board is unable to attribute the Veteran’s bilateral foot disability to his military service. While there is an indication of the Veteran experiencing pain when walking in service, there is no causal link to a bilateral foot disability that the Veteran currently experiences nor is their evidence of aggravation of the Veteran’s bilateral foot disability beyond natural progression. As stated above, there were a few isolated events of pain while walking as mentioned in the Veteran’s STRs. The service treatment records as a whole however, do not establish that the Veteran’s foot disability was aggravated by service. The Board acknowledges the Veteran’s assertions that her plantar fasciitis is due to the many years of military activities which placed undo stress and strain on her heels and attached tissues. The Board also acknowledges the Veteran’s description of her bilateral foot disability describing bilateral pronounced marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement, and severe spasm of the tendo achillis on manipulation that has not improved by orthopedic shoes or appliances during and after her military career. The law provides that laypersons are competent to testify as to their observations and as to some medical matters, including the existence of pes planus (flat feet). Falzone v. Brown, 8 Vet. App. 398, 403 (1995). As such, the Veteran is competent to describe the physical observations and the sensations that she felt with respect to her feet. However, the question as to whether the Veteran’s pes planus was caused by or aggravated by her active service, as opposed to the observation of an existence of pes planus itself, is the type of complex medical matter as to which laypersons are not competent to testify. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The Veteran has not provided any competent evidence establishing that the pre-existing pes planus was caused by or aggravated during active service beyond the natural progression of the disease. The Board places the most probative weight on the May 2019 VA examination as the examiner reviewed the claims folder and examined the Veteran before rendering the medical opinion. The examiner thoroughly reviewed the claims file and discussed the relevant evidence, considered the contentions of the Veteran, and provided supporting rationales for the conclusions reached. Barr v. Nicholson, 21 Vet. App. 303 (2007); Stefl v. Nicholson, 21 Vet. App. 120 (2007). The medical opinion is based on sufficient facts and data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). The VA examiner has the skill and expertise to analyze the medical evidence and render an opinion on whether a pre-existing bilateral foot disability was aggravated or caused by active military service. See Black v. Brown, 10 Vet. App. 279, 284 (1997). The May 2019 examiner considered all of the evidence of record and provided a very detailed rationale to support the medical opinion, explaining that given the nature of the Veteran’s bilateral foot disability, it is not directly related to or aggravated by service, nor is it related to her service-connected lumbar spine disability. (Continued on the next page)   Although the Veteran’s post service medical records note complaints of foot pain, none of these post service medical records include an etiological medical opinion that link the Veteran’s bilateral foot disability to service or show aggravation of the Veteran’s foot disability. The Board finds that the weight of the competent and credible evidence establishes that the preexisting pes planus was not aggravated during active service beyond the natural progression of the disease, is not related to the Veteran’s service-connected lumbar spine disability, and is not otherwise related to active military service. In reaching this conclusion, the Board has considered the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the Veteran’s claim, that doctrine is not applicable, and service connection must be denied. 38 U.S.C. § 5107 (b). Thomas H. O'Shay Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Dorsey-Kwansa, 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.