Citation Nr: 21003112 Decision Date: 01/19/21 Archive Date: 01/19/21 DOCKET NO. 14-11 894 DATE: January 19, 2021 ORDER Service connection for bilateral plantar fasciitis is denied. REMANDED Entitlement to service connection for degenerative changes of the lumbar spine at L4-L-5 and L5-S1 is remanded. Entitlement to service connection for left ankle chondromalacia grade II changes is remanded. FINDING OF FACT The weight of the evidence is against a finding that the Veteran’s bilateral plantar fasciitis onset during or was caused by his active duty service. CONCLUSION OF LAW The criteria for entitlement to service connection for bilateral plantar fasciitis have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2020).  REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 1974 to October 1978 and from July 1980 to March 1988. These matters are before the Board of Veterans’ Appeals (Board) on appeal from an August 2011 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In December 2017, the Veteran testified at a videoconference hearing before the undersigned; a transcript of that hearing is of record. In May 2018 and August 2020, the Board remanded the Veteran’s appeal to the RO for further evidentiary development. Subsequently, an October 2020 rating decision granted entitlement to service connection for left knee meniscal tear status post ACL reconstruction with osteoarthritis and right knee status post meniscal repair with osteoarthritis. As this constitutes a full grant of the benefits sought on appeal in regard to the left and right knee disabilities there remains no issue of controversy for adjudication by the Board on those claims. See Grantham v. Brown, 114 F.3d 1156, 1158-59 (Fed. Cir. 1997). Entitlement to service connection for bilateral plantar fasciitis The Veteran contends that his diagnosed bilateral plantar fasciitis was caused by or onset during his active duty service. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Establishing entitlement to direct service connection generally requires: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service - which is the so-called “nexus” requirement. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Turning to the evidence, the Veteran’s service treatment records include a report of an ingrown toenail in June 1975, July 1976 and February 1977. In May 1977, the Veteran reported experiencing pain in his toe. There is no evidence of plantar fasciitis until January 2008, when the Veteran’s private physician diagnosed plantar fasciitis. He reported bilateral foot pain in January 2009. In June 2011, the Veteran had a VA examination. The examiner diagnosed right foot osteoarthritic first digit metatarsophalangeal joint and calcaneal spurs, stable, and left foot osteoarthritis first digit metatarsophalangeal joint and calcaneal spurs, also stable. The examiner opined that there was no one single active duty record that clearly defines left foot plantar fasciitis. The examiner noted the great toe discomfort shown during service, but indicated that this did not support a diagnosis of plantar fasciitis. The Veteran testified before the Board in December 2017. He said that his feet started hurting shortly after boot camp because he had to run five times a week, and that he used over-the-counter medicine for pain throughout his Marine Corps career. The Veteran testified to developing heel contusions during running exercises on active duty. The Veteran said that he frequently had a pins-and-needles sensation in his feet since leaving service. A February 2018 private medical opinion from the Veteran’s primary care physician, Dr. J.A., states that the Veteran experienced numerous heel contusions in service and that he reviewed the Veteran’s treatment records reflecting treatment for heel contusions and plantar fasciitis. The letter also discusses the Veteran’s hearing, tinnitus, and back, and knee disabilities. Dr. J.A. concludes his letter by generally opining that the pain and discomfort the Veteran experienced was a “definite carry over of all the injuries and treatments” during his service. The Veteran underwent a VA examination for foot conditions in October 2019. The nurse practitioner diagnosed bilateral plantar fasciitis and right foot degenerative arthritis. The Veteran said that during boot camp he began to feel pain localized in the balls of his feet and arches, particularly when wearing boots. The examiner opined that it was less likely than not that the Veteran’s bilateral plantar fasciitis was caused by or onset during service because no nexus had been established between the foot pain the Veteran experienced in service and plantar fasciitis. A VA medical opinion was prepared in October 2020. The examiner reviewed the Veteran’s records and concluded that it was less likely than not that the Veteran’s current plantar fasciitis was caused by or incurred during military service. The rationale was that the Veteran was treated only for painful ingrown toenails in 1976 and 1977, with no other foot conditions documented during active duty service. The examiner found that the Veteran’s current plantar fasciitis would not be the result of active duty service over 20 years prior to the diagnosis. The examiner considered the Veteran’s statements regarding his symptoms, but noted that he was not qualified to ascribe his symptoms to a diagnosis. Applying the criteria for service connection, the Veteran has a current diagnosis of bilateral plantar fasciitis. The Veteran’s service treatment records show that he had ingrown toenails while in service, was treated for toe pain, and the Veteran testified that he developed heel contusions during or shortly after boot camp. Therefore, the first two criteria for direct service connection are present. Shedden, 381 F.3d at 1166-67. However, the weight of the evidence is against a finding that the Veteran’s bilateral plantar fasciitis was caused by or onset during his active duty service. First, the Board affords little weight of probative value to the June 2011 and October 2019 VA opinions. The June 2011 opinion did not reflect consideration of the Veteran’s competent lay statements regarding his in-service experiences and his symptoms after service. Additionally, the examiner only provided an opinion regarding the right foot. The October 2019 VA opinion was conclusory and did not provide a clear rationale for the conclusions reached. It also did not reflect consideration of the Veteran’s statements that he had developed heel contusions during running exercises in service, that his feet began hurting after boot camp, that he felt tingling sensations in his feet after service, and that he began to feel pain localized in the balls of his feet and arches during boot camp. The Board also affords little weight of probative value to the February 2018 private opinion of Dr. J.A. that found that the Veteran’s pain and discomfort was a carry over of the injuries and treatments he received in service. Although this opinion reflects consideration of the Veteran’s medical records and his competent lay statements, the opinion only generally states that his pain is from events in service. It does not provide a clear opinion and rationale regarding whether the Veteran’s plantar fasciitis is due to his service. The Board places the greatest weight of probative value on the October 2020 VA medical opinion. The examiner indicated that she reviewed the Veteran’s treatment records and considered the Veteran’s lay statements and included an explanation, based on the evidence of record for her conclusion that it was less likely than not that bilateral plantar fasciitis was related to an in-service injury, event or disease, including treatment shown during service. The opinion is consistent with the absence of any record of complaints, diagnosis, or treatment of plantar fasciitis during service or after service until 2008. The Board has considered the Veteran’s statements; as a layperson, he is competent to testify regarding observable symptomatology. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). Although lay persons are competent to provide opinions on some medical issues, as to the specific issue in this case, the probable etiology of a disorder such as plantar fasciitis falls outside the realm of common knowledge of a lay person. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). The Veteran has not demonstrated or alleged expertise in determining a medical nexus, and he does not offer any supporting medical opinion. Therefore, his opinion as to the cause of his plantar fasciitis has no probative value. For the reasons set forth above, the preponderance of the evidence is against a finding that the Veteran’s bilateral plantar fasciitis is related to his service. Accordingly, service connection for bilateral plantar fasciitis is denied. 38 C.F.R. § 3.303, 3.304. In reaching this conclusion, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran’s claim, that doctrine is not applicable. See 38 U.S.C. § 5107(b); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990). REASONS FOR REMAND 1. Entitlement to service connection for degenerative changes of the lumbar spine at L4-L-5 and L5-S1 is remanded. The Board remanded this claim in August 2020 and directed the RO to obtain a new medical opinion. The medical opinion was prepared in October 2020. The VA physician’s assistant concluded that the Veteran’s back condition was less likely than not caused by his military service. The rationale was that the Veteran’s in-service back pain was muscular while his current condition, degenerative changes of the spine, is not muscular in nature; and that the Veteran reported back pain once in 1977 and three times in 1983, and that “there are no additional noted complaints or treatment for back pain during active duty service.” The October 2020 medical opinion is inadequate because it does not address the June 1983 service treatment record which stated “dx as LBP probably mechanical.” Additionally, the opinion, although indicating the Veteran’s service records were reviewed, incorrectly states that there were no other reports of back pain while in service; in fact, the Veteran reported back pain in July 1975, November 1977, January 1978, June 1978, and seven times in 1983 (January 6, January 20, April 5, April 21, May 9, June 16, and June 22). As such, remand is necessary for a new medical opinion.   2. Entitlement to service connection for left ankle chondromalacia grade II changes is remanded. The Board also remanded the left ankle claim in August 2020, directing the RO to obtain a new medical opinion. The October 2020 VA medical opinion concluded that it was less likely than not that the left ankle condition was related to service, in part because “[p]ost service records are… negative for ankle complaints until C&P exam in 2019, creating a gap of over 40 years.” However, the record contains private treatment records from January and February 2009 noting pain in the left ankle, tarsal tunnel surgery on the left ankle, and post-operative notes. As the opinion is based on an inaccurate factual premise, it is inadequate for evaluation purposes and remand is necessary for a new medical opinion. The matters are REMANDED for the following actions: 1. Obtain the Veteran’s VA treatment records for the period from June 2020 to the present. 2. Obtain a medical opinion to determine the nature and etiology of degenerative changes of the lumbar spine at L4-L5 and L5-S1. If the reviewing clinician determines that an examination of the Veteran (including via telehealth interview) is necessary to provide the requested opinion, then such should be scheduled. (a.) The clinician must opine whether it is at least as likely as not that the Veteran’s degenerative changes of the lumbar spine at L4-L5 and L5-S1 are related to an in-service injury, event, or disease, including treatment in service shown in the service treatment records (including the Veteran’s reports of back pain in July 1975, November 1977, January 1978, June 1978, and seven times in 1983 (January 6, January 20, April 5, April 21, May 9, June 16, and June 22 – back pain with sciatic nerve tenderness). The clinician should also address the Veteran’s assertion that it is related to his experiences as an amphibious vehicle crewman. (b.) The clinician should address the reports of sciatic nerve tenderness and the diagnosis of “LBP probably mechanical” in June 1983. (c.) In providing an opinion, the clinician should note and address the Veteran’s December 2017 testimony before the Board, including that he injured his back riding a bumpy amphibious vehicle and lifting a heavy object, that he had back spasms and pain radiating down both legs afterward, and that his back pain continues to radiate down both legs. The examiner should also note and address the Veteran’s statement to the October 2019 examiner that his back pain onset during active duty when lifting the hood of a vehicle and the hood slammed down, and that the condition has worsened since that time. A complete rationale for all opinions must be provided. If the clinician cannot provide a requested opinion without resorting to speculation, it must be so stated, and the clinician must provide the reasons why an opinion would require speculation. The clinician must indicate whether there was any further need for information or testing necessary to make a determination. Additionally, the clinician must indicate whether any opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the particular examiner.  3. Obtain an addendum opinion to determine the nature and etiology of left ankle chondromalacia. If the reviewing clinician determines that an examination of the Veteran (including via telehealth interview) is necessary to provide the requested opinion, then such should be scheduled. (a.) The clinician must opine whether it is at least as likely as not that left ankle chondromalacia is related to the alleged in-service injury playing football at Camp Pendleton and claimed subsequent light duty or any treatment received during service (including a February 1977 complaint of pain in his bilateral ankles). The examiner should note and address the Veteran’s December 2017 testimony that his left ankle was injured in a football game, and that he had surgery on it after leaving service. (b.) The clinician should note the Veteran’s October 2019 statement to the VA examiner that his left ankle was injured playing football during active duty in 1981, and that the symptoms have remained the same since he left service. (c.) The clinician should also address the private treatment records from January and February 2009 noting pain in the left ankle and tarsal tunnel surgery on the left ankle. A complete rationale for all opinions must be provided. If the clinician cannot provide a requested opinion without resorting to speculation, it must be so stated, and the clinician must provide the reasons why an opinion would require speculation. The clinician must indicate whether there was any further need for information or testing necessary to make a determination. Additionally, the clinician must indicate whether any opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the particular examiner. M. SORISIO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R. Dean 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.